HomeMy WebLinkAboutBLDP-18-000334 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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I/ CITY Yarmouth MA DATE 7/14/17 = PERMIT# �-//P 7?
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JOBSITE ADDRESS 94 Stratford Lane I OWNER'S NAME Robert Abair,,.
OWNER ADDRESS�_, _ v Same TEL 508-362-8808 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL [Q RESIDENTIAL
PRINT
CLEARLY NEW:® RENOVATION: REPLACEMENT:Q PLANS SUBMITTED: YES 0 NOD
FIXTURES 1 FLOOR—* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB �1—�........_. E- ,. E7711 , , INN
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM l I 11 !ll ][ 11 , 1 1l... 111 11 -
DEDICATED GAS101USAND SYSTEM {l,.__,.,.,.:,[. �_.� ..._,.... ..u_� ( . ...�._.,.4......
DEDICATED GREASE SYSTEM ( ! " . j
DEDICATED GRAY WATER SYSTEM (I .._ 111 I
DEDICATED WATER RECYCLE SYSTEM ,I 1
DISHWASHER I .. _.., f �- i'. ...
DRINKING FOUNTAIN 1 11 „ t i I
FOOD DISPOSER ... ✓..... ,.,.,._.. I I ., ( 1
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) I.._...._ .. f .,. .., L..... ..: ......... .' _ .....
KITCHEN SINK
LAVATORY 1 11 ..... I II
ROOF DRAIN
SHOWER STALL { KAIMC^ 11
SERVICE!MOP SINK
1.
TOILET I I I ..�(,. f(..-.. !I .._.. � ..,_. �{ ': ..,
URINAL i 11 t( I1.
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES I. '.I _ _ -111 4
WATER PIPING
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...1 'II , .;I(,.,,.,.. i . _dl ,..ill..
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
LIABIUTY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY 0 BOND
OWNER'S INSURANCE WAIVER:1 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 Y AGENT Ej
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 sgmplianc�al Pertinent provisi of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /t✓t* R
PLUMBER'S NAME Craig Bishop.e...... LICENSE# 15101 SIGNATURE
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MP ED JP:3 CORPORATION 0# (PARTNERSHIPD# LLC 0#,
COMPANY NAME High Efficiency r ADDRESS 378 Route 130
CITY Sandwich `STATE Ma I ZJP 02563 j TEL 508-825-3695
FAX . CELL ' EMAIL admin@hightfficiencyllc.com