HomeMy WebLinkAboutP-13-818 piL • MASSACHUSEIFS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY Yarmouth MA DATE 05/30/13 PERMIT # P/3- Vir
JOBSITE 327 South Shore Drive(South Yarmouth) M#266/L#118 OWNER'S NAME Riviera Beach Resort
POWNER ADDRESS SAME TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL ® EDUCATIONAL 0 RESIDENTIAL 0
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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 CONNECTION DEVICE
DEDICA TED SPECIAL WASTE SYS TbM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM '
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER •
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR IAREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
3NO1N1 RZIEL
SERVICE I MOP SINK •
TOILET •
URINAL
WASHING MACHINE CONNECTION �' (� !✓
YJATEIFHEATFIALL'fYpES �3' '
WATER PIPING ! `�
OTHER
INSURANCE COVERAGE:
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 POLICY Q OTHER TYPE OF 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 - e and accurate to4 my knowledge and
that all plumbing work and installations performed under the permit issued for this application will be In •• with all Pertii . ision f the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 151
•
as
PLUMBER'S NAME James Pazakis LICENSE#PL-15030-M SIG •TURE • .
MP ® JP ❑ CORPORATION )#C-2803 PARTNERSHIP LD # LLC❑#
COMPANY NAME:Hall Plumbing&Heating,Inc. k 1 DRESS:4477Old Chatham Road
CIN:South Dennis STATE:MA ZIP:02660 i� I , • 'I r I ,EL 508-385-9127
• 1111
FAX 508-385-6604 CELL J` HAY €SIF do echru @c)omcast.net
1:0d:i DEPT gvit YV
7
BING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ - PERMIT i
PAN REVIEW NOTES
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