Loading...
HomeMy WebLinkAboutP-13-873 t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ?'" -''� CITY YARMOUTH , MA. DATE 06/17/13 PERMIT# P14 zvS JOBSITE ADDRESS 25 ROUTE 6A OWNER'S NAME GARREFFI P OWNER ADDRESS: YARMOUTHPORT TEL 508-897-9325 FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXUTRES 7 FLOORS esmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS _ . DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT 7(�1 FLOOR/AREA DRAIN Fr-44(1642M— INTERCEPTOR (� a p II,INTERCEPTOR INTERIOR 0 L5 _7 v d U ly , KITCHEN SINK LAVATORY x �� i' 2013 ROOF DRAIN SHOWER STALL flU-LDTNC 8E SERVICE/MOP SINK By, Q TOILET x _ URINAL _ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES X WATER PIPING X OUTSIDE SHOWER X INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO 0 If you have checked YES please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY © OTHER TYPE 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 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Zt . Walt/4 1 PLUMBER NAME: LEON E CLARK,JR. LICENSE# 11734-M SIGNATURE COMPANY NAME: TC TYNDALL&CLARK PLUMBING AND HEATING ADDRESS: 18 ATLANTIC AVENUE CITY: SOUTH DENNIS STATE MA ZIP: 02660 FAX 508-385-9177 TEL: 508-385-8868 CELL 508-367-1451 EMAIL MASTER❑ti JOURNEYMAN 0 CORPORATION 0# PARTNERSHIP 0# LLC 0# ,r1 pi--o•dh ' o/c//.5