HomeMy WebLinkAboutBLDP-18-002386 I— MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
•-,-41 CITY'Yarmouth I MA DATE 110/23/2017 I PERMIT#
JOBSITE ADDRESS 17 Trowbridge Path I OWNER'S NAMEIDominic&Wendy Mengella
POWNER ADDRESS j TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL[J EDUCATIONAL 0 RESIDENTIAL 0
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CLEARLY NEW:sj RENOVATION REPLACEMENT: PLANS SUBMITTED: YES' ' NOE1
FIXTURES 7 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN _.,..
FOOD DISPOSER �M-
FLOOR/AREA DRAIN _.._.
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1 a
WATER PIPING
OTHER Boiler backflow device 1
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO D
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 AGENT I,
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are tnd a •-- • my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in co. ce � '• /•'vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. //
PLUMBER'S NAME Peter J.Hassett LICENSE# 11682 SIGNATURE
MP JP❑ CORPORATIONL I# 3506 PARTNERSHIPD# LLC®# I
COMPANY NAME Hassett Plumbing and Heating,Inc. - ADDRESS 8 Skipper Lane
CITY Yarmouth Port STATE MA ZIP 102675 —1 TEL 508-744-7555
FAX CELL 508-237-2175 EMAIL hassett357m@msn.com