HomeMy WebLinkAboutP-14-728 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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=.�3r s CITY YARMOUTH , MA. DATE 05105114 PERMIT#"PAP"7.-S
JOBSITE ADDRESS 49 MACOMBERS DRIVE OWNER'S NAME HANSON
P OWNER ADDRESS: YARMOUTHPORT TEL: 970.209-8545 FAX
TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW:0 RENOVATION:% REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO❑ti
FIXUTRES 7 FLOORS-. Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB t
CROSS CONN DEVICE
DEDICATED SPECIAL WASTE SYS
DEDICATED GAS/01L/SAND SYS
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYS
DEDICATED WATER REUSE SYS
DISHWASHER
DRINKING FOUNTAIN
FOOD WASTE GRINDER UNIT
FLOOR 1 AREA DRAIN
INTERCEPTOR INTERIOR
KITCHEN SINK
LAVATORY 3
ROOF DRAIN _
SHOWER STALL 1
SERVICE I MOP SINK
TOILET 2
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING _ —_
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INSURANCE COVERAGE I MAY 0 3 1IY'P4 )
I have a current liability insurance policy or its substantial equivalent which meets the requirements of M L Ch.142 YES NO ❑
BUILDING DE•PAPBALr.T
If you have checked YES,please indicate the type of coverage by checking the appropriate box below. e y _Cerr I �p
UABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY 0 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
CHECK ONE ONLY: OWNER 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my
Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
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PLUMBER NAME: LEON E CLARK,JR. LICENSE# 11734-M NATURE
COMPANY NAME TC TYNDALL 8 CLARK PLUMBING AND HEATING ADDRESS: 18 ATLANTIC AVENUE
CITY: SOUTH DENNIS STATE MA ZIP: 02660 FAX 508-385-9177
TEL: 508-385-8868 CELL: 508-367-1451 EMAIL.:
MASTER❑ti JOURNEYMAN❑ CORPORATION Illi # PARTNERSHIP 0# LLC❑#
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