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HomeMy WebLinkAboutBLDG-23-001332 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i,H CITY YARMOUTH MA DATE September 13,202 PERMIT# BLDG-23-001332 h f=1 /Fe JOBSITE ADDRESS 22 EDGEWATER DR OWNER'S NAME PEZZELLA PATRICIA M G OWNER ADDRESS 16 ADAMS FARM RD SHREWSBURY MA 01545 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 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER • FIREPLACE FRYOLATOR FURNACE GENERATOR 1 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 ❑ 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 LICENSE# 15496 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ 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 bendiamant000ulos(a.gmail.com S310N MIA NVId #11INN3d $ 33d ❑ ❑ 110183d 3H1 Stl SAS SIH1 oN so). S310N NO1103dSNI IVNId AINO 3Sf1 210103dSNI NOd 3OVd SIHI S31ON N01103dSNI SVO HOflO2J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rf a'--'-a:•;-1;71 CITY MA DATE 1 PERMIT# 5.— 1 - 3 Z-- tZ JOBSITE ADDRESS I. flNER'S NAME / ".....r.--- --1-.1„4 1 GOWNER ADDRESS ! I TYPE OR OCCUPANCY TYPE COMMERCIAL.1 EDUCATIONAL J RESIDENTIAL PRINT CLEARLY NEW: __J RENOVATION: 1 REPLACEMENT: t PLANS SUBMI I I ED: YES . NO T( APPLIANCES 1 FLOORS-{ BSM 1 2 3 14 5 T 6 7 8 9 10 11 12 13 14 BOILER i11.._..J __I _._.._1 I_____ ___i __..1 .____J!____..I __.___J ___j.-J • •••••_._.. ........_..1, BOOSTER .____I J l 1 r 1_,__U 1 _I,I, __I , 1 1 C 1 _I CONVERSION BURNER 1 __._ I ,_1 —I __I ____I _ J f ____1 ____1 _. I __I_ 1 ____1 __I COOK STOVE I ----I _...r,_j.___._-1+ ,._L... _--___J: 1_____I --_.:____I _.r--1�__._ I --—J 1 DIRECT VENT HEATER ' _.1 _1; _____J _� _-_—___f_.._—I 1 __ _ — I �'__ 1 DRYER • ____I 1 __—___1 ___J _I . ! 1-1 .__..._.I, * C I _ I,_ I ___1 .___J FIREPLACE ..�._ + — _ 1•--1 _1 1 �J —_�_ .__��.__ i_I __I I I,—I --� _ - FRYOLATOR 1 I. —I ._ _.I: _ I 1 1 ________I ____I _ ►, _,__ 1,._._____I ._..__.J __1 FURNACE - T. ' . __ Ir - 1 __ _ -- A I I ._____I t 't _______I _____J _i I, GENERATOR I ... I I, ,� 1 I} 1 i .___t _____,I. 1 _1 ...__..._ - i GRILLE _______.i . . . ?,__:..._1 , ____.1 . 1 �.I __I f _ _I _ INFRARED HEATER I S r�_J- r I._._' 1 _1 . 1_'_1 ,-,i 1 I _1 ..-__ J -- LABORATORY COCKS I - _ --1 ______1 _j___—__i ! _._..J L____I _.___1 _----1 .— _ _____1 ______1 MAKEUP AIR UNIT . . -._. _I ,_._,__.1 _1 - 1 I ..____J J _I ____ ..1 _i 1 ..._.,_._ '.___.__.1 OVEN _ - 1 _ _1 i 1 I _,..,__,__i _ _ 1 I .._.._-1 1 ...-____ I ____I I POOL HEATER .._,_,J.___10_1 ..._.d 1,.,- 1 ------1 _I .....1__,J ______I 1 ...._._.. .w.kmpowJ .__-._....1 I . 1 ROOM /SPACE HEATER I A_____1 ' I . I - 1. E 1 I y �I : ___ ! I 1 ROOF TOP UNIT , TEST i 1 r .......... ._.___.' _...__r+ 1 I _ ___ _-fe-_ UNIT HEATER UNVENTED ROOM HEATER ____.1 .... , ,,___ . ., ____j I — .___.1 ___LI _3 i __-1 .---.J 1\—_It WATER HEATER ._. ___ --_ - - -+ , 1 I, I . I I I ____I,._.._--. , J I s ___ 1 —a OTH t ER __ ► 1 - I _ 1 ..__� 1 ___J .__._1 _.,_1 1 1 1 1 I + _ I 3 - -- J 1 i 1 1 .7 1 .___._._J { 1 I . . i: I I I ' ' I I _+ ___J 1 1 — '. INSURANCE COVERAGE _ I have a current liability insurance policy or Its substantial equivaien c meets the requirements of MGL. Ch. 142 YES NO U I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _._, OTHER TYPE INDEMNITY _ LIABILITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licenseedoes 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 _! AGENT ._..; SIGNATURE OF OWNER OR AGENT i hereby certify that all of the detas and information I have debmitted or entered regarding this application are true and accu to 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 II inent provision of the Massachusetts State Plumbing C••e and Chapter 142 ofe General Laws. PLUMBER-GASF R NAME 44 L ® Ufa ill, / ,� r ' ENSE# R Si ATURE 1 MP F V---- JG -1 LPGI _j CORPORATION _ I# 1 PARTNERSHIP !# I LLC J# I COMPANY NAME: f _ t ADDRESSZT____. A w its CITY zigm .I -3 - if- I STATE . IP • A� L " I �- I r �•_ FAX j CELL - JEMA1L / ' / - 0IA ' IIt ,_ * r I . i .. _ A \ --,-1' , . T D Email . SEP 12 2022 �_ . BU ►CS)I G4 E By