HomeMy WebLinkAboutP-13-660 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMITTO PERFORM PLUMBING WORK
CITY Yarmouth MA DATE 3/28113 PERMIT # 13-4O
JOBSITE:261 & 263 Old Tovm House Road (West Yarmouth) M#363/ P#18 OWNER'S NAME: Krec LLC
POWNER ADDRES: 10 Atlantic Avenue South Yarmouth MA 02644 TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL In
PRINT `,'ptw�5 antY
CLEARLY NEW:❑ RENOVATION: 0 REPLACEMENT: 9 PLANS SUBMITTED: YES 0 NO❑
FIXTURES-• FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB Z
CROSS CONNECTION DEVICE
DEDICA FED SPECIAL WAS FE SYS FEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR 1 AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK -Z
LAVATORY 2 .
ROOF DRAIN
SHOWER-STALL
SERVICE I MOP SINK
TOILET. Z
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES •
WATER PIPING Z(�����
OTHER A�rFQ1E LLQ
INSURAN LOVbRA(E:
I have a current!lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 9 NOD
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 9 OTHER TYPE OF INDEMNITY ❑ BOND 0
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true • _-: rate tot - - . "17. • -.ge K.
that all plumbing work and installations performed under the permit Issued for this application vim be in oomph. Pert'.- pro ' 4, i -
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ �
PLUMBER'S NAME James Pazakis LICENSE#PL-1503 do 1- if,TURE N t
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MP ® JP ❑ CORPORATION ®#C-2803 PAR I RSHIP ❑# LLC ❑# co -41
COMPANY NAME:Hall Plumbing&Heating,Inc. ADDRESS:447 Old Chatham •0W a_ :_r
CITY:South Dennis STATE:MA ZIP:02660 TEL 50&3yj2 4,
. FAX 508385-6604 CELL. @
EMAIL Halltechnician tco�mcastnet I
BING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
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