HomeMy WebLinkAboutBLDP-22-002281 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
+ CITY YARMOUTH MA DATE 10/20/21 PERMIT# BLDP-22-002281
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I' JOBSITE ADDRESS 225A WHITES PATH OWNER'S NAME WGI HOLDINGS LLC
P OWNER ADDRESS 9 HEMLOCK RD WESTON,MA 02493 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL 0
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CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:9 PLANS SUBMITTED: YES NO
FIXTURES z 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/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTE
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN 2
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY 4
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET 4
URINAL 2
WASHING MACHINE CONNECTION
WATER HEATER
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 m NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY m OTHER TYPE OF INDEMNITY❑ BOND El
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 Massachusetts(MA) SIGNATURE
MP 9 JP 0 CORPORATION ❑# PARTNERSHIP 0# LLC ❑#
COMPANY NAME Braga Bros,Inc. ADDRESS 110 Breeds Hill Road Unit 5
CITY Hyannis STATE MA ZIP 102601 TEL
FAX 1 CELL 7744870199 EMAIL 1
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
FEES$ PERMIT#
PLAN REVIEW NOTES