HomeMy WebLinkAboutBLDP-16-000613 11
MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK
CITY '1 f
— MA DATE 434I57 PERMIT# /�, / —cce?cf�
JOBSITE ADDRESS ac1-1,4s . i`eJ OWNER'S NAME a4
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL a/
PRINT
CLEARLY NEW:❑ RENOVATION: ® REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES 1. 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
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
OTHEr ///o, te -.76,130
// INSURANCE COVERAGE:
I have a cur ity insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES(� NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 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 El 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 t-sivk LICENSE# 30 Dt( SIGNATURE
MP❑ JP E CORPORATION ❑# PARTNERSHIP❑# LLC El#
COMPANY NAME \c-"O etk34-1‘ ADDRESS P C3' l` "5—
CITY STATE r14 ZIP 02.-(4' 9 TEL 77Y-2-12"2z86
FAX CELL EMAIL
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
/ uo d,t -G2 ii ef''hik- Yes No •
f r THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES
_ I
4
Hall, Lee
From: James Lucid <lucidjames@yahoo.com>
Sent: Friday, July 29, 2016 9:40 AM
To: Hall, Lee
Subject: release of old plumber
To town of Yarmouth plumbing inspector's office and to Lee Hall.
July 29, 2016.
I,James E. Lucid reside at 9 beachwood road. I hereby release from contract, KMD Plumbing and Kevin Decoteau, license
30804 I refer to permit bldp 16-000613. And i now have hired Robert Wilson to continue plumbing in my bathroom.
Sincerely, James E. Lucid
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