HomeMy WebLinkAboutBLDP-19-000296 V
MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK
r! GI- 1 MA DATE 7l I U l Lj PERMIT# ,'0/"-1? (i+l
-�_°�a_I_� CITY 141���M(�1�01 1� B
JOBSITE ADDRESS 1/ei ryiG(d` fi'vu ; OWNER'S NAME / l ' 10 d4 f I'icr- I
POWNER ADDRESS TEL 3b5•S62.- 3S7 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ® RESIDENTIAL Er-
PRINT
CLEARLY NEW:® RENOVATION:® REPLACEMENT:Lj PLANS SUBMITTED: YES ID NO Lii
FIXTURES 1 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB .� B .x, Mat 1111111MMUMILIM
CROSS CONNECTION DEVICE I 1 ._ _NM ME MEM MiliEllw Mt
DEDICATED SPECIAL WASTE SYSTEM OM s1 tI 1I ;1wW 1t mousecoomplM
DEDICATED GAS/OIUSAND SYSTEM n I rillIMIIIIII .DEDICATEDGRAYWATERSYSTEM RNRRI RRRRRR
DEDICATED WATER RECYCLE SYSTEM , r I_____, _ - -_. .. � I I • ,.I_ _ I
DISHWASHER S
DRINKING FOUNTAIN I . i I..irlia
FOOD DISPOSER N.MK W. W.
FLOOR 1 AREA DRAIN (.�..,.. e I;
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INTERCEPTOR(INTERIOR) �, u
E .En
KITCHEN SINK _ M. :11111111M MN 111011 NMI: Mi s
LAVATORY ,..,n ,
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ROOF DRAIN
SHOWER STALL `M'Imo i 'I>-..I
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SERVICE 1 MOP SINK .., a, _ W IMOMMINII li . .-Jim M.W m"
TOILET : . _.._ .. ' t
URINAL l._.. .II
WASHING MACHINE CONNECTION I t'WATER HEATER ALL TYPES 1
OTHER I —ill—' . ..
WATER PIPING
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ma MS 11111 NW 111•11110 iiiiim.un.=NNE ummilm'_ , !.. _
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESJ NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ® BOND LI
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 0
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and infonnation I have submitted or entered regarding this application are true and accurate to t.- • t of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian�h all P- t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R PETER CHECKOWAY LICENSE# 13417 /�iC�DFfiTURE
MP 0 JP® CORPORATION(# 4008 PARTNERSHIP # LLC®#
COMPANY NAME BOURQUE HEATING&COOLING CO ADDRESS 1199 PITCHERS WAY
CITY HYANNIS STATE MA ! ZIP 02631 TEL 508-790-2887 I
FAX 508-771-9696 I CELL 508-735-9993 EMAIL info@bourgeheatingandcooling.com
L/R
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
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