HomeMy WebLinkAboutBLDP-14-289 MASSACHUSE ITS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY Yarmouth MA DATE 10121/13 PERMIT # fill O/g f
JOBSITE 97 South Shore Drive(South Yarmouth) M#19/P#4 OWNER'S NAME Ocean Mist Beach Hotel&Suites
POWNER ADDRESS SAME TEL 508-619-4769 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL
PRINT
CLEARLY NEW: ❑ RENOVATION: 0 REPLACEMENT: ® 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
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYS I'EM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK -
LAVATORY (,3 - r
ROOF DRAIN '
t5WE17SfiAA �► a a1 ./
SERVICE 1 MOP SINK �l ,IV ---ii--n_-
TOILET -
URINAL
WASHING MACHINE CONNECTION
WATEWREA1 PES
WATER PIPING
OTHER
REta /s,r
- _QL 1 22'3 , INSUXANt.t LUVLHAOE:
I have a u nt IiabiF DTE (�t •r its substantial equivalent which meets the requirements of MGL Ch.142. YES 9 NOD
Lots o IF YOU C•ECIte ' . • •TSE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
ev•
LIABILITY INSURANCE POLICY 9 OTHER TYPE OF INDEMNITY 0 BOND D
OWNER'S INSURANCE WAVER: 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 NI AGENT ❑
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 raW o my knowledge and
that all plumbing work and installations performed under the permit issued for this application will be in complian ith all P it ent pro ' on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME James Pazakis LICENSE#PL-1 IGN•TURE
MP ® JP ❑ CORPORATION ®#C-2803 P ERSHIP C ❑#
COMPANY NAME:Hall Plumbing&Heating,Inc. ADD :447 Old Chatham Road
CITY:South Dennis STATE:MA ZIP:02660 TEL 508-385-9127
FAX 508-385-6604 CELL EMAIL Halltechnician@comcastnet •
BING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT#
PLAN REVIE NOTES
e?
1 F"=s
4-}
La a