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Home My WebLink AboutBLDP-23-005074 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK `; CITY YARMOUTH MA DATE 3/15/23 PERMIT# BLDP-23-005074 JOBSITE ADDRESS JJ,rz 24 HEDGE ROW OWNERS NAME CAMBAL BARBARA J TR P OWNER ADDRESS BARBARA J CAMBAL TRUST 24 HEDGE ROW WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO 0 FIXTURES FLOORS--J 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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 1 OTHER 1 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY 0 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 Benjamin Diamantopoulos LICENSE 18496 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME BENJAMIN DIAMANTOPOULOS ADDRESS 25 ANTHONY RD 25 ANTHONY RD CITY W YARMOUTH STATE MA ZIP 026733776 TEL FAX CELL EMAIL bendiamantopoulos@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 i3 /D P- Z3 --de): >>}. rRECEVED MASSACHUSETTS UNIFORM APPLICATION FOR A PER T TO PERPLUMBING WO -�� -� I �- �A� t � 28�3 -==1F= CITY /ILCCL)TLjMA DATE JOBSITE ADDRESS Lt' 0 NER'S NAME\ BO ill _ G 'r�.. T POWNER ADDRESS ,3' ( itC TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL El------ _ PRINT CLEARLY NEW: E RENOVATION: REPLACEMENT:[}— PLANS SUBMITTED: YES❑ NO❑ FIXTURES-1 FLOOR-' 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/OILISAND SYSTEM ' DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ' DISHWASHER r DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN , INTERCEPTOR(INTERIOR) r KITCHEN SINK LAVATORY ROOF DRAIN i SHOWER STALL SERVICE/MOP SINK TOILET ' )-1 ' URINAL WASHING MACHINE CONNECTION I WATER HEATER ALL TYPES WATER PIPING ,..} .... t OTHER INSURANCE COVERAGE: I have a current lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY EL.----- 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 i 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 I hereby certify that all of the details and information I have submitted or entered regarding this application are true nd accurate to the best of my knowledge and that all plumbirg work and installations performed under the permit issued for this application will be in compli nce with all Pertinent provision of the Massachusetts Sta.e Plumbing Code and Chapter 142 of the General Laws. iJ PLUMBER'S N ME��j ,-• LICENSE#/, �(/ /SIGNATURE MP � C ,1p CORPORATION❑# PARTNERSHIP/❑.# LLC❑# COMPANY NAME ( ocTPW ADDRESS 21 1 6`J/V Okq VffilZi/libt)-1-1-c CITY STATE11-44ZIP TEL5OB C� '1 L `' FAX CELL EMAIL Old t'a I �-1 VI V -Q ti S >441i 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 •