HomeMy WebLinkAboutBLDP-16-006866 _ l
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
of® 4 CITY,YARMOUTH MA DATE 6/9/16 PERMIT# 132_OP �,-00 ��-64
Tt JOBSITE ADDRESS (54 CEDAR STREET OWNER'S NAMEi CHERYL KIDNEY
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OWNER ADDRESS SAME TEL FAX I
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL El
PRINT
CLEARLY NEW: _ RENOVATION:11 REPLACEMENT: i PLANS SUBMITTED: YESI-1 N0[1
FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
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CROSS CONNECTION DEVICE '
DEDICATED SPECIAL WASTE SYSTEM - --
DEDICATED GAS/OIL/SAND SYSTEM I-
DEDICATED GREASE SYSTEM �
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DEDICATED GRAY WATER SYSTEM it j- 1--- iI
r)FnlrATFr)WATFR RFCYCI F SYSIF�d .. �1t �'r—_lam _J r It._. 1 i�_..: .
DISHWASHER _— `
DRINKING FOUNTAIN 'r ;I I`a i MIR
FOOD DISPOSER r---.--- -_ �.. _ -_
FLOOR/AREA DRAIN ii
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INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY i 1 `-VV .
ROOF DRAIN 1 _I�... ,.. '..
SHOWER STALL i _....-
SERVICE/MOP SINK
TOILET —__ 1
URINAL 1 rl
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WASHING MACHINE CONNECTION 17 —11 i
WATER HEATER ALL TYPES
-
WATER PIPING 1
OTHER
I 11
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES/ NO `_E,
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 L AGENT U 1
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this applicati' • 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 .�f co .fiance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. a AO
N T 10 ,,
PLUMBER'S NAME rRichard J.Whiteside w.. _ LICENSE# 15850 SIGNATURE
MP JP❑ CORPORATION! 'I# 3969 PARTNERSHIPI 1# LLC`._ 1#
COMPANY NAME Murphy Services Inc ---I
ADDRESS 34 Whites Path j
CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660 ,
FAX 508-760-1670 CELL EMAIL cshea@callmurph s.corn // ekarukas@callmurphys.com I
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