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HomeMy WebLinkAboutBLDP-19-002750 J13113 $50.00 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 10/29/18 PERMIT# //(//)/,� .--6 ,?k �' 5 JOBSITE ADDRESS 23 BANISTER LANE ' OWNER'S NAME COLLEEN COURTNEY POWNER ADDRESS 30 CLIFF RD MELROSE MA 02176 TEL 781-307-2751 FAX; TYPE OR OCCUPANCY TYPE COMMERCIAL Ell EDUCATIONAL —I RESIDENTIAL CD PRINT _ CLEARLY NEW:n RENOVATION:0 REPLACEMENT:—)1 PLANS SUBMITTED: YES E NOS, FIXTURES Z FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I I. ° I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM ( s 1 DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM F DEDICATED GRAY WATER SYSTEM l , I i €- 1 . . . ,1 I[ DEDICATED WATER RECYCLE SYSTEM i j, 1 i I DISHWASHER E_ [ DRINKING FOUNTAIN i _ ( FOOD DISPOSER I ) FLOOR/AREA DRAIN r ii INTERCEPTOR(INTERIOR) I i f. I KITCHEN SINK H . I - LAVATORY I ROOF DRAIN ' i .e .. SHOWER STALL 1 li ., <1 1 (. I ( 1( , SERVICE/MOP SINK H e ( j i s , 1 TOILET F I, I I URINAL 1 1 ...- . ,E - WASHING MACHINE CONNECTION t € ( 1.,,_ $ _ II WATER HEATER ALL TYPES IL WATER PIPING 1 '1 ._fl.... I _.. . .I a .,..... (' II OTHER 1 :I. I 1 I 1 € it .. iI {I l i ' I I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY II OTHER TYPE OF INDEMNITY BOND (,II 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. CHE ONE ONLY: OWNER AGENT El SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applica'. : +rue ar`1d aCcura .the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will .- . .' • nce with all - .t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME[Richard J.Whiteside N� �LICENSE# �15850 SIGNATURE MPEI JPEI CORPORATION# 3969 PARTNERS •1- i# LLCLJ#I COMPANY NAME Murphy Services Inc ADDRESS 34 Whites Path CITY South Yarmouth STATE MA ZIP 02664 TEL 508-760-1660 FAX 508-760-1670 CELL 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