HomeMy WebLinkAboutBLDP-19-005413 •
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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i CITY Yarmouth Port MA DATE 3/19/19 PERMIT#/', ./2P/?--0° C 45
JOBSITE ADDRESS 148 Kate's Path OWNER'S NAME Barbara Wingardner
POWNER ADDRESS SAME TEL 774-330-3920 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Q
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOD
FIXTURES 7 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I 4
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM i 1 , a 1
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM 1 I r
DEDICATED GRAY WATER SYSTEM I 1 I I 1 ;. I 1 i
WAT
ER TER RECYCLE SYSTEM 1
DISHWASHER 111 111111111
NCO
I
DRINKING FOUNTAIN ;,
FOOD DISPOSER � � iFLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)KITCHEN SINK
LAVATORYi
ROOF DRAINSHOWER STALL 1 ,, i� 1 - I I, 1
SERVICE/MOP SINKTOILET URINALWASHING MACHINE CONNECTION 1 IWATER HEATER ALL TYPES 1WATER PIPINGOTHER 1 1 1 1 1
1111111111111111111111111111111111111111111111111111
1 II 1 ; 1 I i 1
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY ❑ 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 ❑ 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 tru a o e best of y knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co n ith II ertinent pr sion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. —.
PLUMBER'S NAME Keith J.Famham LICENSE# 11601 SIGNATURE
MP❑ JP❑ CORPORATION0# 3698C PARTNERSHIP❑# LLC❑#
COMPANY NAME South Shore Heating&Cooling ADDRESS 57 Whites Path
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-398-6901
FAX 508-760-2681 CELL EMAIL IMO °' aA115 egP `1Q.ari 001i r GDry,
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