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HomeMy WebLinkAboutP-19-2496 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK es CITY YARMOUTH MA DATE 10/26/18 PERMIT# BLDP-19-002496 ras JOBSITE ADDRESS 6 SCOOP CIR OWNER'S NAME MURPHY CORAL A TR P OWNER ADDRESS MURPHY FAMILY RLTY TRUST 6 SCOOP CIR YARMOUTH PORT, TEL MA 02675 TYPE OR i OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES NO ED FIXTURES 1 FLOORS— RSM 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 SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK _ LAVATORY 1 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET • URINAL _ 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 I9 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY m OTHER TYPE OF INDEMNITY 0 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'S NAME Alex Braga LICENSE#5668 SIGNATURE MP ea JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# • COMPANY NAME ADDRESS 110 Breeds Hill Rd, Unit 5 CITY Hyannis STATE MA ZIP 02601 TEL 7744870199 FAX CELL EMAIL 1 , V 911 S310N M3IA321 Mild #1IIMd3d $S334 sinCaC 0 0 311l SV 3M3S NOI1VOI1ddV SIHl oN saA S31ON N019J3dSNI 1VNIA A1NO 3Sf1331110 1101 M013/1 S31ON NOI9J3dSN1 DNIUI Lflld 11011021