HomeMy WebLinkAboutBLDP-20-002840 IL, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
=.eitim CITY Yarmouth MA DATE 11/14/19 PERMIT# 0/"0-00 VO
JOBSITE ADDRESS 31 West Woods Circle OWNER'S NAME Peggy Bratz
POWNER ADDRESS Same TEL FAX I j
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL:.P IP I
PRINT
CLEARLY NEW: RENOVATION:', REPLACEMENT: PLANS SUBMITTED: YES fl NOH
FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 ! 10 11 12 13 14
BATHTUB III___-_-
CROSSDICTEDCO SPECIONAL DEVICEESYSTEMMI @�@@@
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM III
.
DEDICATED GRAY WATER SYSTEM IMII r
DEDICATED WATER RECYCLE SYSTEM —__IIIIII____-___M_
DISHWASHER IIIIII__Mill________MIN
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DRINKING FOUNTAIN I_INIIIIIII--_-_--_ 1111111
FOOD DISPOSER —1111111111-_--____NM
FLOOR/AREA DRAIN __MIMI •=@=@@
INTERCEPTOR(INTERIOR) M-IIIIIIIIII____
KITCHEN SINK Mil_M1 __________
LAVATORY I�_____________
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK _
TOILET
URINAL
WASHING MACHINE CONNECTION imiNil IMMO
WATER HEATER ALL TYPES MEI_____ AN___� /�_
WATER PIPING 1111 �_®��MilIB NIMI_'�!i
OTHER MI 111111--
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 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 compliance with all Pertinent prevision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .„ ....
PLUMBER'S NAME Richard Farrenkopf LICENSE# 33051 SIGNATURE
MP JP CORPORATION # PARTNERSHIP❑# LLCLJ#
COMPANY NAME R Farrenkopf III P+H ADDRESS 41 Riverdale South
CITY South Dennis
STATE MA ZIP 02660 TEL 5083603175
FAX CELL EMAIL richardfarrenkopf@yahoo.com