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Home My WebLink AboutBLDG-22-004177 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �' CITY YARMOUTH MA DATE January 26,2022 PERMIT# BLDG-22-004177 4, JOBSITE ADDRESS 136 KATES PATH VILLAGE OWNERS NAME Christine Young G OWNER ADDRESS 136 KATES PATH YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES 0 NO❑ FIXTURES FLOORS—. BSM 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 1 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 1 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 0 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 'Benjamin Diamantopoulos I LICENSE# 15496 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG' ❑ CORPORATION❑#I I PARTNERSHIP ❑# LLC 0# COMPANY NAME: IBENJAMIN DIAMANTOPOULOS I ADDRESS. 125 ANTHONY RD, CITY IW YARMOUTH I STATE MA ZIP 1026733776 I TEL I FAX CELL 1 I EMAIL I S310N M3IA32I NVId #±WJ d $ :33d 111%13d 3H1 SV S3A213S N011VOIlddV SIH1 ON SeA S31ON NOI103dSNI 1VNId AlNO 3Sfl I0103dSNI 2IOd 3OVd SIHI S31ON NOI1O3dSNI SVO HJl02i :i-'7`...,.. MASSA60-d0 ,. USETTS UNIFORM APPLICATION FOR A *ERM[T TO PERFORM GAS FITTING WO s Alf. - ..f- r RIB,6�r,. ` Cif I-E Ar �� V _ r MA 24. PERI T �. 2 Z � 1�7 ? JGBSIT Al DRESS ' %i r- , I � vttilVcR S NAME ; f )0. 2 6 202 O \I APARESc TEL Cy .. "� `Y ] 5 v04-1‘J Y TYPE COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: ❑ c PL�`11��1�, SUBMITTED: YES (,] NO ❑ APPLIANCES 1 FLOORS-+ EJSM 1 2 3 4 5 F BOILER 78 9 10 11 12 I; 1_ BOOSTER CONVERSION BURNER COOK STOVE , I DIRECT VENT HEATER I DRYER ; i FIREPLACE , _______.=._______j FRYOLATOR FURNACE k GENERATOR I GRILLE r INFRARED HEATER _ i , LABORATORY COCKS i MAKEUP AIR UNIT OVEN f r J POOL HEATERI ROOM / SPACE HEATER ROOF TOP UNIT - TEST - UNIT HEATER - UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current lial_AthLinsurance policy or its substantial equivalent which meets the requirements of �IIG� L. Ch. 1 42 YES ' NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAG • CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITYI • ❑ BOND ❑ I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required Massachusetts General Laws, and that my signature on thi, lication wJaives this by Chapter 142 of the permitapplication -- requirement. SIGNATURE OF OWNERCHECK ONE ONLY: OWNER AGENT CI OR AGENT `=�� I hereby certify that all of the details and information I have submitted or entered regardingthis and that all plumbing work and installations performed Linder the permit issued for this application application are true and . curate to the best of my knowledge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. pp cation will be in compliance it. all Pertinent provision of the 9 `j AllePLUMBER-G ` ITIER, AME /5 '/ LICENSE # 51G -,-UF,E MP I �1C-�E= P IBrj F 11" PG1 -'O PM-TION ❑ # PA,RTN`R,SHI P ❑ # LLC COMPANY ICI E ❑ #�: ADDRESS -- / it/U ' CITY • STATE _4W ZIP OF LI F - FAX A.� TEL ,�� CELL / ' A i • 'JW/4W ' EMAIL / , ^ ' �. . ROUGH GAS II(SPEC IION P'IOTES THIS PAGE FOR.INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT ft PLAN REVIEW NOTES