HomeMy WebLinkAboutBLDP-18-000046 Imo" MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
,f1 CITY Yarmouth MA DATE 6/29/17 PERMIT#/P/K-Cwt0
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JOBSITE ADDRESS 45 Rune Stone Road OWNER'S NAME Calarese
OWNER ADDRESS do York Construction y TELF74-200-1889 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL D RESIDENTIAL El
PRINT
CLEARLY NEW: ' RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NOD
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
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 1
ROOF DRAIN 'I" trsrl
SHOWER STALL
SERVICE/MOP SINK
TOILET 1 C - '' — `. ! 5
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER
L
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO
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
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 compliance Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Stephen D.Ewing LICENSE# 15281 C--� SIGNATURE
MP JP CORPORATION Ld#13672_ PARTNERSHIP0# LLC r
COMPANY NAME Edgewater Plumbing&Heating I ADDRESS I P.O.Box 656
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CITY Sagamore 1 STATE MA I ZIP 02561 , TEL 508-317-9680
FAX CELL 508-737-0077 EMAIL steve@edgewaterplumbinginc.com 1