HomeMy WebLinkAboutBLDP-18-002087 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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� -F= - CITY MA DATE PERMIT# %% f j'
JOBSITE ADDRESS 8 WINCHESTER COURT OWNER'S NAME PAUL DEMARCO
OWNER ADDRESS 361 HUDSON ROAD, SUDBURY, MA TEL 508 294 6284 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El
PRINT
CLEARLY NEW:❑ RENOVATION:• REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO E
FIXTURES Z 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 �1
DRINKING FOUNTAIN P^ q�►
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) _
KITCHEN SINK _ _
LAVATORY 2
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK
TOILET 1 eiCiFL 3 Or
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El 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 with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME DOUG LANGTRY LICENSE# 11305 SIGNATURE
MP 0 JP❑ CORPORATION E# PARTNERSHIP❑# LLC❑■ # 3081
COMPANY NAME AQUA SERVICES PLUMBING & HEATING ADDRESS 1268 ROUTE 28
CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 774-470-1350
FAX 774-470-1350 CELL EMAIL DOUG-AQUA@COMCAST.NET
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R UGH PL MBING SPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
�/ ,e/ 1 Yes No
`* / /7 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
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