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Home My WebLink AboutBLDP-22-005161 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH , MA DATE 3/16/22 PERMIT# BLDP-22-005161 `r) JOBSITE ADDRESS 45 PINE CONE DR OWNER'S NAME BROWN ELEANORE M P OWNER ADDRESS C/O AUPERLEE ELEANORE M BOX 487 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑' REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES • FLOORS BSM 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 3 2 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 2 2 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY 0 BOND❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have',he 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 ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME BENJAMIN DIAMANTOPOULOS ADDRESS 25 ANTHONY RD CITY W YARMOUT I 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 ❑ FEESS PERMITS PLAN REVIEW NOTES t + SSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY1 1)!/ ( MO ) ` l7f MA DATE /L/ 2-'2 PERMIT# '2-Z ti I C,I 1 ZgBSItE ADDRESS /9/f(/ r iV / OWNER'S NAME uILDP DEI-AK0@e/NERADDRESS !� TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:( PLANS SUBMITTED: YES NO❑ FIXTURES T FLOOR-4BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ( p 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 FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 0110 LAVATORY '� •• ROOF DRAIN - . SHOWER STALL .4 SERVICE/MOP SINK I. TOILET V _ URINAL WASHING MACHINE CONNECTION ' WATER HEATER ALL TYPES WATER PIPING OTHER II 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 OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND ❑ i 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT �l I hereby certify that all of the details and information I have submitted or entered regarding this application are tru and accurate to the best of my knowledge and that all plumping work and installations performed under the permit issued for this application will be in co li nce with all Pertinent provision of the Massachusetts State Plu bing Code and Chapter 142 of the General Laws. PLUMBER' AME / 9itM A tv-rpoolCENSE# 1 `�ySIGNATURE MP JP CORPORATION❑# PARTNERSHIP❑.# LLC COMPANY 1 y�/�`!� ADDRESS /IV [i- t l Y �� 011 # OM ANY NAME �6'�?' r � 1-9- DRESS s=�-�:J N � ay3 � �3 CITY Y [ )-� STATE �/` ZIP 0`--�// � � T/EL- FAX CELL EMAIL ei 1J a4"frn 6iT A) epvtai1- CGpL. 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