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Home My WebLink AboutBLDP-23-003613 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/3/23 PERMIT# BLDP-23-003613 FS JOBSITE ADDRESS 41 RUBY ST OWNERS NAME VALERI ROBERT V TR OWNER ADDRESS ROBERT V VALERI FAMILY TRUST 7 WHEATON RD ARLINGTON,MA 02474-3507 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL E PRINT CLEARLY NEW: 0 RENOVATION:El REPLACEMENT:0 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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. I PLUMBER'S NAME (Jared Wilber LICENSEI1219 SIGNATURE MP 0 JP 0 I CORPORATION ❑# I I PARTNERSHIP ❑# I I LLC ❑# COMPANY NAME IJARED WILBER I ADDRESS 1474 WINSLOW GRAY RD CITY S YARMOUTH I STATE IMA I ZIP 1026644317 I TEL I FAX I 1 CELL 1 I EMAIL Ijarbernie123@gmail.com • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK yam" .i 1,- CITY 1 oa- P7 C)U I 1 MA DATE I ` 3 2. .3 PERMIT* JOBSITE ADDRESS ki 1 F C if OWNER'S NAME V&k r i e_ POWNER ADDRESS ,Yet 1 TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ TzsaernAL LJ PRINT R CLEARLY NEW: RENOVATION:❑ REPLACEMENT:0 P JBTf E .�D' 'ES NO❑ FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 8 9 JA ND()3 12 ri-- 14 BATHTUB CROSS CONNECTION DEVICE 3UILD NG LEPARTMENT , DEDICATED SPECIAL WASTE SYSTEM - --- -- _ DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM - • DEDICATED GRAY WATER SYSTEM . DEDICATED WATER RECYCLE SYSTEM _ _ . DISHWASHER • DRINKING FOUNTAIN _ FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) 1 KITCHEN SINK LAVATORY • ROOF DRAIN SHOWER STALL . SERVICE I MOP SINK TOILET I URINAL . WASHING MACHINE CONNECTION v WATER HEATER ALL TYPES WATER PIPING OTHER . " I INSURANCE COVERAGE: / I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES I"_'i NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY [7. 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 i Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 11- SIGNATURE OF OWNER OR AGENT 1-kl 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 compli %c with all Pertin9nt p vision of the ( Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /,/1 PLUMBER'S NAME J (NO ec) Ui t j L LICENSE# 15:2/i . SIGNATURE MP[r JP 0 CORPORATION[l PARTNERSHIP❑.# LLC❑# COMPANY NAME .�r,L v e Q i ?(t c.of j✓l — ADDRESS L/ i7 41 ILI(C7 SItiL,J (rG`1 (1 J- CITY .7 , 14,V•mo/� ±ii STATE Ll4 ZIP v Z. a 4/ TEL FAX CELL S 4'(l 1 EMAIL J a Y b.On ie 11_ e, Pi vicar)• car)