HomeMy WebLinkAboutP-13-071 ,...•r MASSACHUSETTS URIFORNI FAP• • • ` • - • • - ' • • - • -MALUM
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CITY Yarmouth MA DATE 07/30/12 PERMIT # 0 3 -- a 1 1
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`"o JOBSITE 23 Wood Duck Rd(West Yarmouth) M#6/P#2 OWNER'S NAME Clay
POWNER ADDRESS SAME TEL 508-775-7867 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW: 0 RENOVATION: 0 REPLACEMENT: 0 PLANS SUBMITTED: YES 0 NOD
FIXTURES-• FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
DEDICATED SPECIAL WASTE SYSTEM IIIIIIIIINPIPJ
DEDIC' • • ' I 'l• • v
DED ED GREASE SY
DEDICATED GRAY WATER SYSTEM ,
DEDICATED WATER RECYCLE SYSTEM DAF 1'
DISHWASHER •�N/
TOMFOUNTAIN G FOIN red\-/
FOOD DISPOSER 111111111111 �% fir
'TT-DOR/AREA DRAIN
"INTERCEPTOR (INTERIOR) O r1
LAVATORY LP.
R OP DRAIN
-SHOWER"STALL __- _ iii ,_____,
SERVICE / MOP SINK
TOILET
URINAL
WASHING MACHINE-CM E I•
'WATER'HEATER ALL7YPE8
WATER PIPING
OTHER —.._
INSUKANt..(.UVbNA .
I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES fp NOD
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY J OTHER TYPE OF INDEMNITY 0 BOND o
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: OW : ■ AGENT 0
SIGNATURE OF OWNER OR AGENT
f hereby certify that all of the details and information I have submitted or entered regarding this application are t •e and ..-.• rate to the b‘. of my knowledge and
that all plumbing work and installations performed under the permit Issued for this application will be in comp'.nce .I Pertinent. 'vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME James Pazakis LICENSE#PL-150 :- •IGNATURE
MP PD JP 0 CORPORATION ®#C-2803 "ART - - HIP r LLC ❑#
COMPANY NAME:Hall Plumbing&Heating,Inc. -a•-ESS:447 Old Chatham Road
CITY:South Dennis STATE:MA ZIP:02660 TEL:508-385-9127
FAX:508-385-6604 CELL EMAIL Halltechnidan@comcast.net