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Home My WebLink AboutBLDP-23-005422 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1[4 re CITY YARMOUTH MA DATE 3/31/23 PERMIT# BLDP-23-005422 JOBSITE ADDRESS 668 ROUTE 28 OWNER'S NAME MANNING GERALD TR P OWNER ADDRESS THE PARKER RIVER REALTY TRUST 121 MAYFLOWER TERR SOUTH TEL YARMOUTH,MA 02664-1120 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES i 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 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 1 OTHER 2 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 Benjamin Diamantopoulos LICENSE 15496 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 i MASSACHUSETTS UNIFORM t I I�i I� V-._ `o =�, APPLICATION FOR A PERMIT TO PERFORM PLUMBING 9 /j, WORK F=7v CITY y , r { Z �r t J ' t f� --'_ MA DATE L �AMIT -Cj�j�' Z Z JOBSITE ADDRESS k ( f� j f'! (( f P OWNER'S NAME J�� I L�� i]� C OWNER ADDRESS TYPE OR OCCUPANCY TEL FAX PRINTS FAX Er EDUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES( 'NO FIXTURES 7. FLOOR—+ Mill BATHTUB 2 3 4 5 6 7 m® 8 9 10 CROSS CONNECTION DEVICE �--1 13 14 DEDICATED SPECIAL WASTE SYSTEM �--- DEDICATED GAS/OILISAND SYSTEM �--- DEDICATED GREASE SYSTEM -_-- DEDICATED GRAY WATER SYSTEM ��-- DEDICATED WATER RECYCLE SYSTEM DISHWASHER - 1M' DRINKING FOUNTAIN FOOD DISPOSER FLOOR/EPTOR DRAIN �n � ■ INTERCEPTOR(INTERIOR) � I. ROOF DRAIN -� _ SHOWER STALL ==_ SERVICE/MOP SINK �—= 1 TOILET -- - j URINAL I � �__— j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES —==t WATER PIPING m___ OTHER -_' f _ -___ —=5- i imer, , , , or ,, � �--- I have a current liability insurance policy or its su ntiahe equivalent ent W COVERAGE: _--� q which meets the requirements of MGL Ch.142. YES it NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE E OF COVERAGE BY CHECKING THE APPROPRIATE LIABILITY INSURANCE POLICY �/ BOX BELOW OTHER TYPE OF INDEMNITY 0 BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not Ve the insurance coverage required by Chapter 142 of the q ' Massachusetts General Laws, and that my signature on this permit application waives this requirement. El SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER �i I hereby certify that all of the details and information I have submitted or entered regarding this application � AGENT and that all plumbing work and installations performed under the permit issued for this application will be in com li Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PP on are nd accurate to the best of my knowledge P true w'h all Pertinent provision of the PLUMBER'S N ��'�� LICENSE# J� MP Jp � / �, 1 �, SIGNATURE �,!� °-�' CORPORATION ❑# PARTNERSHIP❑.# COMPANY NAME !7Ie"/ P: '•_/ LLC # CITY �� V��) ADDRESS �z� /� 1-4/ )/�� FAX j `. STATE ,�� ZIP /� G � -,'5 TEL,J CELL l EMAIL 1 -I°L`icTi! C ‘1 � —',etc:_ I .. , .