HomeMy WebLinkAboutBLDP-16-005739 $60 '1
Caie 312225 SRO S000931126
`,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
' CITY i South Yarmouth1 MA DATE 2/11/2016 i PERMIT# PP"14"--00
JOBSITE ADDRESS 1084 Rt.28 OWNER'S NAME Department of Transportation
OWNER ADDRESS TELL T FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL RESIDENTIAL 0
PRINT
CLEARLY NEW:LI RENOVATION:. ? REPLACEMENT:`--J PLANS SUBMITTED: YES 0 NOE
FIXTURES 1 FLOOR BSt" t 2 3 4 5 o i 8 t Ott 12 13 14
BATHTUB I • t
CROSS CONNECTION DEVICE t
DEDICATED SPECIAL WASTE SYSTEM i 6I r I _,
DEDICATED GAS/OIL/SAND SYSTEM e 1
• DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM ,i ,, �
E
DEDICATED WATER RECYCLE SYSTEM t,,;••_-
,
DISHWASHER
DRINKING FOUNTAIN I�� R
FOOD DISPOSER _ --` ..�. -_i I'l
FLOOR 1 AREA DRAIN ',
INTERCEPTOR(INTERIOR) p xg.
KITCHEN SINK '_. '�
LAVATORY ; , ,.1`
ROOF DRAIN _
SHOWER STALL InitMt -1 .
3 SERVICE/MOP SINK
TOILET
i URINAL rell
WASHING MACHINE CONNECTION <
1 WATER HEATER ALL TYPES
WATER PIPING o MOM
._.._
. OTHER
WATER COOLER t tiv1FIL FR 1 1
.R/0 FILTRATION SYSTEIV it ', :
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO E I
I
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
i
LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY 0 BOND E
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.
I
CHECK ONE ONLY: OWNER J AGENT ®
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the detats 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 wit be in am nt provs ' of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME`Norman R,St.Hilaire,Jr. LICENSE#'t9761 c TIP I
MPEJ JPEJ CORPORATION I,2#3741., - ]PARTNERSHIPEJ#= LLCI #r
COMPANY NAME:Quench USA ADDRESS 780 5th Ave Suite#200
----------------
CITY King of Prussia I STATE;PA ZIP 19406 TEL 610-930-2378
FAX n/a CELL n/a EMAIL nsthilaire@ uenchonline.com cbennett@quenchonline.com
--
'$60 f Le/7r2'l C)L)
Case 312225 SRO S000931 126 A/140W 21./C.0)
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
` Vial. CITY South Yarmouth MA DATE 2/11/2016 PERMIT#
JOBSITE ADDRESS 1084 Rt.28 I OWNER'S NAME Department of Transportation
P OWNER ADDRESS TEL! FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:1:3 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOE
FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 I 9 10 11 12 13 14
BATHTUB i I 1 I 1 1 t j I 1 r '
•
CROSS CONNECTION DEVICE I t 1 H1i '
DEDICATED SPECIAL WASTE SYSTEM 1 11 ( IDEDICATED GAS/OIUSAND SYSTEM .1i1 4 1
1 ( rDEDICATED GREASE SYSTEM j 1 , 1 ( t
DEDICATED GRAY WATER SYSTEM ' I�1!]���3 1M111.�_ (� ;�i y_
DEDICATED WATER RECYCLE SYSTEM 1 ( 1 1 ( ( j
DISHWASHER 1 I r i �� 1
DRINKING FOUNTAIN -- 1 J 1 ( .1 f
FOOD DISPOSER 1111111111
1 1 1
iFLOOR I AREA DRAININTERCEPTOR INTERIOR ( • f 1 i Iu'I
KITCHEN SINK r I (LAVATORY �I I 15 ( I iIi I l
ROOF DRAIN _I_�1�T__�I�I�:�, (1•';�;�1�
SHOWER STALL �111 ,1.1, �I�11��1�1.
SERVICE/MOP SINK (�TOILETURINALlull! -
WATER HEATER ALL TYPES 1♦1♦�1 ,�1 .._ _ . . ,. '•-__-•
WATER PIPING I ( ( 1 I ..._.'
OTHER
WATER COOLER w/FILTER I I J ! I. I I I i
'` I _
'R/O FILTRATION SYSTEM ( I I I ( I I, I 1Y .II I I I I I I
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ❑ BOND E
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 at 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 • ent provi ' of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Norman R.St Hilaire,Jr. UCENSE# 9761 ATU
MPO JP❑ CORPORATION O#3741 1PARTNERSHIP❑#I LLC❑#
COMPANY NAME'Quench USA ADDRESS,780 5th Ave Suite#200
CITY King of Prussia 1 STATE PA ZIP 19406 TEL 610-930-2378
FAX n/a CELL Na EMAIL nsthilaire@quenchcnline,com cbennett@quenchonline.com