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HomeMy WebLinkAboutP-14-210 isek MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4 kw satwic CITY S, Yonnow& MA DATE `l//7/f/7 PERMIT# PA ra/40 JOBSITE ADDRESSJ C{y /(ccns/�ue_ 43/. I OWNER'S NAME (sole- ri ... I POWNER ADDRESS TELT-4bS-5�2- D?'3/ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL 0 RESIDENTIAL E. PRINT CLEARLY NEW:Q RENOVATION:0 REPLACEMENT:- PLANS SUBMITTED: YES 0 NOE BATHTUB 1 2 3 4 5 6 7 8 9 10 11 12 13 14 FIXTURES 7 FLOORS BSM u CROSS CONNECTION DEVICE a 5 Jr_ -- !r 1 it ,L. S -z�� ' DEDICATED SPECIAL WASTE SYSTEM r I ' .Ill I 1 _ .aial _1 DEDICATED GRAY GREASE SYSTEM LS ii '1- J —1! DEDICATED SPECIAL WA TEM ATER 1Ifl_ea �-1�®.. ___ s1 1-11wI--r DEDICATED WATER RECYCLE SYSTEM DISHWASHER lar___1I ! 1 DRINKING FOUNTAIN L possesI II_-iii ,1 1n FOOD DISPOSER tr�jl� OAER OM FLOOR(AREA DRAIN llll INTERCEPTOR(INTERIOR aaaaraaalaaralanala KITCHfit A ROOFDRAINr r^ a as: e �.■� sin "� u u "J"S a SHOWER STALL ,M SERVICE/MOP SINK a --- aIlial 1— Irr/ I 1111 TOILET URINAL r I. ` WASHING MACHINE CONNECTION Ciirs„Y,�+,,v r"I r�® IL�lrIs� 0 WATER HEATER ALL TYPES4� u�t�1'i`�l a t WATER PIPING SISSISSINTIMSISSIANSIMISIM OTHER • asunnownesui - nano ,_ . INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY®+ OTHER TYPE OF INDEMNITY Q BOND 0 OWNER'S INSURANCE WAIVER:tam 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 0 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 and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be in compr nce lb I ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • PLUMBER'S NAME I Joseph Ventresca LICENSE# Ca SIGNATURE MPO JPD CORPORATIOND#I 3255 .PARTNERS P©# - _ LLCD# COMPANY NAME South Shore Heating and Cooling ADDRESS 57 Whites Path CITY I South Yarmouth i STATE MA ZIP 02664 TEL 508-398-6901 FAX 508-760-2681 CELL 508360-5277 EMAIL Igoe@southshoreheatingcoo!ing.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES • •n i P