HomeMy WebLinkAboutP-19-3531 Rafr
-- HILLIS $50.00 Inl 't Or" Reaoui -c.
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
L CITY YARMOUTH MA DATE 11/28/18 PERMIT#/6111,/719'41°551/
JOBSITE ADDRESS 15 TOURAINE WAY OWNER'S NAME MARK HILLIS
P , OWNER ADDRESS SAME TEL 508-377-2055 FAX 11111101111.
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOD
FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB ''x , I II [ rr II r
CROSS CONNECTION DEVICE 1 f
DEDICATED SPECIAL WASTE SYSTEM
I
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM 'an
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEMI
DISHWASHER
DRINKING FOUNTAIN I
FOOD DISPOSER sigim IeI�: I
FLOOR/AREA DRAIN0
INTERCEPTOR(INTERIOR)
KITCHEN SINK 1.1111110111111
LAVATORY moor,Fs , �f
ROOF DRAIN Mrai
SHOWER STALL
SERVICE/MOP SINK Iii
I 1I l
1111111111
TOILET __
URINAL
WASHING MACHINE CONNECTION r 7 -
WATER HEATER ALL TYPES , , Is g
WATER PIPING y r
r iI r r
OTHER , r , Irlt Ir it Fr
I r
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABIUTY INSURANCE POLICY a OTHER TYPE OF INDEMNITY 0 BOND❑
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
C K ONE ONLY: OWNER ❑ AGENT
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this applica • : tru;an. . rate to r- •est of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will .e i .m. ce with al -- . .vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 41
PLUMBER'S NAME Richard J.Whiteside • LICENSE# 15850 I SIGNATURE
MP El JP CORPORATION 0# 3969 PARTNERSHIP❑# ILLC❑#
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
G-leli
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ 0
FEE $ PERMIT# )3V
PLAN REVIEW NOTES )//a /?
e