HomeMy WebLinkAboutBLDP-22-000886 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 8/17/21 PERMIT# BLDP-22-000886
II JOBSITE ADDRESS 51 PARK AVE OWNER'S NAME OSULLIVAN JULIA A
P OWNER ADDRESS OSULLIVAN TIMOTHY CHRISTOPHER 32 BARNESDALE RD NATICK,MA 01760 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
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CLEARLY NEW:El RENOVATIONS,El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑
FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1
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 1
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK 1
LAVATORY 1 2
ROOF DRAIN
SHOWER STALL 1 1
SERVICE/MOP SINK
TOILET 1 2
URINAL
WASHING MACHINE CONNECTION 1
WATER HEATER
WATER PIPING
OTHER 3
OTHER DESCRIPTION:BAR SINK
POT FILLER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY❑ 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 at 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 at 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 I LICENSE MA SIGNATURE
MP ❑ JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# 1
COMPANY NAME Braga Brothers Heating,Plumbing ADDRESS 110 Breeds Hill Rd,Unit 5
and Air Cnndltinnin3
CITY Hyannis SIAVE MA ZIP 02664 TEL
FAX CELL 7744870199 EMAIL
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE 111 El
FEES$ PERMIT#
PLAN REVIEW NOTES