HomeMy WebLinkAboutBLDP-20-000269 � �- 66
- . -yam MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFQFdrPLUMBING WORK
4, CITY /A rx 7< /j ! MA DATE 7//j—//7 PERMIT#/�0P Or' 46?
JOB SITE ADDRESS•2 6.3 (4/h,r.Ps Qa.-1 h OWNER'S NAME Pc-herr/J wr, cl
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OWNER ADDRESS d�l le(p e wo c T-c., R TEL,S0.rk— t/2-2O S FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL E
PRINT
CLEARLY NEW: ❑ RENOVATION: REPLACEMENT:❑ PLANS SUBMITTED: YES E NO❑
FIXTURES 7 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED 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 N 3'N l b tld 3 7 O N I ] 11118
INTERCEPTOR(INTERIOR) I
KITCHEN SINK / I �QZ q i 1Il1 I
I LAVATORY 02 -
ROOF DRAIN
SHOWER STALL U 3 Ai 3 3 -
SERVICE/MOP SINK I s
TOILET
WASHING MACHINE CONNECTION E,1 V E
WATER HEATER ALL TYPES
WATER PIPING / 1 " �,
OTHER (
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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. Y7 NO ❑
1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICC 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 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 applicati i compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME LICENSE# /3?/1- . SIGNATURE
MP� JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑#
COMPANYNAMEA,L ALvst),,,.) 6- /1 'clin,-(cite- /i( ADDRESS 5-0 /4VGti 5 ---
CITY 1-AVAil-c•- STATE 114 A-1- ZIP 0 a _7 G TEL Sofia(,,- y.-J 6
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HARWICH MA
August 15, 2019
Town of Yarmouth
Building Department
1 146 Route 28
South Yarmouth, MA 02664
To whom it May Concern;
The Robert B Our Co., Inc. would like to authorize the transfer of
our plumbing permit for 363 White's 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,
• CIAA-
John D. Our
Vice President
24 Great Western Road,P.O.Box 1539,Harwich,MA 02645 Tel:508-432-0530 Fax:508-432-7057 Web:robertbour.com