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HomeMy WebLinkAboutBLDP-19-000103 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY Ikrmo,rtn d �,j— MA DATE -7-5 PERIv1IT#64/9tf—40,4d_ JOBSITE ADDRESS 3S ���'1t' (0,4 OWNERS NAME De //ey(/7f POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: V REPLACEMENT:❑ PLANS SUBMI I I ED: YES ❑ NO❑ FIXTURES 7 FLOOR—+ BSIv1 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE _ DEDICATED SPECIAL WASTE SYSTEM — DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM _ DEDICA I EU WATER RECYCLE SYSTEM _ DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY Z-. • ROOF DRAIN SHOWER STALL • l . SERVICE I MOP SINK TOILET ( URINAL A WASHING MACHINE CONNECTION • 1 WATER HEATER ALL TYPES WATER PIPING OTHER rr INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[JNO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND 0 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 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 corn ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME N,r. t,.It4:1‹. LICENSE# / o S SIGNATUR MP IV./ JP ❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME � 1 I� f r[ ADDRESS P eU)( 2/Fs- -CITY I w C L STATE /'v ` ZIP Q? TEL, TEL .3(-, 2`7 �•3 2 5" FAX CELL EMAIL tte14,k (C /1,a.' /� i W H EfD 0 H U co o� }❑ o u_r 0 a o U z w 4 ~ O ¢ w 0 > 4 w z p U o_ a. Q � U7 2 W u_ H at Hall, Lee From: Joseph Heavey <jfheavey@gmail.com> Sent: Thursday, November 1, 2018 6:33 PM To: Hall, Lee Subject: Change of Plumber Mr. Hall, I am Joseph F. Heavev 35 Route 6A Yarmouth Port, MA 02675 Ryan White has the permit to do the plumbing for a bathroom renovation for me through a contract with Dublin Construction. He has a conflict with the GC, Rob Dunphy, Dublin Construction; work is not being completed. I wish to change the Plumber on this job to Peter Hassett. Regards, Joseph F. Heavey jfheavey©gmail.corn 914-489-2983 35 Route 6A Yarmouth Port, MA 02675 i