HomeMy WebLinkAboutBLDP-20-001635 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
m >1I=@ CITY Yarmouth MA DATE 9/24/2019 _�PERMIT#,1')P—glJ /&,73--
JOBSITE ADDRESS 82 Center Street Yarmouth Port OWNER'S NAME1 Laura Moruzzi
pOWNER ADDRESS r TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT _
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES ' NO
FIXTURES 1 FLOOR-0 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/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 1 _
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 1
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER ALL TYPES
WATER PIPING 1
OTHER
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 corn fiance all rtipent rovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Peter J. Hassett LICENSE# 11682 SIGNATURE
MP j JP CORPORATION T'#3506 PARTNERSHIP L # LLC`—'#!
COMPANY NAME Hassett Plumbing and Heating, Inc. I ADDRESS 8 Skipper Lane
CITY Yarmouth Port STATE MA-1 ZIP 102675 J TEL 508-744-7555
FAX C 508-237-2175 MAIL peterjhassett@gmail.com
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