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Home My WebLink AboutBLDP-23-00408 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 1/24/23 PERMIT# BLDP-23-004083 ma's, JOBSITE ADDRESS 9 VICTORY LN OWNER'S NAME RINALDI ANDREA L P OWNER ADDRESS 41 NAUSET RD WEST YARMOUTH,MA 02673 `_ _ _TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO El FIXTURFS FLOORS—• BSM 1 2 3 4 _ 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 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 1 SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER 1 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 El 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 1;5496 SIGNATURE MP El JP ❑ 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 MASSAC USETTS UNIFORM APPLICATION FOR A ERMIT TO PERFORM PLUMBING WORK T.—'�T' CITY ` {/ /y ' (/ �1/ MA DATE =1_{—a` / PERMIT# t 3 11040 JOBSITE ADDRESS Il'C�n 7 OWNERS NAME 0 L- . POWNER ADDRESS t TEL FAX TYPE OR OCCUPANCY TYP COMMERCIAL EDUCATION ❑ RESIDENTIAL lEr----_ PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMI I I ED: YES 10❑ FIXTURES 7 FLOOR 8SM 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 SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR!AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK _ LAVATORY _ ? �— ROOF DRAIN ;��N °�Q I Jr--SHOWER STALL �' . SERVICE/MOP SINK r NH 0 MEN r TOILET _r„ 6Ui Dlt URINAL p_`_ . i WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER I(- -- j ll 1 i 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 OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY 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. 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 a 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 complia th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS LICENSE# / / a • SIGNATURE MP JP CORP TIONr # PARTNERSHIP❑.# LLC❑# COMPANY NAME tG !1/L- I ADDRESS 2-- '/ (1- u l j`plot/ V CITY / Mo C/7` / STATE ,��'�l`i� ZIP TEL L I FAX CELL EMAIL . n 1 ) ' 1 C16-4lD�b /.5 tip �l /Z� 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