No preview available
HomeMy WebLinkAboutP-12-112 rip wt. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO PLUMBING ='�'_=Q 9-391_;„11_,..„,.„.„.„, e mwa+— CITYROWN:I Yarmouth APPLICATION DATE: . ___.-.__.� ge •bd 'O JOB ADDRESS: m...23._1R1�.�\.tock__A.t - _...,_.__-___ J PLANS SUBMITTED: YES El NO ✓0 POCCUPANCY TYPE: COMMERCIAL0 RESIDENTIALQ NEW ALTERATION REPLACEMENT EI REMOVAIJDEMOLITIONf r PLUMBING: PIPING-FIXTURES-FIXED APPLIANCES-APPURTENANCES 2 ENTER TOTAL AMOUNT FOR EACH SELECTION(LIMITED TO FIVE(5)NUMERALS ALTERNATIVE TECHNOLOGY I DISPOSER I—n SINK: MOPU SERVICED nn ASPIRATOR DRINKING FOUNTAIN I— STERILIZER DRAIN: AREA FLOOR EJECTORI J STORAGE TANK BACKWATER VALVE _ EMBALMINFill I AUTOPSY J 1 I— URINAL _I---- BAPTISM: IBAPTISM:FONTI-I SACRARIUJ I I FOOD CHEST MISTING SYSTEM VACUUM DRAINAGE SYSTEM I— BAR SINK GLASS WASHER - - ( I WATER CLOSET BATHTUBI-I WHIRLPOOLI-I I---- ICE MAKER I I WATER HEATER:ALL TYPES 1 BIDET I INTERCEPTOR:ALL INTERIOR -I WATER PIPING: CROSS CONNECTION DEVICE I _ _ KITCHEN SINK I I t OTHER NOT LISTED 1 DEDICATED: ACID WASTE SYSTEM I , LAUNDRY CONNECTION I DEDICATED: GASIOILISAND SYSTEM I LAVATORY 1-1� DEDICATED: GREASE SYSTEM PIPE RELINING WORK ONLY 1--I I DEDICATED:RECLAIMED WATER I ROOF DRAINI DENTAL FIXTURE I EQUIPMENT SINK: 1-2-3 BAYI I PREP.( I I— I I ll DISHWASHER SINK:CLINIC [l FLUSH RIM II PLUMBING INSTALLER-FIRM-COMPANY INFORMATION CHECK ONE ONLY NAME:?MG Mechanical Systems LLC. I ADDRESSapo box 797 J Corporation Business# CITY: Forestdale STATE: me� ZIP:,02644 �Partnerahip Buslness# TEL: 5088881745 FAX;I8883745 EMAIL: pmgmechanical@verizonb,net I ✓❑LLC Buslness# 3329 DBA I Unincorporated NAME OF LICENSED PLUMBER: INSURANCE COVERAGE • I have a current liability insurance policy or,its substantial equivalent,which meets the requirements of MGL.Ch.142 YES El NO0 If you have checked Yes,please Indicate the type of coverage by checking the appropriate box below. A liability Insurance policy p Other type of Indemnity❑ Bond 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee don 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!: AGENT❑ Signature of Owner or Owner's Agent OWNER'S NAME:I v t ei .._S:\v¢.Krk A/ __._-._.. __._ ----_J TEL:1,e................_.._.-, I FAX: I hereby certify that all of the details and information I have submitted(or entered)regarding this permit application is true and accurate to the best of my knowledge.I certify that all plumbing work and installations performed under the permit Issued,will be In compliance with all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 of the I Laws. (OFFICE USE ONLY) TYPE OF LICENSE: C.-- Permit# _...--Permit# 7/ 2 "I/V D Plumber gnature of Licensed Plumber Inspector El Master 12535 zdb License Number: Fee: au ❑Journeyman