HomeMy WebLinkAboutBLDP-20-000064 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
-"k'= 'z- CITY Yarmouth, South MA DATE 6/26/2019 PERMIT#/�'�i_d��F%`0 / '
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JOBSITE ADDRESS 6 Captain Stanley Road OWNER'S NAME Mark Romboli
POWNER ADDRESS I TEL 508-694-7263 'FAX I
TYPE OR OCCUPANCY TYPE COMMERCIAL Lj EDUCATIONAL ® RESIDENTIAL Q
PRINT
CLEARLY NEW:® RENOVATION:❑ REPLACEMENT:L3 PLANS SUBMITTED: YES NOLI
FIXTURES-1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
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DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
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DEDICATED GREASE SYSTEM r_••_
DEDICATED GRAY WATER SYSTEM 1 _ 1 , j . 1
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DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN 1
FOOD DISPOSER
.._. _ `Alit 1 Y1'A -I,Y'W MINN! MIN - ,�..)l -.._ A;.
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) f I i 1
KITCHEN SINK
ROOF DRAIN LAVATORYI /MI I : NI 1 f l ,
SHOWER STALL 'i_.
SERVICE I MOP SINK
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TOILET
URINAL 1 ._ I ! ' . . N ._
WASHING MACHINE CONNECTION J
WATER HEATER ALL TYPES 1
WATER PIPING
OTHER Tub/Shower Valve 1 I I
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO d
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 LI
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.
SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER Q AGENT LI
I hereby certify that all of the details and information I have submitted or entered regarding this application ar,' e and acc 1 - - o the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be' complian - ' a,-- i -nt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /
PLUMBER'S NAME Paul Owen
'LICENSE# 11061 i IGNATURE
MPLI JP® CORPORATION 0#4156 PARTNERSHIP # ,LLC®# 1
COMPANY NAME BathFitter Bridgewater Inc I ADDRESS 25 Turnpike St I
CITY W.Bridgewater I STATE Ma I ZIP 02379 I TEL 508-521-2700 I
FAX 508-588-4303 CELL 781-361-5072 I EMAIL powen@bathfitter.com 1
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT#
PLAN REVIEW NOTES r/ /9 , `) /, 7L