HomeMy WebLinkAboutBLDP-20-001446 { 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK •_•_v I.=y 4 CITY 1 Yarmouth _ MA DATE 9/16/2019 PERMIT# / f g4-06/t/1.P .1" JOBSITE ADDRESS 15 Elmcroft Rd Yarmouth Port I OWNER'S NAME Fred Schilpp POWNER ADDRESS ' _ TELT-- 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL H EDUCATIONAL RESIDENTIAL E PRINT CLEARLY NEW:ri RENOVATION:I I REPLACEMENT:1 H 1 PLANS SUBMITTED: YES[—I NOT-I FIXTURES 1 FLOOR-4 BSM 1 2 1 3 1 4 5 6 7 8 9 1 10 11 12 [ 13 14 BATHTUB Q I CROSS CONNECTION DEVICE11111. DEDICATED SPECIAL WASTE SYSTEM _^ ( I I p I I I I I DEDICATED GAS/OIL/SAND SYSTEM I ` I�'�-1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM [ I (�-I I DISHWASHER I I I I I DRINKING FOUNTAIN I I! I I I FOOD DISPOSER I � I FLOOR/AREA DRAIN MK_IN INTERCEPTOR(INTERIOR) 111111111111111M KITCHEN SINK I 1 LAVATORY I , I ROOF DRAIN 1.1111111111 SHOWER STALL I—11 �i ! SERVICE/MOP SINK -----1 { , 11111. — �^�I TOILET I URINAL I ) ^-� WASHING MACHINE CONNECTION �'�- WATER HEATER ALL TYPES i_ I ' II I I_ WATER PIPING 1MINI IIIIII' OTHER Boiler feed and backflow Q i 1 a I I�^. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES I I NO I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY i BOND _] 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 1 I AGENT C 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 co iance with all Pe ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME(Peter J.Hassett I LICENSE# 11682 1 /4" SIGNATURE MPH H JP! j CORPORATION! I#13506 PARTNERSHIP #L J LC ii# COMPANY NAME Hassett Plumbing and Heating,Inc. 1 ADDRESS 8 Skipper Lane ____ -1 CITY Yarmouth Port 1 STATE� MA ] ZIP 02675 _ TEL 508-744-7555 FAX _ CELL 508-237-2175 EMAIL [peteryhassett©gmail.com I a �