HomeMy WebLinkAboutBLDP-20-002311 ., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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,� - - CITY I YARMOUTH I MA DATE 110/23/2019 1 PERMIT#Bg/ai)-g0-0Pg /i
JOBSITE ADDRESS 3�RAY FARM RD SOUTH OWNER'S NAME PAUL SEVIGNY
OWNER ADDRESS L___ TELL � FAX I
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL RESIDENTIAL Li
PRINT
CLEARLY NEW: .I RENOVATION:Li REPLACEMENT:El PLANS SUBMITTED: YES NO j
FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB r" € fl _ ,_ w.....__ ,_.____
UMW
CROSS CONNECTION DEVICE 111.111.1111111111111111111111111111111111111111111011111111111.111M111.11111111111111111
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM11110111111111.10•Mant OM NMI amillaitailINNIIIIIIMIIIM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM 11111111111111111
DISHWASHER411111.111.111.111M011.111111111mmilimilitliiiMigillaiii
DRINKING FOUNTAIN
FOOD DISPOSER N IMP MIN UMW MiliiiiiiMMIONMINIIIIIIMOMIIIII
FLOOR/AREA DRAIN111 M
INTERCEPTOR 11111111.1111.11111.11110MONIMNION.0111111111.10.01101
,10.0
KITCHEN SINK IlailailirnitiNINIONIMINIONIONIMMINIIIIIIIIMIIMIS
LAVATORY � � �=
ROOF DRAIN �_ _ ,. � �
SHOWER STALL l mmt
SERVICE/MOP SINK11111M1111111
TOILET
URINALll 111111M41.11.11.11MMIIMINI
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES MIIIIHNI .11111111111111
WATER PIPING
OTHER =SILLCOCK �� winmillnini
MINIMININIMMIIIIIIIIII.11111111/1111111111111110111M1111111111111111,11.1111111111111*111,
IMMIIIIINMMINIMNMIIIIIIIIIIIIIIIIIIIIIIINIIIMMINIIIIIIIIIIIIIIIIIIIIIWIIIIIIIMIIIIIIIIIIIIIIIIIIIIIINI
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY j OTHER TYPE OF INDEMNITY Li BOND Li
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 1 A AGENT El
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 al Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Sean Hanrahan LICENSE#115822 ' SIGNATURE
MP! JP„ CORPORATION# PARTNERSHIP #L LLCj#
COMPANY NAME`Sean Hanrahan PlumbPlumbin and,Heating ADDRESS i PO BOX 688 ----.
CITY`Centerville j STATE 1 MA s ZIP 02632 TEL 774 238 028b
FAX 508 775.4615 I CELL same EMAIL hanrahanplumbingta mall.com i CT P) 2019
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BUILDING DEPARTMENT
,P#
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT Ei ci
FEE: $ PERMIT#
PLAN REVIEW NOTES