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Home My WebLink AboutBLDP-21-006420 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r rs=.ray„ CITY YARMOUTH MA DATE 5/6/21 PERMIT# BLDP-21-006420 A hI JOBSITE ADDRESS 18 NICHOLAS DR OWNER'S NAME MEEKS JOSEPH L JR P OWNER ADDRESS 18 NICHOLAS DR YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 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: 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 Jared Wilber LICENSE 1b219 SIGNATURE MP ❑ 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 PERMIT Ei FEES$ PERMITS PLAN REVIEW NOTES 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK __ , ,; 1 2( -ou ZO = F=� CITY 1 CSC p~r4 N T� MA DATE ��- �''` PERMIT# U P 6 JOBSITE ADDRESS S 1 N I (A cALL I0Y• OWNER'S NAME p YT1 �t6Q h_ POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL ❑ RESIDENTIAL�----- PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ .PLANS SUBMITTED: YES El NO ❑ FIXTURES 7. FLOOR BSIvi 1 2 3 4 5 6 7 B 9 10 11 12 13 14 BATHTUB I 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 I AREA DRAIN . INTERCEPTOR(INTERIOR) _ . KITCHEN SINK _ I LAVATORY . . ROOF DRAIN SHOWER STALL _ SERVICE I MOP SINK TOILET URINAL WASHING MACHINE CONNECTION ' . 1_, \ i WATER HEATER ALL TYPES _ WATER PIPING .\ : OTHER i I i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ NO ❑ ' IF YDU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2 OTHER TYPE OFNDEMNITY D 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. 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 complia a with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,, I /' J/ Li I PLUMBER'S NAME LICENSE# 5% 1� L GN SIIGNATURE MP ❑✓r JP El p CORPORATION art PARTNERSHIP❑.# LLC 10# • COMPANY NAME JC.k`rec S 7 \Wei l,14-li'� ADDRESS 147I/ ID J i4.› I.J ram_ fj. CITY 3(,uiit% I Lty_ 1lt e l f tt STATE rY_ItriL, ZIP 6 LC; II' V TEL ~ FAX_ CELL 137 .4 O "7 EMAIL J 0. e ��lr12 -ni 44.411Ck) S i • (1,6 WI 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 1 , I _