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HomeMy WebLinkAboutP-19-2884 •,� J13125 $60.00 d MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i.ala ain - - clip/; te` CITY YARMOUTH MA DATE 11/2118 PERMIT#frhfr-I9'"0O4 '1 JOBSITE ADDRESS 8 CAPTAIN YORK RD OWNER'S NAME SUSAN&WILLIAM SULLIVAN P OWNER ADDRESS 64 LYNDON RD PROVIDENCE RI 02905 TEL 617-834-6184 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL Q RESIDENTIAL 0 PRINT CLEARLY NEW:Q RENOVATION:0 REPLACEMENT:Q PLANS SUBMITTED: YES Q NOQ FIXTURES I FLOOR-. BSM 1 2 3 4 5 6 7 8' 9 10 11 12 13 14 BATHTUB .1 - r i- � `� '� -. l i � .l. ,I it II , a 1.1, i CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM --ape p r r inn DEDICATED SPECIAL SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM UMW I Si ntanillig DEDICATED WATER RECYCLE SYSTEM ,, DISHWASHER DRINKING FOUNTAIN an�fl f� �' �fl I!I0R ERII 'i ii1 DRAIN(INTERIOR) i III ,i r 11i , SHOWER STALL �' alilli 0111111111111, , a= 111111 111111111 TOILET URINAL .1, ,H, IL WASHING MACHINE CONNECTION i, „ ; II , 1 WATER HEATER ALL TYPES 1 WATER PIPING i[ 'r 'r 1 F r OTHER r r � T T 1 r -, , lir IL l 11 Ir. II_ , i n r, 1 : . ,I .r l i i i. INSURANCE COVERAGE:. I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY O 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 Q SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applica gli.are t - a • ;ocurate t. - best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will l comp an'-with al t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (� Th L a. PLUMBERS NAME Richard J.Whiteside LICENSE# 15850 ` " - SIGNATURE MPO JP CORPORATIONO# 3969 -PARTNERSHIPQ# LLCQ# COMPANY NAME Murphy Services Inc ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660 FAX 508-760-1670 CELL EMAIL cshea@callmurphys.com II klaube@callmurphys.com Mils- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yea No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ n !� z - o 5 p FEE: $ PERMIT# Z '/1/j? PLAN REVIEW NOTES