HomeMy WebLinkAboutP-13-228 ,r —MASSACHUSETTS-ONIFORM APPILICA1IttN FOR A PENNII I I U PERFORMPEUMBINt,WORK
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iA.> CITY Yarmouth MAi. DATE 10/03/12 PERMIT # f�3 - 222`str� JOBSITE 25 Merti ount Road(W.Yarmouth) M#I Pit OWNER'S NAME Roberts
POWNER ADDRESS SAME TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL
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CLEARLY NEW: 0 RENOVATION: 0 REPLACEMENT: 0 w 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 rho SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GR-E,4SrGYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKIfia FOUNTAIN CoLiltlir
NJ Imin
FOOD DISPOSER
FLDOR/ARUININ
INTERCEIJ I OH (IN I ERTOR)
-KITCAELAVATO� till
ROOF DRAIN
.SHOWER STALL
SERVICE / MOP SINK A
TOILET FCra°
-URINNAL
WASHING-MACHINE CONNECTION S'
'WATER HEATER ALETYPES
TWATERPIPING
OTHER
. INSOHANLh I.UVLKtAU :
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E] NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ❑ OTHER TYPE OF INDEMNITY 0 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 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
-Thereby certify that allo e •e al s an. in orma ion ave su•mi'e• or en ere• regar•ing is app ica ion are an. accu . e 'r e •es o my , ledge aria—
that
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that all plumbing work and installations performed under the permit Issued for this application will be In • • ance with a •- 'nent provision of
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME James Pazakis LICENSE#PL-1503NATU:'
MP ® JP 0 CORPORATION ®#C-2803 PART '*—IP ❑• LLC ❑#
COMPANY NAME:Hall Plumbing&Heating,Inc. ADDRESS:447 Old Chatham Road
CITY:South Dennis STATE:MA ZIP:02660 TEL:508-385-9127
FAX:508-385-6604 CELL EMAIL Halltechnician@comcastnet
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT#
PLAN REVIEW NOTES
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