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HomeMy WebLinkAboutBLDG-23-000439 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I7 CITY YARMOUTH MA DATE July 27,2022 PERMIT# BLDG-23-000439 JOBSITE ADDRESS 15 JUDAN WAY OWNERS NAME IKESHISHIAN VARTAN G OWNER ADDRESS KESHISHIAN SEDA EBRAHIMI 17 MORNINGSIDE LN LINCOLN MA 01773 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS-+ BSM 1 2 3 4 5 6 7 6 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 OTHER 1 OTHER DESCRIPTION:piping repair 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 INDEMNITYE 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 James Portanova LICENSE# 11999 SIGNATURE MP©MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: JAMES M PORTANOVA ADDRESS. 122 NORTH RD, CITY 'DENNIS PORT I STATE MA ZIP 02639 TEL I FAX CELL I I EMAIL liamesportanova(rDgmail.com S310N M3IA321 NVld #1I1A213d $ :33d El 0 'Mad 3H1 Sd S3A213S NO11V311da SIHI oN seA S310N N01103dSNI 1VNH NINO 3Sfl t10103dSNI 2iO 13JVd SIHJ S310N NOI103dSNI SVD HOflOH _ p _ •-ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,t CITY v-v►�cs l,l��- ��.,r.�.� hM'�. DATE 7-26 `2.7r PFFtMIT� Z3 - vL13`7 2 • g4IT AD RESS �� J U" OWNERS NAME -5ili�1.1rc---"- BUGDE ififIVIC6MUrRESS 5 TEL r7'2-.;3' 1 33. nY PR,:.. 00CUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[ CLEARLY NEW:❑ RENOVATION: �� I� REPLACEIJIENT: IDPLANS SUBMITTED: YES 0 IV08 APPLIANCES FLOORS-� 6.M 1 1 3 4 5 6 l 9III t1 t2 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER I DRYER FIREPLACE i FRYOLATOR _ FURNACE GENERATOR GRILLE _J INFRARED HEATER LABORATORY COCKS _ MAKEUP AIR UNIT OVEN POOL HEATER ROOM!SPACE HEATER - ROOFF TOPUNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER I 10 1 tot_- re-491 u `e.<c./k- ii INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND El OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachus : en, • , s,and that my signature on this permit application waives this requirement. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ AGENT ``1•• 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 wit II Pertinent provision of the �' Massachusetts State Plumbing and Chapter 142 of the Li.,), CodeP General Laws. ! Q�� ,Q PLUMBS .7ASFITTER NAME LICENSEI #-/ SIGNATURE MP . MGF❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC 0# COMPANY NAME ADDRESS ZZ itic-I i-L--.51--- CITY '..5 STATE ZIP 62-6 S e\ TEL 5 (.78 3?"C- / 73 FAX CELL EMAIL ---------------- --- ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES `{e5 No THIS APPLICATION SERVES AS THE PERMIT FEE: $ PERMIT # PLAN REVIEW NOTES