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Home My WebLink AboutBLDP-22-003562 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ‘Lriw,- CITY 'YARMOUTH MA DATE 12/28121 PERMIT# BLDP-22-003562 JOBSITE ADDRESS 24 PINE GROVE RD OWNER'S NAME Peter Afouxenides P OWNER ADDRESS LI PINE GROVE RD SOUTH YARMOUTH,MA 02664 I TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL m PRINT CLEARLY NEW:El RENOVATION:0 REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES 1 FLOORS-, RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 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 El NO El 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 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. PLUMBER'S NAME Peter Afouxenides LICENSE 32750 SIGNATURE MP 0 JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME (PETER AFOUXENIDES ADDRESS 48 RIVER ST CITY ARLINGTON STATE MA ZIP 024743540 TEL FAX CELL C EMAIL afoux33@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 ' ' n )q919 '0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK „ _ CM eiq 6rooc 141 ATEJ[d 7I PERMIT#EVôI1' l MA D 6:___ILL/ItZ1L4 JOBSlTE D ESS LOWNER S NAME fiFECAA_______.H___22.LS _ "")-- I TIP 2 gjER L CfYH1 V '1 1V tU` Qj-� T "L -)q-1y/" -i'�I ic FAX DD ESS.�. , B O tFQE AliC TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL ❑ PRINT- CLEARLY NEW: ❑ - RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO L - L FIXTURES 1 FLOOR-4 BSM w 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB - I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM - ') DEDICATED GREASE SYSTEM , DEDICATED GRAY WATER SYSTEM _ _ J (`-'.1 DEDICATED WATER RECYCLE SYSTEM (-Ni) DISHWASHER , DRINKING FOUNTAIN _ FOOD DISPOSER _ - o FLOOR I AREA DRAIN _ - INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK TOILET , URINAL - .� WASHING MACHINE CONNECTION 1 ,,,, WATER HEATER ALL TYPES I ' WATER PIPING OTHER , — - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 1 LIABILITY INSURANCE POLICY E] 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 0 I SI RE OF OWNER OR AGENT 1 hereby certify tha 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 incompliance with all Pertinent provision of the , Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ),e /- PLUMBER'S NAME Pe-fr( il�o0W1 IS LICENSE # , �� 4 .� SIGNATURE MP ❑ JP ❑ CORPORATION ❑ # PARTNERSHIP 0 # LLC ❑ # e� �� LigR Ivf A (e/hdei ADDRESS COMPANY NAMEPi CITY 14 i 1 I I STATE , I 1 ZIP ,,S7 �i) T-1 TEL C _ i - /66 3 EMAIL -PG !1 C' i rI , co fil — F ,.ELL rt" � 1 �� .._ � �� FAX 4.. r riliS ` c 3.31'