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HomeMy WebLinkAboutP-13-022 ,, I /7 - cgs MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY Yarmouth , MA. DATE G7tJJlal Pews �2.� JO OS rr ADORE ' WSfl A /��� � '����%T� OWNER'S NAME t-73 Elinzzj OWNER ADDRESS: D ' 11/ l ECFIA ��'T�0.63-1/2Vf / �. • =Jc B4YPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDE TLAL ;r • CLEARLY NEW:❑ RENOVATION:EI REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOZ C, DCUTRE31 FLOORS-, � 1 2 3 'OSS CONN DEVICE IIIIININI_n DEDICATED SPECIAL WASTE SYS =______ ME 111111 11.1111.111.111.111.11111.11.111.11111.11. �r DEDICATED GAS/OIL/SAND SYS �IIIII _�__ DEDICATED GREASESYSTEM =_ _________ __ DEDICATED GRAY WATER SYS _______ ==_ DECSHWA t:DWATER REUSE SYS ��� ���� 11111111111 DISHWASHER ___ __ ������� F000DRINWG FOUNTAIN ___ -, __=__ ____ FLOOR/AREA DRAIN UNIT WS __ 111111111101111.11.r1111111111111111111.11MINI INTERCEPTOR INTERIOR 111,111111111111 111111 _ ____ 111111111111111111111 MOM NM 11111121111111111 ROOFTCDRAIJNIllNMIII_III_ _ _ SHOWER STALL _.'Oy__�_�_____ __ TERM E/MOP SINK __ . ____________ MN 1.111111111111111111 WASHING MACHINE CONNECTION _ M _ nmm...m....._____11fZISBIGE,EsjiaNsiNNNNI NM MINIS 111111 IIIIIIIIIIIIIIIIIIMINIMINIIIIIIIIIIIIINIIII 111111111111111.1111111 ����� ���O ____— ���----_--------_--__— Ihave acurtent!II ��D�� __����0 ce Policy or its substantial equivalent which meets the menti of MGL.Ch.142 YES Q NO 0 Ifyou have checked yf please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY SU OTHER TYPE INDEMNITY OWNER'S INSURANCE WAIVER I am aware that the licensee • 0 BOND 0 MassaCxuetts General laws,and that my signature on this permit nt requirement this required by Chapter 142 of the SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT 0 • I hereby certify that al of the details and information I have submitted(or entered) Knowledge and thatgwu Plumbing installations performed under theme�N application application MU t,t'the best one Provision of the permitera wed for Ns a ��y� PLUMBER I^g Code and Chapter 142 of the General Laws � / �'lo all Pertinent NAME:fl7. -.�yt LICENSE/ COMPANY NAME SIGNATURE CITY: n into ,E�� ADDRESS: rain, aaIra� STATE WA ZIP: Mt E2E222MEEI FAX CELL•%E4-1� MASTERS JOURNEYMAN 0 CORPORATION❑#EnD PARTNERSHIP 0 s ©LLC❑l[n— FINAL INSPECTION NOTES Ply BEI O �'rE tICE ONLY M410iW cverT[ON NOTES y, No C t0, • r :... 0 ❑ FEE: S_- -- PERWTI------ r N REVIEW NOTES ------------ ------------------ ------------- --------------- ------------------ --------------- ---------------- i;