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HomeMy WebLinkAboutP-14-609 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK c n g' CITY morons'd_gair.. . .__ MA DATE b/I-*/1`7`.. ..�PERMIT# V �y 6,091 Opo JOBSITE ADDRESS IP i foot . g2-t.Q = T OWNER'S NAME`/{1/:Q--''//C(S P OWNER ADDRESS 9�G`__-. _ _._ , _ _I TEL .P74-rD4'4 / FAX L•W, , TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL,0 ' RESIDENTIAL PRINT CLEARLY NEW:® RENOVATION:© REPLACEMENT:gilz PLANS SUBMITTED: YES Q NOEl FIXTURES 1 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB [ r , ,( _-' CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OIL/SAND SYSTEM l5a5 ,I I terers DEDICATED WATER RECYCLE SYSTEM , moum'parpsy r ssiapsys DISHWASHER FOOD DISPOSER r INTERCEPTOR • ,• ' lit6 f ia"__' . w FT KITCHEN SINK l LAVATORY julini ilit5 S S — S J- n tsgMN TOILET Man MN URINAL Or r r ? ram ., WASHING ll ninnn � tI 1,11;11,1111:777k O HE — K,. sr _ is _. r ±. .. .. I_ _a ir rrAi; T I BUILD NG D//�yENT INSURANCE GE COVERA I •Ve a current liah11ity insurance pi Iicy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO ® IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW . LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY Q 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 CHECK ONE • OWN ' * AGEN 'V SIGNATURE OF OWNER OR AGENT 1 hereby certify that all of the details and information I have submitted or entered regarding this application are true ilccu -te to the 'est of my o edge and that all plumbing work and Installations performed under the permit Issued for this application will pe In compliance i all Perlinnt provision i e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. l\ PLUMBER'S NAME I STEPHEN A.WINSLOW LICENSE#012298 , I SIGNATURE MP +® JPD CORPORATION CI#j3261C , _JPARTNERSHIPD#0. _�LLCD#L,_J COMPANY NAME E.F.Winslow Plumbing 8 Heating Co.,Inc. ADDRESS08 REARDON CIRCLE CITYLSOUTHYARMOUTH_ STATE MA' , ZIP 02664 TEL 508.394-7778 1 FAX 508-394-8256 CELL EMAILaccountspayable efwinslow.com q ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES 1246 ©n i 3 flVk/ . THIS APPLICATION SERVES AS THE PERMIT Yes No FEE: $ PERMIT# PLAN REVIEW NOTES `. • • •