HomeMy WebLinkAboutP-14-013 XW MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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CITY YARMOUTH PORT MA DATE 7/2/2013 PERMIT# P/ $ 0/
JOBSITE ADDRESS 30 Tranquail Trail OWNER'S NAME Dwain Dadoly
P OWNER ADDRESS SAME TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL 0
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CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED: YES 0 NOD
FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1=11M11=11111111111111111 M.S M''fi.M M IS M I M
CROSS CONNECTION DEVICE N l r MINI 1111111111111=1 al MINI111111111111111111111 fi 51
DEDICATED SPECIAL WASTE SYSTEM I=' an.fIS u f; SI�'5,mils
DEDICATED GAS/OIL/SAND SYSTEM MI NNS'ma g iiM um NEIN=Um ow w mitimi
DEDICATED GREASE SYSTEM MN f MI'11111111111111S MS=I IIIIIII SI la SS
DEDICATED GRAY WATER SYSTEM f;f;fM,11111.111111•1111.111111011111111111 11•111111111111.1111S
DEDICATED WATER RECYCLE SYSTEM 5 ?f`511=111.'5111111111fr an 11Miiiiiimillimil
DISHWASHER =I_55rMMil"MIMSMN I•
DRINKING FOUNTAIN flfl MS 11.1100.1111.1 lin.SIS ISSUE
FOOD DISPOSER INN liNrI♦SI Mil INN MIN 1111.1=1111111111111111MalINIS
FLOOR/AREA DRAIN MNliii.MI MIN ION MIN EINEM MIMIla5fMill
INTERCEPTOR INTERIOR Eli,MIN llll IN MMISS lai SUSS_111111 NIS 1111111.1111
KITCHEN SINK NMI MIN MIN IIIIIII__INN Ell I♦INN MI=II an=
LAVATORY I♦I♦1, 1111111,1111111 IS'INISINIIIIIIIII Urn I•1111'5SIS
ROOF DRAIN I==ION 5in5flfMN=fMN 11....
SHOWER STALL M'MIMI MN N 5:5_`l1M IME'MI MIMI
SERVICE/MOP SINK Siisimir�lmium:Si',Mgiiiii'Simi siouSims 55
TOILET fONII♦M.5MS MN MNMINI NMI al
URINAL 511111111•11S—fl-555— lIIIIII
WASHINGMACHINECONNECTION sn:n,rIIIMNMI M.INS INNS_MUNI_MEI
WATER HEATER ALL TYPES 0=MN=I'M tel=al 111111111111111111111=1 a al
WATER PIPING NimiSS;SNEISIS slaiioulm/s,vas
OTHER MI=11111.111111.11111SINIIIIINTSVIIIMSaMIS
Mill—afi111111aNINNS SIM MNaMal
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S Sal1111 MN MI SIMI SISalS laS
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POUCY Q OTHER TYPE OF INDEMNITY 0 ._ 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 o I„: - , Is requirement
/dW.DLit , f•• CHECK ONE ONLY: OWNER 0 AGENT ❑
SIGNATURE OF OWNER OR AGENT •, f
I hereby certify that all of the details and information I have ub itt:: ” - t" -• fir, • ng is:pplication are true and :•• •- to the best of my knowledge
and that ell plumbing work and Installations performed und= the permit Issued for this appli :ti,n will be In compllan - - >, •ertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of t : ,:y= i t ZL DEPARTMENT /�
PLUMBER'S NAME JASON DREW mar—- -:-Frill SIGN TA URE
MPO JP® CORPORATION❑# PARTNERS" P❑# LLC❑#
COMPANY NAME DREWS PLUMBING ADDRESS 6 AGASSIZ ST
CITY BREWSTER STATE MA ZIP 02631 TEL 508-367-5739
FAX — CELL — EMAIL /
Z- 6-