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Home My WebLink AboutBLDP-22-007430 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK tips-Al CITY YARMOUTH MA DATE 6/27/22 PERMIT# BLDP-22-007430 `ice p JOBSITE ADDRESS 1 AVERY LN OWNER'S NAME charles constantine P OWNER ADDRESS 1 AVERY LN SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES❑ NO❑ 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL 1 WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 1 • OTHER 2 OTHER DESCRIPTION: bar sink/pump 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 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. PLUMBER'S NAME Benjamin Diamantopoulos LICENSE t6496 SIGNATURE MP ❑ JP El 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 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEESS PERMIT# PLAN REVIEW NOTES /DD. 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMI TO PERFORM PLUMBING WORK !_ I `' E 6 2Z PERMIT# ZZ _7473G 1=-��=' �1Tf";.o V141��"�1;=�/�% MA DATE U ITE ADDRESS / (/ 6g 7 �/ WNER'S NAME JUN 2 4 21f� � Cep(-r�S�e��l�� OWNER ADDRESS TEL FAX BUIL G DEPARTMENT 9Y 1 PE-OR-_-,_OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:[2--------R-ENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ 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 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ ..",_____ _______ DISHWASHER DRINKING FOUNTAIN 7 FOOD DISPOSER FLOOR I AREA DRAIN _ INTERCEPTOR(INTERIOR) ' KITCHEN SINK j LAVATORY ROOF DRAIN _ SHOWER STALL SERVICE I MOP SINK TOILET i URINAL . j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER LC tAl% k 3,-----' - 1 . _ 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 TH E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY 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 t Massachusetts General Laws, and that my signature on this permit application waives this requirement. r CHECK ONE ONLY: OWNER 111 AGENT ❑ SIGNATURE OF OWNER OR AGENT I 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 compile ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. J: PLUMBER'S NAME 'f V00446 YObrel.4iza# /5-R. 1 SIGNATURE MP❑ JP❑ CORPORATION ORPORATIO # PARTNERSHIP LLC El# COMPANY E !tO' /�c� 10 �g ADDRESS � I�—�J,/cl Q�CITY )4?1'ZI?A STATE kin' ZIP L/ 3 TEL , 4r FAX CELL EMAIL l l� v O J ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES