HomeMy WebLinkAboutBLDP-19-003597 •
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
A.- � CITY YARMOUTH MA DATE 12/13/18 PERMIT# BLDP-19-003597
JOBSITE ADDRESS 11 CAPT DANIEL RD OWNER'S NAME KRIKORIAN JOHN P
P OWNER ADDRESS KRIKORIAN DEBRA 11 CAPT DANIEL RD SOUTH YARMOUTH, MA TEL
02664
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW; 0 RENOVATION:❑ REPLACEMENT: IU PLANS SUBMITTED: YES NO
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/OIUSAND 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
ROOF DRAIN
SHOWER STALL -
SERVICE/MOP SINK _ _
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER 1
WATER PIPING
OTHER
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 0 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 MA SIGNATURE •
MP 0 JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑#
COMPANY NAME Braga Bros. inc ADDRESS 110 Breeds Hill rd, Unit#5
CITY [HYANNIS STATE MA ZIP 02601 TEL
FAX CELLEMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE 0 0
DCD\IIT
FEES S PERMIT#
PLAN REVIEW NOTES
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