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HomeMy WebLinkAboutBLDP-22-002980 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY IYARMOUTH I MA DATE 111/22/21 I PERMIT# BLDP-22-002980 Ls- I OWNERS NAME ILATSHAW GEORGE R JR JOBSITE ADDRESS 183 LAKEFIELD RD p OWNER ADDRESS (LATSHAW ELIZABETH 83 LAKEFIELD RD SOUTH YARMOUTH,MA 02664 I TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO FIXTIIRFS z FLOORS--. RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: YES El NO 0 I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND❑ 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 on are e and accurate to the best of my I herebywl certify that all of the tails and wok and installations performed under then I have submitted or ered regarding this permit issued for this application will ben compliance with all Pertinent provision knowledge and that all plumbing of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. SIGNATURE LICENS:15668 PLUMBER'S NAME Alex Braga PARTNERSHIP 0# � LLC ❑# MP © JP El CORPORATION ❑# 11111111 Braga Bros,Inc. ADDRESS 110 Breeds Hill Road Unit 5 COMPANY NAME g TEL STATE IENINIIINI ZIP 02601 CITY FAX CELL 7744870199 EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e 1= CITY YARMOUTH MA DATE November 22,2021 PERMIT# BLDG-22-002981 JOBSITE ADDRESS 83 LAKEFIELD RD G OWNER'S NAME LATSHAW GEORGE R JR OWNER ADDRESS LATSHAW ELIZABETH 83 LAKEFIELD RD SOUTH YARMOUTH MA 02664 TYPE OR OCCUPANCY TYPE TEL PRINT COMMERCIAL ElRESIDENTIAL El CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 111 FIXTURES FLOORS cm 1 2 PLANS SUBMITTED: YES 0 NO BOILER 1 Nil MIN 8 9 10 m® 13 1121 BOOSTER == _ - CONVERSION BURNER _=====_11111111111111111111111111111 COOK STOVE _ - DIRECT VENT HEATER __ ___ _______- DRYER ______======__- FRYOLATOR __________=== _-_ 11111111111 Ell GENERATOR11111111111111 Ell 1:1111111111 Ell Ell __ _- INFFRARED HEATER ==___ _ _ _- LABORATORY COCKS ___ ____- OVEN _____11111111111111111 ___- POOL HEATER _______ == ROOM/SPACE HEATER =====_________- ROOF TOP UNIT _ -__=====____- Ell Ell MEE ___- UNVENTED ROOM HEATER � === ________- _ETMEZIIIIIII ___ ____111111111111111111111111 __- OTHER _�_______=___- OTHER DESCRIPTION: ___- INSU NCE COVERAGE: 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 I have a current Iiabili insurance policy or its substantial equivalent which meets he requirements of MGL Ch.142. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW YES 0 NO❑ LIABILITY INSURANCE POLICY © OTHER OF INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not ave 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pe provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. my Pertinent PLUMBER-GASFITTER NAME MP 0 MGF 0 JP 0 JGF 0 LPGI LICENSE# ❑ CORPORATION❑# SIGNATURE COMPANY NAME: �� PARTNERSHIP E�''� CITY ADDRESS. ❑#�LLC ❑#� FAX �� STATE CELL EMAIL ZIP TEL