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Home My WebLink AboutBLDP-22-003674 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w, CITY YARMOUTH MA DATE 1/3/22 PERMIT# BLDP-22-003674 JOBSITE ADDRESS 5 CADET LN OWNERS NAME LICAUSI ANGELO P OWNER ADDRESS 11 SAINT JAMES RD MEDFORD,MA 02155 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURFS 1 FLOORS—r RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER WATER PIPING 1 OTHER 1 OTHER DESCRIPTION:ice maker 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 0 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. 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 1E496 SIGNATURE MP ❑ JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME BENJAMIN DIAMANTOPOULOS ADDRESS 25 ANTHONY RD CITY W YARMOUTH STATE MA ZIP 026733776 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 FEES$ PERMIT# PLAN REVIEW NOTES IL_ /020. 16 MASSACHUSETTS UNIFORM APPLICATION FOR A ER IT TO PERFORM PLUMBING WORK 'E t E D , �!� .,. ' CITY Imo' �V -7 MA DATE ( 5 <^/ _ PERMIT# L'-- "(..?‘'j � N O�.I�TE D�`ESS �� OWNER'S NAME 4-764-1-21.‘) BUIPirvG DENONNMRNDD•ESS _;/1G'(/r TEL FAX ' • - ii- •"•''- ' TYPE COMMERCIAL❑ EDU TIONAL ❑ RESIDENTIAL EI,'"--- - PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES ❑ NO❑ FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 ' 14 BATHTUB /yyj CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER11- • "— DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL i SERVICE!MOP SINK _ TOILET 1— URINAL j WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES y WATER PIPING jj :-.../......... _ OTHER I C� A _ i i /- - INSURANCE COVERAGE: I have a current liability insurance policy or its sub antial 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 s Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1Q,.1 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' nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER' MEI f7l441i1 (f1OPC't)W5 LICENSE# SIGNATURE MP JP IICO0TIO 0# PARTNERSHIP❑.# `LLC❑# COMPANY NAM 0/54-ft--r T( ADDRESS 2-6-�l i / 1 A r gi> CITY Y/1747-A STATE iten ZIP TEL 'k) r 1 c FAX CELL EMAI 'I/ fmlfr 7 r ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT It PLAN REVIEW NOTES 1