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Home My WebLink AboutBLDP-19-002027 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4! CITY Yarmouth MA DATE 9/24/2018 PERMIT#&/3,/?QCiOZ4727 y _r JOBSITE ADDRESS 22 Aarons Way OWNER'S NAME I. 45 r N /N a iZ-A OWNER ADDRESS I TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL �] EDUCATIONAL Li RESIDENTIAL❑ PRINT CLEARLY NEW: RENOVATION: REPLACEMENT:!] PLANS SUBMITTED: YES❑ NO FIXTURES- FLOOR-V 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/OIUSAND 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 6 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 5 i URINAL 1 • _. __ ._ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 2 WATER PIPING 1 _ OTHER 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. 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 applicati ar rue and a rate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will in plian th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME David DuVerger LICENSE# 18252 SIGNATURE MP JP ' CORPORATION # PARTNERSHIP ]#F ]LLC�#� _] COMPANY NAME David DuVerger ADDRESS 26 Dove Ln _ J CITY West Yarmouth STATE Ma ZIP 02673 TEL I FAX r 1 CELL 5089442027 EMAIL 4 27 CIS Hall, Lee From: Anne Seminara <anneseminara@gmail.com> Sent: Wednesday, September 26, 2018 2:35 PM To: Hall, Lee Subject: 22 Aarons Way Follow Up Flag: Follow up Flag Status: Flagged Inspector Hall, Please be advised that we have changed the plumber from Jon Gremila to David Duverger at the job located at 22 Aarons Way W. Yarmouth. If there is anything else you need, please contact me, Anne Seminara. Thank you very much. 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ni l'. -rWO'' CITY YC"C(no L/kit MA DATE ,2--S-17 PERMIT# /17''/T-06 '-� ,-2Serr;�n c,cc) JOBSITE ADDRESS 22 1^-1 F,�4 r,S �,.�a 5 OWNER'S NAME L v. POWNER ADDRESS Uh/s WAY TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL. EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO, ] FIXTURES T FLOOR-4 BSM 1 2 3 4 5 6 1 I 7 8 9 E 10 11 12 13 14 BATI-(TUB CROSS CONNECTION DEVICE y DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM ,- 0D I DEDICATED GRAY WATER SYSTEM �� DEDICATED WATER RECYCLE SYSTEM 1 DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER . FLOOR/AREA DRAIN 2. INTERCEPTOR(INTERIOR) I ,;,� r'• KITCHEN SINK LAVATORY 6 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK _ �in�j TOILET = i —� !W URINAL I • . i WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING 1 OTHER . ( INSURAN COVERAGE: I have a current liability insurance po y or its su>bstantia quivale which meets the requirements of MGL Ch.142. YES IS NO 0 I IF YOU CHECKED YES,PLEASE INDICATE TYPE QF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 12r 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. 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 co • nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME J c n GCerf\, � LICENSE# 16(V. . SIGNATURE MP 0 JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME , f G ?i`.) fn b, h.5 ADDRESS ?d r3 C. OS 9 O S6 CITY fl. &asi-4 a(' STATE r 9- ZIP O EC 5 f TEL c, FAX CELL EMAIL 77'7 -7 Z2 "3 c r Ti 0--I- I O 370D n m=� mm� CO E0co -1 3 co O n tpJ c 1io ✓ DXQo li ' � a DAD , Lfl 'J N W , Z CTc) i r▪u Z rOo i 7 Ul 7-',a r I. et. 1.1 ru r I ► p "II , • 1 I{ III m ii, Iv ii,� it.: � �� ill 1 el ` i il r i r a 0tn 0 al 1. O V • -4, „ NS- ;04- 4i