HomeMy WebLinkAboutBLDP-20-001029 'c.6`' 3 75ooLe $. so.06
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
=""_- CITY Yarmouth,South MA DATE 8/20/2019 PERMIT#,//-0/` 0'4bM
JOBSITE ADDRESS 6 Captain Stanley Road OWNER'S NAME Mark Romboli
POWNER ADDRESS TEL 508-694-7263 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0
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CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO0
FIXTURES 1 FLOOR—) BSM0 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE ', .
DEDICATED SPECIAL WASTE SYSTEM 1
DEDICATED GAS/OIL/SAND SYSTEM I { ',IL A., ®,�
DEDICATED GREASE SYSTEM a
I 1
DEDICATED GRAY WATER SYSTEM F � [ r I � _r y � „ r _ J
DEDICATED WATER RECYCLE SYSTEM I
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER I I • �r I.r. 1._,
FLOOR/AREA DRAIN
INTERCEPTOR INTERIOR)
KITCHEN SINK ,
LAVATORYgm _
ROOF DRAIN „
SHOWER STALLII
SERVICE/MOP SINK
URINAL w
TOILET , / ,
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES liml I
j
WATER PIPING
OTHER [Drain Adjustment III 1 1.
a , _ _
. ,
I _ r
f
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 POLICY0 OTHER TYPE OF INDEMNITY 0 BOND 0
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: OWNE• [ 1 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 tr - -nd a • h- be-
of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in • pliance wi nen •rovision of t
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. M " T. v
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PLUMBER'S NAME Paul Owen 'LICENSE# 11061 glow SI NATURE
MP 0 JP O CORPORATION 0#4156 PARTNERSHIP O# LLC O# W
COMPANY NAME BathFitter Bridgewater Inc I ADDRESS 25 Turnpike St
CITY W.Bridgewater STATE Ma I ZIP 02379 I TEL 508-521-2700
FAX 508-588-4303 CELL 781-361-5072 I EMAIL powen@bathfitter.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES