HomeMy WebLinkAboutBLDG-20-002755 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
li' CITY Yarmouth , gyp
`,=��IJ_� I MA DATE 11/05/2019 PERMIT# .��D a7,�j
JOBSITE ADDRESS 4 Keel Cape Drive,South Yarmouth I OWNER'S NAME Linda Bond
POWNER ADDRESS 4 Keel Cape Drive,South Yarmouth TEL 774-212-1526 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:[j PLANS SUBMITTED: YES LI NOD
FIXTURES Z FLOOR-- BSM 1 I 2 3 4 5 6 7 8 i 9 J 10 11 12 13 14 -
BATHTUB 1 J
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM I i I
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEMIII ER ME I 11111
DEDICATED WATER RECYCLE SYSTEM 1111111
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DISHWASHER
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DRINKING FOUNTAIN ii
FOOD DISPOSER '�
FLOOR/AREA DRAIN
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INTERCEPTOR(INTERIOR
KITCHEN SINK
LAVATORY
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ROOF DRAIN
SHOWER STALL 11 '
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SERVICE/MOP SINK i�MM
TOILET MI MIN IMMIX MN=RIM =I
URINAL i I ' I I
WASHING MACHINE CONNECTION 1111111.111111141.1111W I
WATER HEATER ALL TYPES
WATEROTHER I IPIN4G,Y£GT a 21
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INSURANCE COVERAGE: v
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ® BOND El
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 ® 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 P ine provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Kevin J.Sullivan LICENSE# 13041 1 ��
NATURE
MP Q JP❑ CORPORATION❑# 2433 PARTNERSHIP❑# I LLC®#
COMPANY NAME Ready Rooter,Inc. J ADDRESS P.O.Box 371
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CITY Sandwich STATE MA ZIP 02563 TEL 508-888-6055'� �,: " '''-- ` '''',7 C"
FAX 508-888-0242 CELL EMAIL .kjs@readyrooter,com