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Home My WebLink AboutBLDP-23-004081 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 9W-ff--WA CITY YARMOUTH MA DATE 1/24/23 PERMIT# BLDP-23-004081 JOBSITE ADDRESS 7 WATER ST OWNER'S NAME Two Cees LLC P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ 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 SERVICE/MOP SINK TOILET 1 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❑ 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 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 15496 SIGNATURE • MP ❑ 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 sr ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES I MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO PERFORM PLUMBING WORK I V YIA CITY MA DATE PERMIT#� �� 1 v JOBSITE ADDRESS C)/I T -7 WNER'S NAME �t VJ` �S'� POWNER ADDRESS / TEL FAX _ TYPE OR OCCUPANCY TYPE COMMERL❑ EDUCAT NAL ❑ RESIDENTIAL D------------ PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1. FLOOR- BSM 1 2 3 4 5 6 7 B r 9 10 11 12 13 14 BATHTUB l"� CROSS CONNECTION DEVICE ' DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER .1 \--5 :E----- 1); 1 _.__ DRINKING FOUNTAIN - NI__ FOOD DISPOSER 7:: FLOOR 1 AREA DRAIN _ JAPE 2 0 2V1 '1 4\_ INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY • E B t � UILD N� 'J . , z I M EN, t ROOF DRAIN sY " SHOWER STALL SERVICE!MOP SINK TOILET '� URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING y OTHER I _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TY F 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 t Massachusetts General Laws, and that my signature on this permit application waives this requirement. r 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 d 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 ce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 2 PLUMBER'S NAME LICENSE# /L�1_.Lq` ., SIGNATURE MP D_—. JP h:1---;:: t ) CORPORATION❑# PARTNERSHIP❑.# LLC❑# COMPANY NAME ()p /�- I p 4-14 ADDRESS �� /7/V P`-/c d V y CITY yilM4A STATE 1"(il*( ZIP 3 TEI50 c_ • ‘v C J FAX CELL EMAILki_(/4V2,/MI72,,bi7OC .) 6) i 141 C1C-4- lD I3u 0 z i 1 0 cxq G v] o� z �� W o oa. Q W co W Q U 0 0 J a a_ Q ter UJ Li 2 W F— U Cl) 0 z 0 I