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Home My WebLink AboutBLDP-18-005858 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK q, v nz CITY [ARMOUTH MA DATE 4/23/18 PERMIT# BLDP-18-005858 ._.1W- JOBSITE ADDRESS 52 SEMINOLE DR OWNER'S NAME ROMANO BERNADETTE A z., P OWNER ADDRESS ROMANO ROBERT T 22 REDWOOD RD NEW HYDE PARK, NY TEL 11040 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 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 El NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El 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 James Pazakis LICENSE Ak5030 SIGNATURE MP El JP 0 CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JAMES M PAZAKIS ADDRESS 158 WHITTIER DR CITY DENNIS STATE MA ZIP 026382400 TEL FAX CELL EMAIL ROUG11 PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ DGC MIT FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t�^ s CITY YGLrrn0 per---t— MA DATE LI/l7/16 PERMIT# /WP-' er-d05Y re- JOBSITEADDRESS Sa 5ern`71(,.. E DrYt' . OWNER'S NAME n')°(6._ -cfeC(..,00 POWNER ADDRESS , TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL I I EDUCATIONAL ❑ RESIDENTIAL I PRINT CLEARLY NEW: I I RENOVATION:U REPLACEMENT:❑ PLANS SUBMITTED: YES I I NO FIXTURES 1 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB II L L I. U 11 I II I LI I CROSS CONNECTION DEVICE I 1 IL I I U U I i U 1 I I DEDICATED SPECIAL WASTE SYSTEM _ _11 I J 11 L J II_ 1 U I f LL I 11 DEDICATED GAS/OIL/SAND SYSTEM I U I. U ,L I L I 1 1 U I U DEDICATED GREASE SYSTEM U L l U J 1 I I �( U I 1 DEDICATED GRAY WATER SYSTEM U 1 U I U I U 1 U U l U I U DEDICATED WATER RECYCLE SYSTEM U 1 1 I 1 1 U U U I 1 U U DISHWASHER I I 11 t I I. U I I I U IL U DRINKING FOUNTAIN L U U U ) U 1 I I. I I U II I U FOOD DISPOSER L U U J U U 1 U U U U U I U FLOOR/AREA DRAIN I U U I. I I 0 U 0 U 1 L I U 1 INTERCEPTOR(INTERIOR) L 1 I I U I. I I I 1 I I KITCHEN SINK 1 U I I I U U I IL U U 11 1 I 1 LAVATORY I I . it ti I. II U I. 11 1 I I U ROOF DRAIN 11 1 1 I U 1 I I U II- I. I I SHOWER STALL 1 1, 1 U 1 U I U U U 1 1 EL. SERVICE/MOP SINK I _1 U 1 I I l 1 1 1 - 1 TOILET l URINAL L U I IL U U 1 1 U U U U 1 - .I WASHING MACHINE CONNECTION . 11 L I U U U I U U I J II_ _1 WATER HEATER ALL TYPES I I L I I I. U U I I I L u .l . L.. WATER U e I. PIPING U L 1 IL II U U I I L .. OTHER 1 U 1L .11J It I ._ � t li 1 t t_ _ d 1 It I .J 1 1 1. II L l_ _ 1 I. I 1 L Lilt 1 1 l l L 1 1 U 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 I i I 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. CHECK ONE ONLY: OWNER AGENT ❑ 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 -: of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn. 'h - Pertinent pr'vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ PLUMBER'S NAME James Pazakis LICENSE# 15030 ATURE MP i JP❑ CORPORATION 0# C-3984 PARTNERSHIPO#— LLC❑# COMPANY NAME JM Pazakis Inc. ADDRESS 447 Old Chatham Road CITY South Dennis STATE MA ZIP 02660 TEL 508-385-9127 FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES y/a3/l g &,vt7ea 2 o i Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /Uor I r ., YET- , FEE: $ PERMIT# Y76/ g1/1 It Q k < �0LOl13 Ill PLAN REVIEW NOTES 7� (fie Get ) ) r1 QAmas A 2€ allele re,o -