HomeMy WebLinkAboutP-13-008 ,1;:a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
"Ills CITY South Yarmouth MA DATE 7/3/2012 PERMIT# f s 16
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JOBSITE ADDRESS 3 Cape Isle Drive OWNER'S NAME George Heiter
P OWNER ADDRESS Same TEL 508-760-5109 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL 0
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOD
FIXTURES 1 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 :14
BATHTUB 11 r I _
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM 111.111111111
DEDICATED GRESAT SYSTEM
DEDICATED GREASEASESYSTEM
DEDICATED GRAY WATER SYSTEM M r��11�1 '
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DRINKING FOUNTAIN ,o r , L 1—
FOOD DISPOSER ! .."..:LS%--II
FLOOR/AREA DRAIN nn
INTERCEPTOR INTERIOR _ K gyp, ,f,IP, i;O„WA ,� „�- — M
KITCHEN SINK �n as MIS allS,M111111(♦31111 r- MINS
LAVATORY Millainalleallielissasseimmt , was
ROOF DIRAIN NEW►_'1111111111111111111 ■M P P p,p' SS
SHOWER
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TOILET1161 1M111
WASHING MACHINE CONNECTION IMAM MantalS111111 7 a
WATER HEKI ER ALL TYPES IMMINN 1.41.1.11.11 MN Mt 7 MI
WATER PIPNG 11_fll�l�l■i p f111I111a1111111f11�1111 1 111111
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MIK SPS011111,111111i 111111:, — I it III
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑
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❑
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 ❑ 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 a • acc rate t• •, •est of my knowledge
and that all plumbing work and Installations performed under the permit Issued for this application will be In oil, plla a wi - - '-rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
A ..2 J:
PLUMBER'S NAME Keith J.Farnham LICENSE# 11601 / SIGNATURE
MP +❑ JP CORPORATIONO# 3321 PARTNERSHIP❑#HEM LLC❑# 1
COMPANY NAME Murphys ADDRESS 34 Whites Path
CITY South Yarmouth STATE Ma ZIP 02664 TEL 508-760-1660 1
FAX 508-760-1670 I CELL EMAIL Itetrault@callmurphys.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
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Yes No
THIS APPLICATION SERVES AS THE PERMIT El ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
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