HomeMy WebLinkAboutBLDP-23-8523 #25 ‘4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
_ CITY WEST YARMOUTH i MA DATE.5/18/2023 i PERMIT#BLDP' Z3 8'Sz ;
JOBSITE ADDRESS 503 ROUTE 28 UNIT 25 OWNER'S NAME=SUSAN MCLELLAN
OWNER ADDRESS__ __* TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL,_.i EDUCATIONAL z RESIDENTIAL
PRINT
CLEARLY NEW: = RENOVATION ,,_. REPLACEMENT:' ' PLANS SUBMITTED: YES NO;/I
FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE ' _ "{
DEDICATED SPECIAL WASTE SYSTEM , , '� ,! ' ," '
DEDICATED GAS/OIL/SAND SYSTEM ! ; _ I
DEDICATED GREASE SYSTEM , I
DEDICATED GRAY WATER SYSTEM I � q I
DEDICATED WATER RECYCLE SYSTEM , 1 ,("
DISHWASHER ; imil �...,.. =_g
DRINKING FOUNTAIN 1 - I.no, .,,,,, ; E . ` r ;1
FOOD DISPOSER r
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r- : , if 1- - i i al
FLOOR/AREA DRAIN i
INTERCEPTOR(INTERIOR) ; i—�i � �`I a� �s va
PI KITCHEN SINKIMMO 'Mil
LAVATORY _ = WWI or: Iit it i
ROOF DRAIN r — T ��_ME OM� r r
SHOWER STALL
SERVICE/MOP SINK I it ,� �
TOILET i __,
URINAL
WASHING MACHINE CONNECTION 1111111,11 M._ i . ;
WATER HEATER ALL TYPES
WATER PIPING
OTHER PLUMBING REPAIRS
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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 Fm.71 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 i
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 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 compliance with all rtinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Sean Hanrahan I LICENSE#° 15822 SIGNATURE
_..
. _ _ —
MP i JP CORPORATION= l# 1PARTNERSHIP' #_ LLC 1#.
COMPANY NAME Sean Hanrahan Plumbing and Heating I ADDRESS;PO BOX 688
CITY Centerville (STATE i MA I ZIP ,02632 TEL;774-238-0286
FAX .508 775 4615 CELL same 1 EMAIL i hanrahanplumbingea gmail.com I