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Home My WebLink AboutBLDG-23-005883 I . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK VZIffl CITY YARMOUTH MA DATE April 24,2023 PERMIT# BLDG-23-005883 ? <, JOBSITE ADDRESS 72 SEAVIEW AVE OWNER'S NAME ARNOLD SCOTT G OWNER ADDRESS ARNOLD GRETCHEN 47 RIMFIELD DRIVE SOUTH WINDSOR CT 06074 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES El NO El FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 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 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 El NO❑ IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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-GASFITTER NAME Dimosthenis Kapoukranidis I LICENSE# 34414 SIGNATURE MP❑ MGF ❑ JP El JGF El LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 9 Adams Road, CITY West Yarmouth STATE MA ZIP 026732401 TEL FAX CELL EMAIL MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CiTY: )/(1q- MA DATE CD 9/2..9t2 3 PERMIT# 3 0 JOBSITE ADDRESS: 7 _S'clav eu OWNER'S NAME: 5 L.014- A Y yi r G OWNER ADDRESS: 2/7 gm( -14 Dv 5,1k, 4pkc'TT7?.40 TYPE OR OCCUPANCY TYPE: COMMERCIAL El EDUCATIONAL 0 RESIDENTIALA PRINT CLEARLY NEW:0 RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES E:1 NO D APPLIANOES1 FLOOR-4 Bsmt 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 kA INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER I if E CF v ROOM I SPACE HEATER ROOF TOP UNIT t TEST L APR P 4 2023 z UNIT HEATER 14j UNVENTED ROOM HEATER euit n(Nc..DERA WATER HEATER R ME T INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 1:2 NO If you have checked YES,please Indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY 1,1 OTHER TYPE INDEMNITY 0 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. CHECK ONE ONLY: OWNER 0 AGENT ED 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 ance with all Pertinent provision of the Massachusetts State.Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME:1 tiria54ji hi kgrubictili Cti&NSE#34 itt GNATURE COMPANY NAME: ADDRESS: 9 44am( Ac) CITY: yeky Y4004-11 STATE: NA ZIP: 02.61 I FAX: TEL: CELL:_1109 661 8.7 6 3 EMAIL: lAcAPot-'1461h 71.(f.,(A4 MASTER ED JOURNEYMAN[g LP INSTALLER[3 CORPORATION 0# PARTNERSHIP Q# LLC D# E :