HomeMy WebLinkAboutBLDP-20-000094 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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;i� = CITY Yarmouth —1 MA DATE 7/2/2019 I PERMIT# 64✓P'�-WOO 6N
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JOBSITE ADDRESS 32 Mayflower Terrace —1 OWNER'S NAME Susan Buckley '
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OWNER ADDRESS TEL 617-347-3707 IFAX I
TYPE OR OCCUPANCY TYPE COMMERCIAL( EDUCATIONAL 0 RESIDENTIAL 0
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CLEARLY NEW: Li RENOVATION:Li REPLACEMENT:Ri PLANS SUBMITTED: YES❑ NOQ
FIXTURES-1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB f --.. _I
CROSS CONNECTION DEVICE IL 'r
DEDICATED SPECIAL WASTE SYSTEM ;, .,i IL___
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM ir m _ -1- irk- W
DISHWASHER 1—
DRINKING FOUNTAIN 1,7-_.
FOOD DISPOSER
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FLOOR/AREA DRAIN II
INTERCEPTOR(INTERIOR) j �( lL.
KITCHEN SINK r-
LAVATORY 1
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK ; _
TOILET
URINAL _
WASHING MACHINE CONNECTION I 11 —?1 In—
WATER HEATER ALL TYPES
WATER PIPING _ it
Tub/Shower Valve ---
OTHER i 1 ;; t -y
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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 Q NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 71 OTHER TYPE OF INDEMNITY L j 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 0 • OWNER 0 AGENT L
SIGNATURE OF OWNER OR AGENT ,
I hereby certify that all of the details and information I have submitted or entered regarding this application are tr - and a .to o e best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co plian !� II 7 e nent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Of,
PLUMBER'S NAME Paul Owen (LICENSE# 11061 I ' SIGNATURE
MP U JP❑ CORPORATION 0#4156 (PARTNERSHIP❑# LLC❑#
COMPANY NAME BathFitter Bridgewater Inc ADDRESS 25 Turnpike St I
CITY W.Bridgewater STATE Ma ZIP 02379 TEL 508-521-2700
FAX 508-588-4303 CELL 781-361-5072 I EMAIL powen@bathfitter.com I
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /
FEE: $ PERMIT# /Ail/
PLAN REVIEW NOTES