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HomeMy WebLinkAboutBLDP&G-22-003809 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/7/22 PERMIT# BLDP-22-003809 ._ JOBSITE ADDRESS 99 WEST YARMOUTH RD OWNER'S NAME COTTO OLIVIA A P OWNER ADDRESS COTTO STEPHEN J 5488 HAVERFORD WAY LAKE WORTH,FL 33463 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURFS 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/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 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 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❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT 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 t6496 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME BENJAMIN DIAMANTOPOULOS ADDRESS 25 ANTHONY RD CITY W YARMOUTH STATE MA ZIP 026733776 TEL FAX CELL EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMIT# PLAN REVIEW NOTES G ,r - . HUSETTS UNIFORM APPLICATION FOR A ERM T TO PERFORM PLUMBING WORK 0-=_)_l=6� CITYitig V V !41 MA DATE PERMIT# LZ 3?0 r I ��'�' N 0 7 2022U�P J055nt A R, SS 9 i I -7- /fitteig0 V f R'S NAME t C b`0 P RING u oN R R:SS ‹_ /3714 g TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[I--------- PRINT ----r—~ CLEARLY NEW: ❑ 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR!AREA DRAIN _ INTERCEPTOR(INTERIOR) ` KITCHEN SINK _ LAVATORY - ROOF DRAIN SHOWER STALL SERVICE 1 MOP SINK ' TOILET i URINAL WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES WATER PIPING I OTHER i INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF AGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND 0 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. -- 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 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 compli with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. n `/ .--- PLUMBERS NAME15,. .m L1 LICENSE# / (( SIGNATURE MP JP Ll CORPORATION❑# PARTNERSHIP❑.# LC❑# COMPANY NAME X 1 H ADDRESS 2.5-- 1/ ! V 4" CITY yf I / Aat -n--/ STATE/O ZIP O 2 TE - _At •` is FAX CELL EMAI I ( I V , 104°0 U 05 e 9041 Y4 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT (l FEE: $ PERMIT it PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE January 07,2022 PERMIT# BLDP-22-003809 JOBSITE ADDRESS 99 WEST YARMOUTH RD OWNERS NAME COTTO OLIVIA A G OWNER ADDRESS COTTO STEPHEN J 5488 HAVERFORD WAY LAKE WORTH FL 33463 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 NO❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 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 ❑ NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY❑ BOND 0 OWNERS 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-GASFITTER NAME Benjamin Diamantopoulos LICENSE# 15496 SIGNATURE MP 0 MGF❑JP 0 JGF❑ LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC❑# J COMPANY NAME BENJAMIN DIAMANTOPOULOS ADDRESS. 25 ANTHONY RD, CITY IW YARMOUTH ISTATE MA ZIP 026733776 TEL FAX CELL 1 EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT CI ❑ FEE: $ PERMIT# PLAN REVIEW NOTES to It .__ , .) E D4SSACHUSETTS UNIFORM APPLICATION FOR A PERM T TO PERFORM GAS FITTING WORK li7-1-24*, +P /4'1OGITT(12MA DATE l j / ZPERIIT # TiO, JOBS TE 'DDRESS /111441/0 ,j w AME C-0 /� B ILDIIG�EPA TMENT B : -- —OWNER DDRESS ,, TEL FAX ,^. TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL IDEDUCATIONAL L RESIDENTIAL CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT PLANS SUBMITTED: YES - - APPLIANCES ❑ NO ❑ .L FLOORS-I EoyI 1 2 3 1 5 6 BOILER o 9 11 I.I 12 13 1! BOOSTER ----- CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER _� FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE ,______1 INFRARED HEATER — 1 LABORATORY COCKS MAKEUP AIR UNIT ` OVEN POOL HEATER ROOM ! SPACE HEATER ~"`— ROOF= Tf�PUNIT —� , TEST . UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE1 1 I have a current IEabifi insnrar�ce policy or its substantial e� uiv �Ei�AGE �4 which meets the requirements of NIGL. Ch. 142 YES \l0 [7:11-- I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE'. , •. ..BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 2 OTHER TYPE INDEMNITY ❑ BOND lij • OWNIER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance ' Massachusetts General laws, and that my signature on this permit application waives this recouuiremerage ntl>!rired by Chapter 142 of the CHECK ONE ONLY: OWNER ❑ AGENT SIGNATURE OF OWNER OR AGENT El L',i� I hereby certify that all of the details and information I have submitted or entered regardingthis application and that all plumbing work and installations performed under the permit issued for this application willbe i ace true and accurate to the best of my knowledge Massachusetts State Plumbing Code an hapter •142 of the General Laws. amplian e th all Pertinent provision of the `t.i, 4 PLUMBER-GASFITTEF, NAME .) '' LICENSE # SIGNATURE MP ! GF-ffr JP JGFGI CORPORATIOI.FC Rr1T1P /LADDRESS26nkThfC/UVJL5 # PA,P,TNEP,SHIP ❑ it LLC ❑ #1: COMPANY NAM - CY--- CITE( M r STATE r ZIPSir air TE ,5F3‘Q ,39 FAX CELL EMAI PIM ° if • V- / ) ( CY'S d r r . .- . ROUGH GAS INSPECTION NO`IES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: v PERMIT# PLAN REVIEW NOTES • • •