HomeMy WebLinkAboutBLDP-21-000098 , , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
WI-$., CITY'YARMOUTH 1 MA DATE 7/2/2020 `PERMIT# Plt/,)/ "1/-W
JOBSITE ADDRESS I 2 PLACID ST ,,, OWNER'S NAME MIKE AUCOIN,,,,,,,,,,,,,,,,,,,H� W,,,,a,,,,,,,,,,,,,,,,,,,,,,,,,,,,,�,,,H,,,,,,,,A�„� �,
OWNER ADDRESS TEL ,,, FAX I-
TYPE OR OCCUPANCY TYPE COMMERCIAL` ' EDUCATIONAL LA RESIDENTIAL „ „
PRINT
CLEARLY NEW: ,,,,,,, RENOVATION:laj REPLACEMENT: �,y PLANS SUBMITTED: YES NOI,J
FIXTURES 7 FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 1 11 1 12 13 14
BATHTUB 1
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM qr
DEDICATED GASIOILISAND SYSTEM j: ii
DEDICATED GREASE SYSTEM I I
DEDICATED GRAY WATER SYSTEM , ,,
DEDICATED WATER RECYCLE SYSTEM 4
DISHWASHER
ti a
DRINKING FOUNTAIN Y""""""""""""""""""""""� �'�
FOOD DISPOSER % l'�- • �"
- i as. ; ," .a
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 1
ROOF DRAIN
SHOWER STALL
SERVICE I MOP SINK `i
-r;
TOILET V .' 1
URINAL
WASHING MACHINE CONNECTION S
WATER HEATER ALL TYPES
WATER PIPING ,._....................... aO
OTHER
aOMPOW
7
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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 + NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ii OTHER TYPE OF INDEMNITY 1 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 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 Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME'Sean Hanrahan „LICENSE#115822 1��—�`SIGNATURE
MP .., API1 CORPORATION Lj#1 PARTNERSHIP # 1 LLC 1,;j11#1 ._..,.,,..,._.._.........._._..,..,,.I
COMPANY NAME ,�..,,,,,.._,........_._._...,, _,_... ,
Sean Hanrahan Plumbinc and Heatin j ADDRESS PO BOX 688 J
CITY!Centerville STATE MA ZIP ?02632 y TEL` /� //iN, ,„„,,„.,„ ,,,,,,,,, ,,,,,„„„„,„„, ,,, 1774-238-0286 1
FAX 508-775 4615 W, CELL;same ,,,,,,, ,,,,, EMAIL 1 hanrahanlumbina�mail.com,,,,,,,,, ,,,,, ,,,,, ,uu,,,,,,,, ,,,,, „� ,,,,, W,,,,, ,,,, ,,, ,,,u ,,,,,, ,, ,,,,, ,,, ,H,,
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