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HomeMy WebLinkAboutP-12-260 MASSACHUSET S UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK rig r, Wbj_=.t CITY YARMOUTH MA DATE // /, i PERMIT# 1112- -260 V / W r-rt .. g...„42sr._ QD2Js JOBSITE ADDRESS 3,�0�, 6 J� 19! u OWNER'S NAME P OWNER ADDRESS I /5 Gq/yl-e TEL! — FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL Q RESIDENTIAL Q PRINT ,—,/ CLEARLY NEW:C� RENOVATION:[Y REPLACEMENT:Q PLANS SUBMITTED: YES Q NOD FIXTURES 1 FLOOR-0 BSM1 2 3 4 5 6 7 8 9 10 11 12 13 14 . BATHTUB __ _ _ - _ _ _ n -..a -_, Later I • CROSS CONNECTION DEVICE -I I , "-\ DEDICATED SPECIAL WASTE SYSTEM H 1n) ,..d 11 VAI gNi I DEDICATEDGRAYDEDICATED OWATERSYSTEM 1USAND SYSTEM I I 'I II ,I !1 ' 1 NOV DEDICATED GREASE SYSTEM 4 ' I - l GU DEDICATED WATER RECYCLE SYSTEM , DISHWASHER md-A ! ...J1. r6. 1 %L-k '{Y:kJ5.i!_q.A L AINS',.....'“MAk LQ&J ,J9=.PN..1 �y 1,,,--..„*.'. .--� . '. DRINKING FOUNTAIN I (, , I' 'I ! FOOD DISPOSER — _... _ I _::_- - FLOOR I AREA DRAIN1 INTERCEPTOR(INTERIOR) I i KITCHEN SINK � 1 i, __ _ ._ LAVATORY it 1 I W.. :.- A `.fM `P �,MA,Jy. I•.," ffP 'G :aTd:.d.,,. .6.4,f':"m,� lU..: iiK..R kG -.+RT h.k+ ROOF DRAIN t 1 I SHOWER STALL / , 4 i i SERVICE I MOP SINK i I i TOILET URINAL t(—, �I 1 +_, WASHING MACHINE CONNECTION I 1 :l ��.. x`,_ WATER HEATER ALL TYPESi. WATER PIPING i. i - r1 t' r . .. OTHER I. 1 ,m. ISII s I :.. 1:6r ,II I � �.w4., a I.. . _w- . ., e_ 4Tkx� ,. h INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[] NO.Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY © BOND Q 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 Q 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 and accurate to th- •- t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be In co pliance with all Pprovision of the - Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME KEVIN LAMOUREUX 'LICENSE# 15383 via NATUl E MP JP r CORPORATION Q# PARTNERSHIPD# LLC 0#1--I COMPANY NAME LAMOUREUX PLUMBING ADDRESS 61 JOBYS LANE CITY OSTERVILLE ,I STATE MA ZIP 02655 TEL 508-420-2068 FAX 508-420-7992 CELL 508-292-5085 EMAIL lamoureuxplumbin9@verizon.net 9