HomeMy WebLinkAboutBLDP-20-000080 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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=-I* CITY[Yarmouth _ MA DATE 7/8/2019 PERMIT#8109110-Dodo zd
JOBSITE ADDRESS 743 Main Street Rt.28 . OWNER'S NAME Dale Laasch
POWNER ADDRESS TELJ 508-864-7492 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL I i EDUCATIONAL RESIDENTIAL U
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CLEARLY NEW:—1 RENOVATION:Li REPLACEMENT:r 1 PLANS SUBMITTED: YES I 1 NOI i I
FIXTURES-1 FLOOR-4 BSM 1 2 3 4 I 5 6 7 8 9 10 11 il 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
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DEDICATED SPECIAL WASTE SYSTEM ( 0I I
DEDICATED GAS/OIUSAND SYSTEM 1 j
DEDICATED GREASE SYSTEM
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DEDICATED GRAY WATER SYSTEM � u � (
DEDICATED WATER RECYCLE SYSTEM 1 II I I I
DISHWASHER I 1
DRINKING FOUNTAIN
FOOD DISPOSER
It_FLOOR/AREA DRAIN ^ t I
INTERCEPTOR(INTERIOR)
KITCHEN SINK I
LAVATORY II
ROOF DRAIN
SHOWER STALL II ( J
SERVICE/MOP SINK
TOILET I I J
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES I I I
WATER PIPING *.Ili � ' 1
OTHER Building Drain
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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 n
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY!.1 OTHER TYPE OF INDEMNITY 1 BOND U
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 r1
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 ance 'h al di p vision of the
Massachusetts State Plumbing Code and.Chapter 142 of the General Laws.
PLUMBER'S NAME Peter J.Hassett LICENSE# 11682 SIG TURE
MP; ( pH CORPORATION;]#I3506 PARTNERSHIP # LLC' #1
COMPANY NAME Hassett Plumbing and Heating,Inc. I ADDRESS 8 Skipper Lane
CITY Yarmouth Port STATE FM—1 ZIP ;02675 TEL F 508-744-7555 1
FAX CELL 1508-237-2175 EMAIL peterjhassett@gmail.com
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