HomeMy WebLinkAboutBLDP-21-006014 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
=-7-....:icjaCITY YARMOUTH MA DATE 4/17/21 PERMIT# BLDP-21-006014
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tR: JOBSITE ADDRESS 11 KINGSBURY WAY OWNER'S NAME GARB JAMES R TRS
P OWNER ADDRESS KANE SHEILA A TRS 11 KINGSBURY WAY YARMOUTH PORT,MA 02675-1227 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El
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CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:E PLANS SUBMITTED: YES NO❑
FIXTURES 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
DEDICATED WATER RECYCLE SYSTE
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) _
KITCHEN SINK _
LAVATORY _ 1
ROOF DRAIN
SHOWER STALL _ 1
SERVICE/MOP SINK
TOILET 1
URINAL
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WASHING MACHINE CONNECTION _ _
WATER HEATER
WATER PIPING _
OTHER _ 1
OTHER DESCRIPTION:OUTSIDE RINSE STATION
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑
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
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 16668 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# I ( LLC El# I
COMPANY NAME Braga Brothers Heating,Plumbing ADDRESS 110 Breeds Hill Rd, Unit 5
and Air Conditioning
CITY Hyannis STATE MA ZIP 02601 TEL 5088274260
FAX CELL 7744870199 EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE PERMIT El ❑
FEES$ PERMIT#
PLAN REVIEW NOTES