HomeMy WebLinkAboutBLDP-18-000307 - Mattachese MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
=�""® CITY I�eS� y i ni t. MA DATE /ia/1 7 PERMIT#, P gc7
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JOBSITE ADDRESS `WO N /in5 6ro1, e I/ _I OWNER'S NAME ioLorN (X 1 YaFryi-, _
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL LI RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOn
FIXTURES 1 FLOOR—I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1, _
CROSS CONNECTION DEVICE I I 'i.
DEDICATED SPECIAL WASTE SYSTEM 1
DEDICATED GAS/OIL/SAND SYSTEM
._.—, .__. _ III ... __. _... ..._ _.__ _ - ___ -...d
DEDICATED GREASE SYSTEM ,
DEDICATED GRAY WATER SYSTEM '
DEDICATED WATER RECYCLE SYSTEM _ 1
DISHWASHER X j
DRINKING FOUNTAIN I f
FOOD DISPOSER
FLOOR/AREA DRAIN _
INTERCEPTOR(INTERIOR)
KITCHEN SINK j
LAVATORY
ROOF DRAIN
SHOWER STALL '�
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION OW,.
WATER HEATER ALL TYPES
WATER PIPING
OTHER Ter ever _ __ 1 ! I it
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 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 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 complianc ertin t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME James Pazakis LICENSE# 15030 SI NA —'----.
MP❑ JP❑ CORPORATIONQ# C-3982 PARTNERSHIPQ# LLC❑#
COMPANY NAME Hall Plumbing&Heating Inc. ADDRESS 447 Old Chatham Road
CITY South Dennis STATE MA J ZIP 02660 TEL 508-385-9127
FAX CELL EMAIL
Rootff( frL.JI? S — 77y - .2 /z- `7Zf
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No 1 �tG e C�"✓is%/o OW
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
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FEE: $ PERMIT# R I'% C
PLAN REVIEW NOTES /Z/7/01/24 C I 1