HomeMy WebLinkAboutP-13-747 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
„AA." CITY West Yarmouth MA DATE 4/26/2013 PERMIT# ri — 7`/7
JOBSRE ADDRESS 236 South Sea Ave OWNER'S NAME John LoBue
POWNER ADDRESS 236 South Sea Ave TEL 617-529-9676 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL C] RESIDENTIAL 0
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CLEARLY NEW:❑ 'RENOVATION:Q REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES 7 FLOOR-. BSM t 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB IT j 1
CROSS CONNECTION DEVICE 1 4 —
DEDICATED SPECIAL WASTE SYSTEM I ', t i, 1 I j
DEDICATED GAS/OIL/SAND SYSTEM ,
DEDICATED GREASE SYSTEMr _
DEDICATED GRAY WATER SYSTEM ,� ` '' ; r
DEDICATED WATER RECYCLE SYSTEM ; I I
DISHWASHER . - - _--e —
DRINKING FOUNTAIN 1 J
FOOD DISPOSER - - 'fl_; -- '— ), i—
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) I 1— I. I. i .I 1
KITCHEN SINK
LAVATORY 77
ROOF DRAIN
ter
SHOWER STALL
SERVICEIMOPSINK j, TI - . i,- 1( yr
TOILET A
URINAL I r 1 I
WASHING MACHINE CONNECTION , 1 I I .; 6 C
WATER HEATER ALL TYPES j
WATER PIPING 1 -11,- 1- i J r
OTHER r - i
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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❑ NO a
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
' LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND❑
OWNER'S INSURANCE WAIVER:lam aware that the licensee does not have the insurance coverage required by Chapter 142 of the .
Massachuse General ,and that my signature on this permit application waives this requirement
Il U o "— CHECK ONE ONLY: OWNER Q 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 and accurate to the best of my knowledge
and that all plumbing work and installations perfonned under the permit issued for this application will be in compile ' all Pertinent ' ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Steven Mouradian LICENSE# MPL 9005 / SIGNATURE
MPC] JP❑ CORPORATION 0# PARTNERSHIP❑# LLC❑#
COMPANY NAME Steven Mouradian PLB ADDRESS 389 Sterling Road
CITY Jefferson STATE MA ZIP 01522 TEL 508-922-2584
FAX 508-829-8984 CELL 508-922-2584 EMAIL smouradiian@charter.net r .,n, r,. In ` jars)._
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