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HomeMy WebLinkAboutP-19-275 67196 s/4*" <I ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4,1 CITY IYARMOUTH I PERMIT It JOBSITE A DRESS 6 StCOOP CIR MA DATE 7/12/18WNER'S NAME MURPHY CORAL A TR P OWNER ADDRESS MURPHY FAMILY RLTY TRUST 6 SCOOP CIR YARMOUTH PORT, TEL MA 02675 TYPE OR OCCUPANCY TYPE I COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO m FIXTURES 1 FLOORS-. 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 r I DEDICATED WATER RECYCLE SYSTE ryl.if - DISHWASHER I P DRINKING FOUNTAIN 1I /FOOD DISPOSER ik `,. FLOOR/AREA DRAIN / ►�J /L/ INTERCEPTOR(INTERIOR) / _ KITCHEN SINK I LAVATORY I 1- ROOF DRAIN i ' SHOWER STALL I SERVICE/MOP SINK I TOILET I URINAL I _ _ WASHING MACHINE CONNECTION WATER HEATER _ WATER PIPING OTHER 1 OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER: I am awar that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and tha my signature on this permit application waives this requirement. SIGNATURE OF OWNER OIR AGENT • __ hereby certify that all of the details and information II hav submitted or entered regarding this application are We and accurate to the best of my knowledge and that all plumbing work and Installations pormed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 42 of the General Laws. PLUMBER'S NAME Alex Braga i I LICENSEI6717 . SIGNATURE MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Alex B Braga ADDRESS 2 MOUNTWOOD RD CITY MARSTONS MLS STATE MA ZIP 026482111 TEL FAX CELL EMAIL • - ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 0 OCPUIT FEES S PERMIT# PLAN REVIEW NOTES rc1141-C-- E2 • /O/& / /% MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK itCITY YARMOUTH 1 MA DATE July 12,2018 PERMIT# BLDP-19-000275 t. JOBSITE ADDRESS 6 SCOOP CIR OWNER'S NAME MURPHY CORAL ATR G OWNER ADDRESS MURPHY FAMILY RLTY TRUST 6 SCOOP CIR YARMOUTH PORT MA TEL 02675 i TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL PRINT CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES❑ NO© FIXTURES FLOORS—r BSM 1 i 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I BOOSTER I CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER I FIREPLACE I _ FRYOLATOR I FURNACE _ GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS - MAKEUP AIR UNIT _ OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT I _ TEST UNIT HEATER I UNVENTED ROOM HEATER I WATER HEATER I I ' OTHER OTHER DESCRIPTION: I INSURANCE COVERAGE: I have a current liability insurance policy or it$substantial equivalent which meets the requirements of EIGL Ch.142. YES © NOD IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY❑ BOND 0 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. 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-GASFITTER NAMEIAIex Braga LICENSE# 6717 SIGNATURE MPD MGF❑ JP❑ JGF❑ LPGI❑ I CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: Alex B Braga I ADDRESS 2 MOUNTWOOD RD, CITY IMARSTONS MLS I STATE MA ZIP 026482111 - TEL 1 FAX CELLI EMAIL /..441 0 c 0 I G) D w Z m n -1 0 Z • Z 0 m CD m 2 -i El w I EA v tri m oD r-1:1 - m z z 0 XI C m m G A Z < cn mm w v z > 0 o # m CD m xi W ri0 - Z ' - El z 1- 0 /n/e/ it/,J1 T z s�a) �� r z w m n AlC//Z- -71-/ Z -fiq o m :1