HomeMy WebLinkAboutBLDP-20-000973 MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK
-' CITY r P MA DATE / PERMIT#,G ol'D �OPiOj7'5
JO ITE ADDRESS J , OWNER'S NAME tT/ a
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TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑
PRINT
CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMI I I ED: YES NO❑
FIXTURES T FLOOR—F EGO 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE _
_______.1DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM _
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER _
FLOOR I AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK /
I LAVATORYc.P -
ROOF DRAIN
SHOWER STALL _
SERVICE/MOP SINK '‘
TOILET
URINAL R E C I E
WASHING MACHINE CONNECTION r
WATER HEATER ALL TYPES / `,
WATER PIPING /
OTHER
BnTL_ iNVU 13EPA 'TMENT
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO ❑
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I IF YOU CHECKED YES,PLEASE INDICATE THE E 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.
y CHECK ONE ONLY: OWNER ❑ AG A4T ❑
SIGNATURE OF OWNER OR AGENT
k I hereby certify that all of the details and information I have submitted or entered regarding this applica on are rue an accurate to the :-, o y knowledge
and that all plumbing work and installations performed under the permit issued for this application will se in co, plia with all Perti p ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `o
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August 15, 2019
Town of Yarmouth
Building Department
1 146 Route 28
South Yarmouth, MA 02664
To whom it May Concern;
63 i' '-
The Robert B Our Co., Inc. would like to authorize the transfer of
our plumbing permit for- White' Path South Yarmouth, MA 02664
from being in the name of DNL Plumbing and Mechanical LLC to John
Gough, RBO Plumbing and Electrical LLC.
Please do not hesitate to contact me should you have any questions
at 508-509-4051 .
Best Regards,
Robert B Our III
Co-Owner
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24 Great Western Road,P.O.Box 1539,Harwich,MA 02645 Tel:508-432-0530 Fax:508-432-7057 Web:robertbour.com