HomeMy WebLinkAboutBLDP-18-001081 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
T I1=. CITY West Yarmouth J MA DATE August 24 2017 PERMIT# P/2-401d it
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JOBSITE ADDRESS Maplewood @ Mayflower PL OWNER'S NAME Maplewood Mayflower Place
OWNER ADDRESS 579 Buck Island Road I TEL JFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL RESIDENTIAL
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CLEARLY NEW:El RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YES ID NO 0
FIXTURES 7 FLOOR—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 I R I I_...Rau ,�E....__. [ ... _. ..,.J .__. it
CROSS CONNECTION DEVICE MN NM � .NM NMI NMI NM
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM [ II
DEDICATED GREASE SYSTEM NMIII.Ili.Mi.MN ail inn MN
DEDICATED GRAY WATER SYSTEM iuuriuuumr-narmurllIll'INIF111.IIIIIIIIIIWIIIIIFJIIIIrIIIIIIFIIIIIFlillt
DEDICATED WATER RECYCLE SYSTEM ;; ' [ 111111
DISHWASHER MI INN NM NM MC MI MI INK MI MN IIIIIIIII Inn NM MK MI
DRINKING FOUNTAIN ' I all lilt 11111111111111111
FOOD DISPOSER iii1, 1 , ,
FLOOR/AREA DRAIN MAN rill 11=
INTERCEPTOR(INTERIOR) !� all €IN S W 1 .M M!
KITCHEN SINK IMO 11/7III MIKNMNMNMNM NMI.MUWM Wig WMM•IIIIIII
LAVATORY NMI--illi lin€—` 11111 1
ROOF DRAIN NM NM MN 11111111 111111111 MEM MN M MI MN MIS NM
SHOWER STALL 111111111111111 1111111111111111111111111 NM III.111.111111111111 Mil.
SERVICE/MOP SINK nil nil ! f ' T, 2XVaS INF
TOILET WO�__ L- �.� "` MUURINAL r 1 Ma MR
WASHING MACHINE CONNECTION iI [IIRUR
WATER HEATER ALL TYPES MN MN MN MIR Eli M .; ;
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WATER PIPINGim-,
OTHER A- Arir A11111111111111111.1 NOM nil Min INN IIIIIII IIII MI XIII MB NMI MIN III MI MI III
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO CI
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY 0 BOND Ej
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 Li AGENT
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 an. acc -te to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complia .-with:II • rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. __
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PLUMBER'S NAME Walter,Kenne „ ,,LICENSE# 9202 fr . ,r SI A URE��
MP0 JP0 CORPORATION0# PARTNERSHIP®# LLCEi# 3197
COMPANY NAME East Coast Plumbing, LLC ADDRESS 23 Summerwind Lane
CITY N.Falmouth STATE[ MA ZIP 02556 TEL 508 563 5373
FAX 508 564 6681 I CELL 508 8891864 i EMAIL mkenney@eastcoastplumbing.com
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