HomeMy WebLinkAboutBLDP-17-000945 - ,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
- � ,—e
- CITY(
a-, Yarmouth MA DATE 8/15/2016 PERMIT#A-,O-/`7'e'O 7 `
JOBSITE ADDRESS 117 Pawkannawkut Dr OWNER'S NAME,John Aubin
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OWNER ADDRESS 213 Run Hikk Rd,Brewster TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL'TJ
PRINT
CLEARLY NEW: RENOVATION:_7'„ REPLACEMENT:C PLANS SUBMITTED: YES 1j NOE
FIXTURES Z FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB ::- A i I I Il ! u El
CROSS CONNECTION DEVICE 11 3 j P I
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM -'� J A. , — 4
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DEDICATED GRAY WATER SYSTEM f ,, �. ,
DEDICATED WATER RECYCLE SYSTEM L
DISHWASHER t
DRINKING FOUNTAIN f
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FOOD DISPOSER
FLOOR I AREA DRAIN r�
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INTERCEPTOR(INTERIOR) I I
KITCHEN SINK , 1 d— j j -, 1
LAVATORY a ..r_„ i
ROOF DRAIN
SHOWER STALL 1, 'IL
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SERVICE/MOP SINK E
TOILET 2 F -- ,
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URINAL r # '
WASHING MACHINE CONNECTION r 1 -�r I'! .�. 9
WATER HEATER ALL TYPES T. 1
WATER PIPING 1
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OTHER _ .
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES v NO i
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY i 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 applicat are true and acc e to the b of my knowledge
and that all plumbing work and installations performed under the permit issued for this application wil compliance all ertinent rovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME David DuVerger LICENSE#�18252 / as UR
MP JP L CORPORATION 0#— (PARTNERSHIP f#r LLC # _v_
COMPANY NAME David DuVerger 1 ADDRESS( 26 Dove Ln
CITY West Yarmouth STATE ' ma ZIP 02673 TEL I E AUG 15
2015
FAX I I CELL 15089442027 —I EMAIL ._