HomeMy WebLinkAboutBLDP-20-001702 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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CITY SOUTH YARMOUTH_ MA DATE 9/11/19 ' PERMIT# / 07P' �/7�
JOBSITE ADDRESS 16 APRIL WAY OWNER'S NAME CHARLOT
POWNER ADDRESS 16 APRIL WAY TEL 508 367 2797 ,FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL 0 RESIDENTIAL LJ
PRINT
CLEARLY NEW: RENOVATION:Q REPLACEMENT: PLANS SUBMITTED: YES❑ NOLI
FIXTURES Z FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB [ I ..: ,_ I —'''
CROSS CONNECTION DEVICE 1
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OWSAND SYSTEM _ irV r.
DEDICATED GREASE SYSTEM _ __ _ C -
DEDICATED GRAY WATER SYSTEMer, � ,_ _I n
DEDICATED WATER RECYCLE SYSTEM , 1, I� '-
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DISHWASHER r ... ��. ._ .
DRINKING FOUNTAIN i ... 1 ,... I r
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) , _1
.._ r
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KITCHEN SINK _.
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LAVATORY ;1
ROOF DRAIN �,
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL -`' _ I ,
, _
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING ... l ... � 1 I_
OTHER
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO LI
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Li OTHER TYPE OF INDEMNITY 0 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 ONL OWNER Q AGENT LI
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 to to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in liance ' ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME MARK MORAN LICENSE# 20786 SIGNAT
MPO JP CORPORATION 0# PARTNERSHIPQ# LLCD#
COMPANY NAME MORAN PLUMBING&HEATING ADDRESS 16 BRAMBLEBUSH DRIVE
CITY FORESTDALE STATE MA ZIP 02644 TEL 508-648-2934 _
FAX CELL 508-648-2934 EMAIL MORANPANDH@GMAIL.COM 0 Lao __& L.,'
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
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PLAN REVIEW NOTES Ok .14f1