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HomeMy WebLinkAboutBLDP-22-001032 unit 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 8/24/21 PERMIT# BLDP 22 001032 % JOBSITE ADDRESS 845 ROUTE 28 OWNER'S NAME JANFRA RLTY LLC P OWNER ADDRESS 87 TONELA LN BARNSTABLE,MA 02630 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL D PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS ' 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 1 TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 1 OTHER DESCRIPTION:3 bay sink INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D 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 D 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 Jared Wilber LICENSE 1219 SIGNATURE MP D JP D CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JARED WILBER ADDRESS 474 WINSLOW GRAY RD CITY S YARMOUTH STATE MA ZIP 026644317 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 1/2.1..r ryi a MA DATE 3 " ( PERMIT* JOBSITE ADDRESS 1-1 5 Pt F LAY( 1 )' I OWNER'S NAME OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION; ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO ❑ FIXTURES T FLOOR— BSI 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 SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL CFI V SERVICE/MOP SINK 1 TOILET URINAL 3o WASHING MACHINE CONNECTION WATER HEATER ALL TYPES BUILDING LIENA <TIviE NIT WATER PIPING OTHER 31 • 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 E( OTHER TYPE OF INDEMNITY 0 BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1` Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ 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 complian e with all Pe 'nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (16 ' /J J PLUMBER'S NAME 3-�r av(9` \'`)1 l V zr LICENSE# 1�; 1 fijl(A,lf SIGNATURE MP [Er' JP❑ cC CORPORATION grft PARTNERSHIP❑.# LLC❑# COMPANY NAME iJo''edS t' ADDRESS CITY 1l(vito U u 1 STATE MA ZIP U L, TEL 6 G • FAX CELL 5 c\Irk e- EMAIL ( Vie l E. L Ili e t C:C31�►1 y C [64II(21?- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT FEE: $ PERMIT It PLAN REVIEW NOTES • • I -