HomeMy WebLinkAboutBLDP-20-000013 +,:‘, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
it. K-z
J1 CITY, South Yarmouth MA DATE,06/26/2019 PERMIT#/3�/�� /3
1, ..d m v �_,1\
'2'4,_--,,,./ _ _..,_ , _
JOBSITE ADDRESS " 15 Bass River Terrace i OWNER'S NAME;Joe Celona
OWNER ADDRESS SAME TEL' 978 505 0262FAXr
TYPE OR OCCUPANCY TYPE COMMERCIAL ` EDUCATIONAL 1 RESIDENTIAL ,
PRINT
CLEARLY NEW: L,,,] RENOVATION _ REPLACEMENT j PLANS SUBMITTED: YES g NO
FIXTURES 7 FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUBI"._.
CROSS CONNECTION DEVICE x-'7 !1--
,"_._ .. i Rimplan
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM '� '
DEDICATED GREASE SYSTEM g 11111111111111
DEDICATED GRAY WATER SYSTEM ,..„. .,,..„: ,
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN Mill MN mum 11111111111111Mir .., MN
FOOD DISPOSER MIMI ,'IIMNIMIIIIIIIIIIIMIIIIIMIMIIIIIIIIIIIIIIINENIIIIIIIIIIIM
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) _., .... _.
KITCHEN SINK r
LAVATORY
ROOF DRAIN
SHOWER STALL All 1101111111111.11.01111. . MS. NMI
SERVICE/MOP SINK
TOILET
URINAL
g.
WASHING MACHINE CONNECTION :ill" 1111111111111111111,11"1111111.11111MINEMMANUINI
WATER HEATER ALL TYPES [ _ ! [ 1
WATER PIPING _ : �`_. :;'_ 1 i'
OTHER i
IINIM
1111111111111111011.1111111111111111111111111MMIMMI
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 1 OTHER TYPE OF INDEMNITY , ' BOND 1-1
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 ri 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 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 complian • I Pertine t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME KEVIN G.SARGENT LICENSE# `PL16471 M �1 TURE
MP ' JPL- I
CORPORATION£ # 4117 PARTNERSHIP}; 1#, LLC 1w #
,. � .� �..� .��. _...�_d �� __.��_ ,
COMPANY NAME; CAPE COD GAS HEAT&A/C SYSTEMS ' ADDRESS 115 JAN SEBASTIAN DRIVE#D4
CITY[SANDWICH STATE e MA ZIP i 02563 1 TEL' 508-539-9303
I
FAX 508-833-9389 ] CELL; 617-834-0785 `EMAIL INFO@CAPECODGASCOM [
z--R# oVAD---1(i-6'-v--
_
\c)
( )