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Home My WebLink AboutBLDP-23-004085 - r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK re CITY YARMOUTH MA DATE 1/24/23 PERMIT# BLDP-23-004085 sr JOBSITE ADDRESS 4 WHALE RD OWNER'S NAME BARRY JAMES J TR P OWNER ADDRESS JAMES J BARRY TRUST 2005 35 JACKSON CIR MARLBOROUGH,MA 01752 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL C 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 DRINKING FOUNTAIN FOOD DISPOSER - - FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY 2 ROOF DRAIN SHOWER STALL - 1 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ 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. 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 plumting 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 15496 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME [3ENJAMIN DIAMANTOPOULOS ADDRESS 25 ANTHONY RD 25 ANTHONY RD 1 CITY W YARMOUTH STATE MA —I ZIP 026733776 TEL FAX 7 CELL 7 EMAIL bendiamantopoulos@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMITS PLAN REVIEW NOTES &Il /5t ryV)� MASSA HUSETTTSUNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY //) J �'q MA ,D/AJT�E, 2^ PERMIT# M JOBSITE ADDRESS "I W E ( 0Z1_/ 0 ER'S NAME Oct))I\J POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL[SI----.---- PRINT CLEARLY NEW:❑.RENOVATION: REPLACEMENT:[3----- PLANS SUBMITTED:YES NO❑ FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE _ DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GASIOILISAND 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 p ROOF DRAIN • 1r a At F_D SHOWER STALL ! F SERVICE/MOP SINK �13 TOILET ' f -JAN 2 p 1- URINAL _ `, WASHING MACHINE CONNECTION �' c Hti rME WATER HEATER ALL TYPES A T WATER PIPING '1 OTHER IC't(*- Jam' — , INSURANCE COVERAGE: ,_� I have a current liability insurance policy or its suhstanti equivalent which meets the requirements of MGL Ch.142. YES p NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE 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 J Massachusetts General Laws,and that my signature on this permit application waives this requirement r CHECK ONE ONLY: OWNER❑ AGENT 0 SIGNATURE OF OWNER OR AGENT LU 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 comp nce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the Generally Laws. / PLUMBER'S NAME l-�! m�T /-c t✓L CEN #l5-L`g6 SIGNATURE MP 1-21/;rCOMPANY NP E ,v0r CORPORAT 0 # /PARTNERSHIP6CCC�� ❑# LLC❑# CITY ` , L 'l 3 / ADDRESS STATE ZIP TEL - 05 FAX CELL EMAI (I OS Cl lvk iav — Y 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