HomeMy WebLinkAboutBLDP-23-0019841 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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uMA_ -_ CITY YARMOUTH
DATE 10/13/22 PERMIT# BLDP-23-001981
'l' JOBSITE ADDRESS 443 STATION AVE OWNERS NAME MARTIN JOHN F JR TR
P OWNER ADDRESS WAREHOUSE NOMINEE TRUST 47 FARM LN SOUTH DENNIS,MA 02660 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑
PRINT
CLEARLY NEW:D RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑
FIXTURES 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 1
INTERCEPTOR(INTERIOR) 1
KITCHEN SINK
LAVATORY _ 4
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK _
TOILET 4
URINAL ,
WASHING MACHINE CONNECTION _ 1
WATER HEATER
WATER PIPING 1
OTHER 7
OTHER DESCRIPTION:hand sinks
3 compartment sink
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 0 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
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 1b496 SIGNATURE
MP ❑ JP ❑ CORPORATION ❑It 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
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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CITY MA DATE i PERMIT# Z f t cj 7
JOBSITE ADDRESS ' NER'S NAME: )7 / dJ `
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑
PRINT
CLEARLY NEW: RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑
FIXTURES Z 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/01USAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
FOOD DISPOSER —�
FLOOR/AREA DRAIN �jr 4
INTERCEPTOR(INTERIOR) 1� j ` •
KITCHEN SINK
LAVATORY /71) / _ ______
1 N o
ROOF DRAIN 1 "'' _` 7 I�0
SHOWER STALL
SERVICE/MOP SINK j BEIT 12 7fl22 ,
I TOILET 4/ fi
URINAL
R1 i I niNi: 11FP4 RTME NI;
WASHING MACHINE CONNECTION I By ,_
WATER HEATER ALL TYPES
WATER PIPING
OW � /ir7 D .3k' -
e 'e)//Ar 5/it//(:_. j. .---- ,
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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
LIABIUTY 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
11 Massachusetts General Laws, and that my signature on this permit application waives this requirement.
•
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
VI I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ccurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complianc w' all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME I P74 Alf ti 1 i'fe VI��LICENSE# / 7 q SIGNATURE
MP JP RPORATION❑# PARTNERSHIP❑.# LLC❑#
Alf COMPANY NAME / iir Cttit, r ADDRESS_- Akr�/ V CITY Y STAT ZIP '2 TEL;,�v 7& J,?_t
FAX CELL EMAIL/
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