HomeMy WebLinkAboutBLDP-17-005068 t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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. - ;4 CITY South Yarmouth MA DATE 03/29/2016 PERMIT#�-,0P-/7—C'C�5
JOBSITE ADDRESS 33 Quartermaster Row OWNER'S NAME Jason Healy ,
POWNER ADDRESS 33 Quartermaster Row _ TEL 5082163869 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL C--i RESIDENTIAL
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CLEARLY NEW:L RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES'-1 NOzj
FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
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BATHTUB
CROSS CONNECTION DEVICE . 1
DEDICATED SPECIAL WASTE SYSTEM I .
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM ,
DEDICATED WATER RECYCLE SYSTEM ` (
DISHWASHER .: i ,
DRINKING FOUNTAIN _
FOOD DISPOSER ,
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL ,
SERVICE/MOP SINK
TOILET _
URINAL
WASHING MACHINE CONNECTION r
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WATER HEATER ALL TYPES 1
WATER PIPING , _=.
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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 i NO
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 application are nd accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be i o ance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Phillip Durfee LICENSE# i 1 74 , SIGNATURE
MP i JP _.1 CORPORATION7 1# PARTNERSHIP # LLC i # 3152
COMPANY NAME Durfee Plumbing&Heating LLC ,ADDRESS 2A Huntington Ave. I
CITY I South Yarmouth _,i STATE L4_ MA J ZIP 1 02664 TEL 05 8 619 3078
FAX 508-258-0592 CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;joy@durfeeplumbing.com^
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