HomeMy WebLinkAboutBLDP-22-006830 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
w,z CITY YARMOUTH MA DATE 5/24/22 PERMIT# BLDP-22-006830
rl� JOBSITE ADDRESS 33&37 SEASIDE VILLAGE RD OWNER'S NAME Jack Hynes
P OWNER ADDRESS SOUTH YARMOUTH,MA 02664 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO El
FIXTURFS • 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 12 8
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET
URINAL
WASHING MACHINE CONNECTION 1
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 El NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY 0 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 El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# Lc ❑#
COMPANY NAME BENJAMIN DIAMANTOPOULOS ADDRESS 125 ANTHONY RD 25 ANTHONY RD
CITY IW YARMOUTH I STATE MA ZIP 026733776 TEL
FAX CELL EMAIL Ibendiamantopoulos@gmail.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
. 14:AlItif :
MAP ,. Pfige6 ( :
1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
r— y ERMIT #
CITY 1` f - I ma DATE
JOBSITE ADDRESS i j ...-/-- ( C- I OWNE 'S NA E -
f S :57.1), 7 54 ' pc t' L/ViI1TEL ---T ..7W•4.-i. Li- )FAX I
TYPE OR OCCUPANCY TYPE COMMERCIAL
EDUCATIONAL 0 RESIDENTIAL '
PRINT PLANS SUBMI I 1 ED: YES ❑ NO
CLEARLY NEW: RENOVATION: REPLACEMENT: ❑
2
-.. --
FIXTURES 1 FLOOR-. BSM 1 I i � 6 7
8 9 10 14 3 NM ��� � ;� MU
— -
BATHTUB MU
CROSS CONNECTION DEVICE . sin � � � �
DEDICATED SPECIAL WASTE SYSTEM um N `1 UN ililm NM No OM � MI M
DICATED GASJOIUSAND SYSTEM -
111
E SYSTEM M m .it - g �•�
DEDICATED GRAY YSTEM NM -' N lm move r `
DEDICATED GRAY WATERS ���;00
DEDICATED WATER RECYCLE SYSTEM NM NM ; �. _-- 0= ,
DISHWASHER MINI
► --
TAIN ;� M _ O =,
DRINKING FOUN � '�
_ ,lam
I
FOOD DISPOSER � .
I
_FLOOR/AREA DRAIN N -�,im � _-- i •
INTERCEPTOR (INTERIOR) u urn m um - -
► KITCHEN SINK
MR m !,
LAVATORY NM WallITIO IIIIIIMMIILIIIIIS �
ROOF DRAINiiitall. i �:
� t - ,, -
SERVICE STALL -inikr- :W ► ►' __ ,
7-1
SERVICE I MOP SINK p - `
TOILET .iiii; ,
URINAL 'NO �
- IIIIII I '� .III f
WASHING MACHINE CONNECTION ` -- 4 ,
TER ALL TYPES _
WATER HEATER ' "-y � ,�
WATER PIPING W r ` '" -
111
OTHER __. -- ---- . � �_ _. � - - 111110"
.. y 1 :1111.101111-1111110M i, rii ir 1 : ': 4
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent
which meets the requirements of MGL Ch. 142. YES Illg NO ❑ . ,
IF YOU CHECKED YES, PLEASE INDICATE TH PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
BOND ❑
OTHER TYPE OF INDEMNITY4
LIABILITY INSURANCE POLICY j
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 U AGENT ❑ 1
SIGNATURE OF OWNER OR AGENT accurate
that all of the details and information I have submitted or entered regarding this application aree true
flea with all to the
best of my knowledge
, ndreby certify
and that all plumbing work and installations performed under the permit issued for this applicationP
of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws
1 r ` CENSE # 14 SIGNATURE
PLUMBER'S NAME t _
s
NERSNIP # � LLC ,�#[ -
CORPORATION # PART Li
MP JP� it-7' t ADDRESS ` f ,
COMPANY NAME i �6�� .� -_ - .-� TELOLOSW i
'
, STATE ZIP [ 0 G , 7 _
CITY t� t
FAX [ CELL [ IEMAIL i , . ' 1 v ‘f .. iJtl 61qjk i k i i (Z7X-1
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