HomeMy WebLinkAboutP-13-506 a-- - --- MASSACHUSETTS UNIFORM APPLICATION FUR A PLRMI I f U PLKhWtM PLUMBING WORK
0 CITY Yarmouth MA DATE 1/31/13 PERMIT # PS L5V 6
JOBSITE:20 Quail Road (West Yarmouth) M#14/P#35/PID#197 OWNER'S NAME:Freeman
P OWNER ADDRES: 108 Elinor Road Newton, MA 02461 TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 , RESIDENTIAL x❑
PRINT
CLEARLY NEW: ❑ RENOVATION: ❑ 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
CROSS CONNEC 1 ION DEVICE I.
DEDICATED 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/AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY ACCFPTEOj7
ROOF DRAIN "
"SxOWERSTALL BY ,
SERVICE / MOP SINK .
TOILET
URINAL
WASHING MACHINE CONNECTION
.W ATEIFAEATERALLT47ES
WATER PIPING .
OTHER
INSUKANCE t.OVtHAGt:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES : 0 NOD
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POUCY 9 OTHER TYPE OF INDEMNITY 0 BOND ❑
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 0 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: • •• - e to st of my knowledge and
that all plumbing work and installations performed under the permit issued for this application will be in •• •• : ' ent p ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ..
PLUMBER'S NAME James Pazakis LICENSE#PL-1 r r, G RE
MP in JP ❑ CORPORATION ®#C-2803 PAR • ❑# LLC #
• COMPANY NAME:Hall Plumbing&Heating,Ina •
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CITY:South Dennis STATE:MA ZIP:02660 IIt ,� E U V E 1'.508-385-9127
FAX 508385604 CELL 4J4jj +ncomcastnDI PT -� lD
By
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ 0
FEE: $ PERMIT#
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= i PLAN REVIEW NOTES
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