HomeMy WebLinkAboutBldp-18-006720 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK}� } CITY ,Yarmouth ,
MA DATE Ma 25 2018 PERMIT#b ��F C87a
JOBSITE ADDRESS 1881 Rt 28 Bldg A j OWNER'S NAMEI Dakota Partners
POWNER ADDRESS 11264 Main Street TEL 781 899-4002 c
... I..-._... FAX 781-899-400.,
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW:13 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES ID NOD
FIXTURES Z FLOOR BSM 1 2 1 3 4 I 5 6 7 8 91 10 11 12 II 13 14
BATHTUBI 18 I 20
CROSS CONNECTION DEVICE _. a.._t_ �' _
DEDICATED SPECIAL WASTE SYSTEM i
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM �.
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM f *= :I 1` r --
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DISHWASHER }�- � I
DRINKING FOUNTAIN r - -
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FOOD DISPOSER _ ��
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FLOOR/AREA DRAIN 1111111111111111Nall lilt 111111111.111.1111r MIIMmt IOW all IMF IMF
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INTERCEPTOR(INTERIOR
KITCHEN SINK f [
9 10
LAVATORYis 20 1 n
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ROOF DRAIN
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SHOWER STALL 18 20 1
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SERVICE/MOP SINK � .-
1
TOILET
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URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 2 �k-
WATER PIPING 1
OTHER f t
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of M i L Qh." � __N*
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IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BEL. MAY �-
LIABILITY INSURANCE POLICY `'- 201'
OTHER TYPE OF INDEMNITY BOND D °If ii�' �,}; ad
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage req is kW i 42 0 ENT
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accu ate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co pli e ' a ertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME
LICENSE# 9202 4
SIGNATURE
MP0 JP 0 CORPORATION # PARTNERSHIP # LLC # 3197
COMPANY NAME East Coast Plumbin. LLC »»
� ADDRESS 23 Summerwind Lane
CITY N.Falmouth STATE
MA ZIP 02556 TEL 508 563 5373
FAX 508 564 6681 CELL 508 8891864 EMAIL mkenne eastcoast lumbin .com
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