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HomeMy WebLinkAboutBLDP-23-003002 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK „, ` CITY YARMOUTH MA DATE 12/1/22 PERMIT# BLDP-23-003002 i' JOBSITE ADDRESS 822 ROUTE 28 OWNERS NAME MACLYN LLC P OWNER ADDRESS 822 ROUTE 28 SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES z 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 3 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 0 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. PLUMBERS NAME Benjamin Diamantopoulos LICENSE 1{496 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 Ibendiamantopoulos@gmail.com } (OLD I g-45H V IL C - MASSACHUSETTS UNIFORM APPLICATION FOR A PERM T TOPERFORM PLUMBING WORK ""= CITY >" Pf4O V f /f MA DATE I 2— i z- PERMIT# 3 3a _1 Y ,n t JOBSITE ADDRESS /-1--- C< 13 WNER'S NAME P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q�EDUCATIONAL ❑ RESIDENTIAL❑ PRINT PLANS SUBMITTED: YES 0 NO 0 CLEARLY NEW:0 RENOVATION:El REPLACEMENT:0 FIXTURES'1 FLOOR-4 BSM 1 2 3 4 5 6 7 B' 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 . SERVICE/MOP SINK I TOILET 5 _ I URINAL ,,,t_ . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER ' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 IF YOU CHECKED YES,PLEASE INDICATE THETY COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND 0 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 kA.1 I hereby certify that all of the details and information I have submitted or entered regarding this application are true an 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 'th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME eN LICENSE*j�/ l /(p SIGNATURE J MP 1E1 -jP CORPORATION 0# PARTNE SHIP❑.# LLC 0# COMPANY N E ADDRESS 2 4-Ai ( i�D//�N C et.. CITY /�l STATE ZIP 2 6 5 TE_ FAX CEL EMAIL b rayon -ro p G