HomeMy WebLinkAboutBLDP-19-006078 .0'` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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.w� CITY Yarmouth Port MA DATE 4/25/2019 - PERMIT#l.//-it/
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JOBSITE ADDRESS 195 MA-6A OWNER'S NAME[Jesse Hagopian
POWNER ADDRESS 95 MA-6A TEL 7749943741 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 1 EDUCATIONAL '�J RESIDENTIAL.
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CLEARLY NEW: RENOVATION: REPLACEMENT: i PLANS SUBMITTED: YES .I NO
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/OIL/SAND 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
SHOWER STALL .--_-11—
:_,,.
SERVICE/MOP SINK —
TOILET 1 —
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING f
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 APR 26
21,
LIABILITY INSURANCE POLICY i OTHER TYPE OF INDEMNITY BOND ///) 0 7P(y)
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter142 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 a u ?o the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. --."--�
PLUMBER'S NAME 1 Phillip Durfee^ LICENSE# ` 13774 .1 G SIGNATURE
MP v JP 1 CORPORATION # PARTNERSHIP # LLC # 3152-
COMPANY NAME Durfee Plumbing&Heating LLC I ADDRESS 12 American Way Unit 1 I
CITY South Dennis STATE MA ZIP ' 02660 TEL 508-619-3078
FAX 508-258-0592 CELL 508-801-8004 EMAIL phil@durfeeplumbing.com;sales@durfeeplumbing.com
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