HomeMy WebLinkAboutBLDP-19-001834 JPS%" t,lr-I50F
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORKblit
?I CITY Yarmouth MA DATE 9/27/2018 PERMIT# /�P'I940/f /,
JOBSITE ADDRESS 111 Nantucket Ave. OWNER'S NAME Cintino
P OWNER ADDRESS 1 TEL • FAX—,
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:D REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOD
FIXTURES 7 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I I I �I 1 t � f I J
CROSS CONNECTION DEVICE f 1—, S
DEDICATED SPECIAL WASTE SYSTEM I —J—�� 1 r-1—
DEDICATED GAS/OIL/SAND SYSTEM __T___, —1_T
DEDICATED GREASE SYSTEM �, N_
DEDICATED GRAY WATER SYSTEM I rI .pii
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER i .__,..1_,___ I-; millnion
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DRINKING FOUNTAIN n7I^I Ir rf ,ii I,
FOOD DISPOSER 1 I I I
FLOOR/AREA DRAIN V (—f I1 F'7- j
INTERCEPTOR(INTERIOR) (—I 1 I I I 1II -
KITCHEN SINK r 1 11-- 1 I- r 1 1
LAVATORY. 1
ROOF DRAIN
SHOWER STALL II '1 I I I ,
SERVICE/MOP SINK ( I-- J—i �(— Malt M.
TOILET 1 -- I (—— illaaer—
URINALI I I ;_
WASHING MACHINE CONNECTION 1—J—I— -1---I— M,M,WS�
WATER HEATER ALL TYPES 4 ,
WATER PIPING I t �) p
OTHER II
1
� _ii j L� "----E-1 EISVI II
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MG C 142. YES El NO ❑ •
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELO SEP 27 2018
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ❑ BOND ❑ BUIL S I lc; P2,--r 14 T ell
OWNER'S INSURANCE WAIVER:lam aware that the licensee does not have the insurance coverage requir_ By' " •�le• •'_. "._'_P y
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER ❑ 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 performed under the permit issued for this application will be In co 4.P: l' Eniv ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ;-
PLUMBER'S NAME Peter J.Hassett LICENSE# 11682 SIGNATURE
MPQ JPO CORPORATION0# 3506 PARTNERSHIP❑# LLC E1#
COMPANY NAME Hassett Plumbing and Heating,Inc. ADDRESS 8 Skipper Lane
CITY Yarmouth Port STATE MA ZIP 02675 TEL 508-744-7555
FAX CELL 508-237-2175 EMAIL peterjhassett@gmail.com
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