HomeMy WebLinkAboutBLDP-20-06265 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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=A� West Yarmouth � �I9
z CITY/TOWN MA DATE 6/12/2020 PERMIT#
JOBSITEADDRESS 61 Bayberry Road OWNER'S NAME Ripley
P OWNER ADDRESS _ TEL 508-430-0771 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL I
PRINT
CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO DK
FIXTURES 1- FLOOR—) 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
ROOF DRAIN
SHOWER STALL
' SERVICE 1 MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
• WATER HEATER ALL TYPES _
WATER PIPING -
OTHER
Rough only for 1st floor 1
bar sink
INSURANCE COVERAGE
I have a current Iiabillty insurance policy or Its substantial equivalent which meets the requirements of MGL•Ch,142 YES [/NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY IA' OTHER TYPE 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
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 ail plumbing work and Installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME Andrew Levesque LICENSE# PL15162
GNATUgg
MP IV MGF❑ JP❑ JGF El LPGI El CORPORATION❑# PARTNERSHIP❑# LLC E2i# 3944
COMPANY NAME Harwich Port Heating&Cooling LLC ADDRESS 461 Lower County Rd
CITY Harwich.Port STATE MA ZIP 02646 TEL 508-432-3959
FAX 508-432-6075 CELL 508-958-4874 EMAIL andy(7a,hphcllc.com kecia@hphcllc.com
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