HomeMy WebLinkAboutP-13-465 L 1z. MASSACHUSETTS UNIFORM APPLICA1 ION FOR A PERMR'1 0 PERFORM PLUMBINGIYPORIT-
tt.hieV: CITY Yarmouth MA DATE 1/15113 , PERMIT # /tail 1/65.-
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,rx JOBSITE 32 New Hampshire Avenue(West Yarmouth) M#16BIock#58/PID#345 OWNER'S NAME Stigmatine Fathers
P OWNER ADDRESS SAME TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0
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CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: ® ' PLANS SUBMITTED: YES 0 NO❑
FIXTURES-' FLOOR BSM 1 2 3 4 5 6 7 8 : 9 10 11 12 1 13 ; 14
BATHTUB
CROSS CONNECTION DEVICE ,
DEDICATED SPECIAL WASTE SYSTEM ) -
DEDICATED GASJOILISANDSYSTEM- I
DEDICATED GREASE SYSTEM i
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM ._
DISHWASHER
DRINKING FOUNT i .'
FOOD DISPOSER I
FLOOR I AREA DRAIN
I
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWERSTALL �_ __ �_.� r _ _ _� .® _ __ .__. ,
SERVICE I MOP SINK ' .
TOILET
URINAL �Ct It) �43
WASHING MACHINE CONNECTION BY. 1'
WATERHEATERALLTYPES (
WA1 ER PIPING
OTHER
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INSURANGEt.OVERAOE:
I have a current)iability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES 9 NO(]
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
• UABIIJTY INSURANCE POUCY fl 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 are true a i• carate • i : of my knowledge and
that all plumbing work and installations performed under the permit Issued for this application will be in compli all P ..nt pro "on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME James Pazakis LICENSE#PL-1 lc, SIG TORE
MP ® JP ❑ , ! CORPORATION ®#C-2803 P" 'ERSHIP ❑# LLC❑#
COMPANY NAME:Hall Plumbing&Heating,Inc. ADDRESS:447 Old Chatham Road
CITY:South Dennis STATE:MA ZIP.02 [I1 c 6 1. I V ' •508-3859127
FAX 508385-6604. CELLtyll • L@comcastnet
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Cy LtilLDltt�^ EPT
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE $ PERMIT#
PL REVIEW NOTES
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