HomeMy WebLinkAboutP-13-421 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK /
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=;kl_ CITY Yarmouth I MA DATE 1/3/13 PERMIT# p/ — Y 1
JOBSITE ADDRESS 1095 Route 28,South Yarmouth OWNER'S NAME TD Bank
POWNER ADDRESS 1095 Route 28,South Yarmouth I TEL 617-694-0464 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ❑ RESIDENTIAL❑
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NOD
FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
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CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM
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DEDICATEDEDICATED WATERGRAYWATER RECYCLE SYSSYSTEMTEM 1
I
DISHWASHER
DRINKING FOUNTAIN 1 1 li I
FOOD DISPOSER
FLOOR I AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORYiIII
ROOF DRAIN 111 ill
SERWEROLL
11 i 11 li
SERVICE/MMOP SINK ,I i
TOILET
URINAL
HIN _
WASHING MACHINE CONNECTION - - I
WATER HEATER ALL TYPES - -
WATER PIPING
OTHER INEF � 1
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INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY ❑ 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 ❑ 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 compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBERS NAME Kevin J.Sullivan E -' LICENSE# 13041 SIGNATURE
MPD JPO -.CORPORATIOND# 2433., PARTNERSHIP❑# LLC 0# , -
COMPANY NAME Ready Rooter,Inc. ADDRESS P.O.Box 371 '' - - —
CITY Sandwich STATE y; ZIP 02563 TEL 508-868.6055
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FAX 508-888-0242 CELL EMAIL kjs@readyrootercom it 7
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