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HomeMy WebLinkAboutBLDP-23-003907 ::a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK >a- CITY YARMOUTH MA DATE 1/18/23 PERMIT# BLDP-23-003907 JOBSITE ADDRESS 668 ROUTE 28 OWNER'S NAME MANNING GERALD TR ts� P OWNER ADDRESS THE PARKER RIVER REALTY TRUST 121 MAYFLOWER TERR SOUTH TEL YARMOUTH,MA 02664-1120 TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTURES ..t 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 2 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 2 URINAL 1 WASHING MACHINE CONNECTION WATER HEATER . WATER PIPING 1 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Benjamin Diamantopoulos LICENSE 16496 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME BENJAMIN DIAMANTOPOULOS ADDRESS 25 ANTHONY RD 25 ANTHONY RD CITY W YARMOUTH STATE MA ZIP 026733776 TEL FAX CELL EMAIL bendiamantopoulos@gmail.com L P'14- t iv rj/i imr-- e MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1,F- CITY t�) L" r MA DATE a 2.. PERMIT# 7-3 3 , d 7 _ \ JOBSITE ADDRESS --, 2 ER'S NAME MAIV Ai/AI C( P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCI EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:[-----"--- PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7. FLOOR-+ 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 _ _ j 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 _ {, E SERVICE I MOP SINK TOILET URINAL _ 1 IAN t 1 i WASHING MACHINE CONNECTION WATER HEATER ALL TYPES , _ a U I L UI ts' 'i=Pti E N 1 { WATER PIPING /'J/' -�- { OTHER INSURANCE COVERAGE: I I have a current liability insurance policy or its sub ntial equivalent which meets the requirements of MGL Ch.142. YES ' NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. _ CHECK ONE ONLY: OWNER ❑ AGENT 0 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 nd 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 comp(' nee with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. L— --t PLUMBER'S NAME LICENSE# //27./ , SIGNATURE MP Eillp❑-/ 7MtLCORPORATION❑# PARTNERSHIP❑.#COMPANY 7,13,, LLC # C , ' i()->CITYCOMPANY N E �IV � � � ADDRESS Z'1 1'' ( 1/ STATEt1471 ZIP 7--3 TEL �� 2/+ /� /� J�Q FAX CELL,C: Jl7C�.�7`1)' EMAIL /' i i.'v- V c jou cc, • GO IL71 lift 2 V