HomeMy WebLinkAboutBLDP-19-003100 __ • SO#135151 $50
: , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 11/12/18 PERMIT# 1./n1).-1`l"CX.W0-0
JOBSITE ADDRESS I 2 RED JACKET RD OWNER'S NAME SCOTT ROBBINS„
POWNER ADDRESS PO BOX 134 YARMOUTHPORT MA 02675 TEL 508-737-1135 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 7 EDUCATIONAL RESIDENTIAL 71
PRINT _
CLEARLY NEW: RENOVATION: REPLACEMENT:E PLANS SUBMITTED: YES NO--
FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB , `': I 4:
CROSS CONNECTION DEVICE i.
DEDICATED SPECIAL WASTE SYSTEM i 1 I I
DEDICATED GAS/OIL/SAND SYSTEM !, minummi 1 I ... .,` .: 1 -���!
DEDICATED GREASE SYSTEM I I ; I
DEDICATED GRAY WATER SYSTEM I ! '
I op
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DEDICATED WATER RECYCLE SYSTEM , IMMIlial I Ala II I
DISHWASHER
s
F___maimr.___7 "onion ,, ,
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN 21111.1mIll I . al
INTERCEPTOR(INTERIOR)
KITCHEN SINK [
LAVATORY q € 'i I.
ROOF DRAIN `
SHOWER STALL :� L -i ); [
SERVICE I MOP SINK
TOILET
URINAL I I
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1 ' a : .
, , ,
WATER PIPING f
OTHER ,
f
1 I; I II i 1
II 1 , I , i '
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Ej NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 1 OTHER TYPE OF INDEMNITY C BOND El
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.
CH'ECK NE ONLY: OWNER I_ I AGENT E
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this app. atioh are true :nd accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application II be in co pia c-with all Pertinent prove ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Richard J.Whiteside At iA' i , \
LICENSE# 15850 SIGNATURE
MPH JP XJ CORPORATION El#1_3969 PARTNERSPIIPLJ# JLLCEl# I
COMPANY NAME Murphy Services Inc ADDRESS 34 Whites Path I
CITY{South Yarmouth STATE MA >> ZIP 02664 TEL 1508-760-1660
FAX {508-760-1670 CELL I I EMAIL cshea@callmurphys.com // klaube@callmurphys.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES