HomeMy WebLinkAboutBLDP-18-002450 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
E u:NT ` CITY[South Yarmouth MA DATE 10/10/2017 PERMIT# i -0-/l-00 9.�i
JOBSITE ADDRESS 941 Main Street OWNER'S NAME Penguins Ice Cream Parlor&Bakery
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OWNER ADDRESS 941 Main Street TEL 5089446795 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL i;J EDUCATIONAL -1 RESIDENTIAL L
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES —I NO
FIXTURES Z FLOOR—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB _1 -_-._..__ss____._ n _
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM , '
...,,,--- l;-,,-- t , .._
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER 4_,_...- , .
—
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
HEM Dip Well_ _ _lj Ii _z
ii Li
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY i OTHER TYPE OF INDEMNITY U 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 acEu to to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli e . II Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME' Phillip Durfee_ u. . .__. LICENSE# 13774 SIGNATURE
MP Li JP Ei#L PARTNERSHIP # LLC�_.# 3152
COMPANY NAME Durfee Plumbing&Heating LLC ADDRESS 12 American Way Unit 1
CITY South Dennis STATE MA ] ZIP 102660 TEL 508 619 3078
FAX i 2 50 -- 58 8-0592 CELL�8-801-8004 EMAIL phil@durfeeplumbing._comsales@durfeeplumbing.com