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Home My WebLink AboutBLDP-23-005209 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ireri ....... f CITY CRMOUTH MA DATE 3/22/23 PERMIT# BLDP-23-005209 -1.11.1F4, JOBSITE ADDRESS 9 HOMER AVE OWNER'S NAME CHRISTINA DEMETRIOU p OWNER ADDRESS 9 HOMER AVE SOUTH YARMOUTH 02664-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El 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 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 1 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER 2 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 El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSJRANCE POLICY❑ OTHER TYPE OF INDEMNITY 0 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 GEORGI VARGOV LICENSE 16972 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME IVARGOV MECHANICAL LW ADDRESS 28 WITCHWOOD RD CITY SOUTH YARMOUTH STATE Ma ZIP TEL FAX CELL EMAIL vargov.mechanical@gmail.com • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES$ _ PERMITS PLAN REVIEW NOTES '^ -, mesSACHUSETTS UNIFOR PTA M APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK '''---1- CITY L MA DATE .a PERMI # ``" R ADD ss q 1 t I i. — OWNER'S NAM L__. _._.. tt_ i\y TEL� '9a - QS3FAx B�N G� R�AiDB � � �1 n�� ar. TYPE OR T OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL C� PRINT PLANS SUBMITTED: YES 0 NO 0 CLEARLY NEW:0 RENOVATION:la- REPLACEMENT:0 6 7 8 9 10 11 12 13 14 FIXTURES Z FLOOR-4 BSM 1 2 3 4 5 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND 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 �� LAVATORY _ ROOF DRAIN SHOWER STALL MIMI SERVICE I MOP SINK TOILET —�� URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING _+= OTHER S: — INSURANCE �� l haveNO 0 a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX B❑ W LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 B 142 of the OWNER'S INSURANCE WAIVER:I am aware that the licensee d not have the insurance this requiree ment. eequ►red by Chapter Massachusetts General Laws,and that my signature on thispermitpp CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT this application are true and accurate to the best of my knowledge I hereby all certifyl that all of the details and information n I have rthesubmittedpermit enteredsissued for regardingPPI with all Pertinent o nowt med ithe and that all plumbing vvorc Plumbing and Chapterof the General Laws. this application will be in compliance �) -- . — Massachusetts StateSIGNATURE n . rl ! G�` LICENSE# r'i_1�r -�;, i PLUMBER'S NAME �e..c is t J f PARTNERSHIP❑# LLC 0# MP 0 JP 0 CORPORATION 0 -, r ADDRESS COMPANY NAME >n ff..11 TB. - My C .,,..►p_ — . I to STATE -- DP FAX CE11:1I!- 11 Z- 2P EMAIL I t( -w 1 Tk /. .. ...._ _f } .,t J, g; I t :}tr E'� i1 r?' i tan i:; t :144411430 Pt)I' 1,- �i_ __7 St t; # �,r i_'.F .j' ,tr(i63: ;;t{?+� .!.� J t - i S .� _ i. - . • lwqp i E ! fi ; ; ; _-._.._ 8 .fi t-iiii : r .._ xF" t !w c' ,al ;ntr K.. • arF, T t•: �� 7 • '!' y6 it t,, i'N_ : • ..