BLDP-19-001952 a, MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK
ard,l_ -t �I CITY. YARMOUTH MA DATE 9/24/18 PERMIT# /"'/i"Gb/1,5 A
JOBSITE ADDRESS 1 SPRUCE STREET OWNER'S NAME SALLY OLIVER
POWNER ADDRESS 50 PRINDIVILLE AVE FRAMINGHAM,MA 01702 TEL 508-760-3442 FAX 1.11111111111111
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL
PRINT
CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑
FIXTURES 1 FLOOR- 6SM 1 2 3 4 5 6 7 I 8 9 10 ' 11 12 13 14
BATHTUB ( I I
CROSS CONNECTION DEVICE 1 •
DEDICATED SPECIAL WASTE SYSTEM Ir I
r
DEDICATED GAS/OIL/SAND SYSTEM 0 t K I ,_—
DEDICATED GREASE SYSTEM • I
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM I
DISHWASHER C 47 f
DRINKING FOUNTAIN t ,f IG_ i _ II
FOOD DISPOSER J
I� it ,.. . ��
FLOOR/AREA DRAIN
KITCHEN TORSINK (INTERIOR) i .. I i J
KITCHEN SINK �
LAVATORY 11 , r 1 r % 1,
ROOF DRAIN ;
I f
SHOWER STALL __
SERVICE/MOP SINK < F
TOILET •
URINAL
WASHING MACHINE CONNECTION
Jlir
WATER HEATER ALL TYPES 1
WATER PIPING I, r
OTHER C
i , H i
'
R_______Wia min JIM
C- t'_ n r I
INSURANCE COVERAGE: ..
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑+ - - OTHER TYPE OF INDEMNITY ❑ BOND 0
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
HECK ONE ONLY: OWNER 0 AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this ap•Ii-n are ti a • • rate to • •est of my knowledge
and that all plumbing work and installations performed under the permit Issued for this applicatio I 'yin' ce with .11 Pertinen • ovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .y t
•
PLUMBER'S NAME Richard J.Whiteside LICENSE# 15850 •`/ S.—NATURE
MPO JP El CORPORATION Q# 3969 PARTNERSHIP❑# Lc p#
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 // klaube@callmurphys.com
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No /
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ Jjy f'`i1C / Le
FEE: $ PERMIT# O/` �/✓2'—
PLAN REVIEW NOTES //S//