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HomeMy WebLinkAboutBLDP-23-005882 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/24/23 PERMIT# BLDP-23-005882 JOBSITE ADDRESS 31 ASPINET RD OWNERS NAME LUIPPOLD JOHN A D OWNER ADDRESS LUIPPOLD DONNA 12 HASTINGS WAY NORTON,MA 02766-2448 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 FIXTURES 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 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 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© NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY❑ BOND❑ OWNERS 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 1b496 SIGNATURE MP 0 JP 0 CORPORATION ❑# I I PARTNERSHIP ❑# LLC ❑# COMPANY NAME 'BENJAMIN DIAMANTOPOULOS I ADDRESS 125 ANTHONY RD 25 ANTHONY RD CITY IW YARMOUTH I STATE IMA I ZIP 1026733776 I TEL FAX I I CELL I 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK s" 0 23 23 FBI ` °6sz. —'�-- CITY �' MA DATE L ..���� JOBSITE ADDRESS 37 , l, >Y ( -- OWNER'S NAME D `� POWNER ADDRESS T Al _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: Ei-/ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES 7 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/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN — FOOD DISPOSER _ - FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK ' LAVATORY - _ ROOF DRAINr__ , SHOWER STALL ; Ft -.; E ! V- E D SERVICE/MOP SINK TOILET ' 1 PR F 2 q 2O2 _ _. URINAL . WASHING MACHINE CONNECTION WATER HEATER ALL TYPES �)' t UiLU� , ut ,AR if,�trvi WATER PIPING / is., ___- _r_ 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 TyF OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY liz.v 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 k.I 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 complia 7ith all Pertinent provision of the Massachusetts State Plumbing' Code and Chapter 142 of the General Laws. �'L�_� PLUMBER'S NAME 56-/k/ LICENSE# 15774 SIGNATURE MP LE' JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑ COMPANY N E 6/1- PnfDRESSl 2--,--/9-Al rFto/u Y (e--1-7 CITY //19—K_ 2 0 STATE/ /�2/ ZIP v ---c�y 0J TEL ,5-0l/ 77 l FAX CELL'l o � EMAIL /q�a YI 0 �,(J cS t c� � \ D � i0 -- 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