HomeMy WebLinkAboutBLDP-13-148 ,
in MASSACHUSETTS-UNIFORM APPEECATIONFOR A PERMITTO PERFORM-PCIIMBINGWORK
1'r" b fiY /} p
v1 15 CITY Yarmouth MA DATE 09/04/12 PERMIT # (' 17 "- 1 If6 •
as
•
ia.0. JOBSITE 39 Rune Stone(South Yarmouth) M#101/P#87 OWNER'S NAME Boguski
POWNER ADDRESS SAME TEL 508-394-2859 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW: ❑ RENOVATION: 0 REPLACEMENT: 0 PLANS SUBMITTED: YES 0 NO❑
FIXTURES-' FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 <, 13 14
BATHT'U'B I
-CROSSOONNECTIORDEVICE
DEDICATED SPECIAL WAS IE SYSTEM I
-DEDICATED GAS/OIL/SAND-SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER /
FLOOR I AREA DRAIN
-INTERCEPTOR—(INTERIOR)
-KITCHEN�S1NR
MU-AMR? v e D
-ROOF DRAIN E-
SHOWER STALL R (�_ e._._. _. .. ...-.-_._.._......._.____. .�.. ...�.,
SERVICE / MOP SINK rt-el C
TOILET ' i
St
URINAL ,gP •
-WASHING MACHINE CONNECTION V1t-Gln _
WATER HEATERALLTYPES•" ev. ��'
-WA1ERPIPING ,,�gap�t y ,,
OTHER ( A4, ta II p,C�la' ,V
— 31'
INSURANCE LU\'tRAtA:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E] NOD
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 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 ❑
SIGNATURE OF OWNER OR AGENT
'Thereby certify aa o e •e al s an. in orma ion ave su•mi'e• or en ere. regar.ing is app Ica ion are rue -•• - Mrs" •_ • -. knowledge and"
that all plumbing work and installations performed under the permit issued for this application will be in compli.• : �• - nent provision o the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .
PLUMBER'S NAME James Pazakis LICENSE#PL-15030r GNATURE
MP ® JP 0 CORPORATION ®#C-2803 PART - HIP ❑# 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@comcast.net
- r
•
•
Cer? "1,
i
S3ION1 At3IA32I NIV I.
, • #IIW213d $ :33d
P
0 ❑ LW213d 3Hl SV S3A- S NOIIVOIIddV SIHl
oN saA
S31014 NOLLO3dSMI'IVNILI A 1MO 3S1133LIJO 103 MO'I3fl S3,LONI NIOLLO3dSNI1 orcin fY1d 11011021