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Home My WebLink AboutBLDP-23-000089 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 717122 PERMIT# BLDP-23-000089 E JOBSITE ADDRESS 99 STUDLEY RD OWNER'S NAME James Had P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURFS FLOORS RSM 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 1 LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 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 D 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/6496 SIGNATURE MP ❑ JP ❑ CORPORATION El 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 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES S PERMIT# PLAN REVIEW NOTES - ) ' C> - MASSACHUSETTS UNIFORM APPLICATION FOR PER TO PERFORM MBING WORK � A C Yo-aitiLut) 1A DA PERM( # 71-7-17_1=11 V DZ 3 Co00 BS TE �,DDRESS aq 5TV i (i� OWNER'S NAME l t1 ( -T J a/'��-JJUL ub 2��P - p OWN R ADDRESS / 1" /V TEL FAX B ILDIPIF� DEPARTMENT B -- ----AP:WPMCY E COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: ❑ REPLACEMENT:D----------- PLANS SUBMITTED: YES El NO❑ FIXTURES 1 FLOOR-4 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/OILISAND SYSTEM T DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN r FOOD DISPOSER f FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) / KITCHEN SINK , LAVATORY ': ROOF DRAIN SHOWER STALL - _ SERVICE/MOP SINK I TOILETJ----- ' , I i URINAL _ _ 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 ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TV 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 t Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ `, SIGNATURE OF OWNER OR AGENT 41 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 ith all Pertinent provision of the Massachusetts State PIu ing Code and Chapter 142 of the General Laws. PLUMBERS NAME — b/ /V llT t(J Ta adti SE# / / SIGNATURE MP dp CpORRPORAJTI9N El# PARTNERSHIP❑..j# �LLyC) 0#,/ /'� COMPANY NAME / k / / 4'v I� ADDRESS 2_6 /I &r 7 l'/C,� /t/ "1 �W CITY Y1LJ1/1OUTLI STATE G\lf ZIP 6 TE 63 l FAX CELL EMAIL q"1)// ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT [1 n FEE: $ PERMIT # PLAN REVIEW NOTES