HomeMy WebLinkAboutBLDP-16-005732 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
E="�1 CITY South Yarmouth 1 MA DATE 04/22/16 PERMIT# 1Lr,&— >57
JOBSITE ADDRESS 82 A River Street 1 APR 2 2 20 js
BUILD OWNER'S NAME John Woods
P OWNER ADDRESS 82 A River Street L___.. it. FAXL
TYPE OR OCCUPANCY TYPE COMMERCIALTI 7UCATIONAL RESIDENTIAL✓
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: ✓ PLANS SUBMITTED: YESf NO./
FIXTURES 7 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 1, 12 i 13 14
BATHTUB
,
CROSS CONNECTION DEVICE _
DEDICATED SPECIAL WASTE SYSTEM Ti
DEDICATED GAS/OIL/SAND SYSTEM4 :A
t
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM 1 ---- — I _ _,_ ;
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER j
DRINKING FOUNTAIN 1�
FOOD DISPOSER !
FLOOR/AREA DRAIN ..! — _
INTERCEPTOR(INTERIOR)
KITCHEN SINK 1 _ _
-!
LAVATORY �
ROOF DRAIN _ _, _:I . _�..__ ._:1.. ,
SHOWER STALL � 1
J4
SERVICE/MOP SINK j
TOILET -: _
._ . 1,_____,. ... _ 1
URINAL , --- �,.
�- �. . t _
WASHING MACHINE CONNECTION 1 ; .I- ..-_„„1,,_ 1
WATER HEATER ALL TYPES 1 1 I
WATER PIPING —Tx
OTHER F
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 a urate to the best of my 4 owled
and that all plumbing work and installations performed under the permit issued for this application will be in co • nce with all Pertinent pro e
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Virgilio Silva LICENSE# 31395-J TURE
MPC JP[/ CORPORATIONQ# PARTNERSHIP,# LLCF—#L
COMPANY NAME Silva Plumbing&Heating ADDRESS 155 Sudbury Lane
CITY Hyannis STATE MA ZIP 02601 TEL
FAX CELL 774-836-0176 EMAIL virgiliomga@hotmail.com