HomeMy WebLinkAboutBldp-20-002312 A. , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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, i MA DATE 10/23/2019................... j PERMIT# / DP;2aODa1/A
JOBSITE ADDRESS 67 ADAMS RD OWNER'S NAME JUDY HARMONY
POWNER ADDRESS 1 TEL JFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW:Ij RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO0
FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 j 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE O Ism.0111111111.,Mat 1h 1 llMal NM NMI MI
DEDICATED SPECIAL WASTE SYSTEM ��� IIIII
DEDICATED GAS/OIL/SAND SYSTEM 1111111111111111111111111.11 11 _._._ :
DEDICATED GREASE SYSTEM ' AMR iiiffill.111111.11111111111MINIR,_ MI NM INN MR
DEDICATED GRAY WATER SYSTEM 1StIIIIIIHNINIMINEM 1 1� ;
DEDICATED WATER RECYCLE SYSTEM i [� � � , g
DISHWASHER ,�I,I �MR I 1111111101, �OM MO
DRINKING FOUNTAIN ,�i ,.i / __
FOOD DISPOSER � fii_
FLOOR/AREA DRAIN IMP=WM0 16M�1111111111111
iiNTERCEPTOR(INTERIOR) .111111111111._
KITCHEN SINK
LAVATORY 11
ROOF DRAIN MI MIRIMMININSUMONUillit
SHOWER STALL j, ;Oantinew
TOIMg PINFilir
LETE/MOP SINK 6a11.111,
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URINAL
a � =N—IM=SMIOIINIIIIIIIIIIuIIlnl1$I11Ii111I10.IIw ��
WASHING MACHINE CONNECTION 111 ,1EM
WATER HEATER ALL TYPES :__ _ M '
WATER PIPING 1111 iUNISSIN /k ,111,11111111111111111111111111011
OTHER NNIIMM �11
OM NOMil
111.11111.11111111111111111111111111 11F
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 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 ID AGENT U
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 al ertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME rSean Hanrahan LICENSE#I 15822� SIGNATURE
MP 0 JP® CORPORATION®# JPARTNERSHIPLJ# LLC0#
RECEIVE ''
COMPANY NAME Sean Hanrahan Plumbing and Heating ADDRESS PO BOX 688 __-- -
,,
CITY Centerville 1 STATE MA i ZIP 02632 TEL 774 238 0286 _______Ti....7
FAX 508 775-4615 J CELL same 1 EMAIL hanrahanplumbing@gmail.com (,] 3 201901,
BUILDING DEPARTMENT I
C\c/ ` lCs-r
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ A1-6 , O
FEE: $ PERMIT#
PLAN REVIEW NOTES