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HomeMy WebLinkAboutBLDG-22-005441 ,� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�' CITY YARMOUTH I MA DATE (March 29,2022 I PERMIT# BLDG-22-005441 JOBSITE ADDRESS 216 WINSLOW GRAY RD OWNERS NAME 'Joel Dorce G OWNER ADDRESS MA 02452 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 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 I 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 0 NO El IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El 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 at 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 George Fotopoulos LICENSE# 10477 SIGNATURE MP©MGF❑JP❑ JGF❑ LPG( ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: GEORGE C FOTOPOULOS ADDRESS. 18 RIVEST CT, CITY [CHICOPEE STATE IMA I ZIP 010201241 TEL FAX CELL EMAIL none S31ON M3IA321 NVld #1I 1 d $:33d ❑ 0 11Wa3d 3H1 SV SaNES NOIIVOIldd`d SIHI oN saA S31ON NO1103dSNI 1VNId AlNO 3Sfl 210103dSNI 21Od 30Vd SIHI S31ON NO1103dSNI SVO HJf102i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY Yarmouth MA DATE 03/24/2022; 'I PERMIT # JOBSITE ADDRESS 216 Winslow Gray Road I OWNER'S NAME Joel Dorce GOWNER ADDRESS Same TEL 774-606-5072 _FAX i - I TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL .,: EDUCATIONAL RESIDENTIAL V' CLEARLY NEW: - RENOVATION le REPLACEMENT: ;;,. . PLANS SUBMITTED: YES NO APPLIANCES -1 FLOORS--' I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _wFv..._,._. ...M ._. ... __ __I.. ___1,. ..,. I I _ _ _ _1 ,� ..___. _ _____J BOOSTER / i .___I ____J I . . _I .. .m._I' CONVERSION BURNER ,,. ,. , ,,�„ 0 COOK STOVE ___I : ___I r I DIRECT VENT HEATER ..,M I ____J DRYER ..: I I ,,, 1 , :.,,, .. . . .- „... ... .�.,., .�...�,,,. 1 I FIREPLACE ::� :. I ,.�..,,a, w......._. .,, . ...,.. . ,:.. . :I `_....,, �... 1 _1 FRYOLATOR �.__.:M_:..., f . ._,.. J .P,.�..�.�.a I M l t FURNACE '_ I 1. .__.._....__I �.,.__I _....__..... _...__I __... „1 [____.1 I . J _ _' GENERATOR � F 1 _...__ . ....� m.. __: L . . ' v ,,,. �._, GRILLE . ,�:.� _ ._I _ m. '- , �. ..�. ,, ,..” . INFRARED HEATER .:..m.„ - . , . m. . ... __1.... _ _ LABORATORY COCKS ._....... . ,. ....ram ..:::. _ ..�., . .. , 1.,., .�.... , .,, ,, , is , , MAKEUP AIR UNIT .. .. '. w _. . . ... ..... _ ',..___I _I .. ...�,.A_: . , . _. _1 (._...�.... __I OVEN „„,1 ::: ___,_ n,:. I ,.. a ,.,, POOL HEATER .,. .__ _ :�..� . _, :,� .. : y ------- ROOM / SPACE HEATER .,,,.,�... 1 .�,, .� L _.�_.,..�.., :,. .. r, ... . r ,. j., _ ,, :„ ROOF TOP UNIT . .._..,_,,,,, 1 ,. « . ...4_J , ,,, ,,., TEST I: _., __ .. _ �. .�.... L.L..,,, . ..�.,,:..,. . 1 i __ __.1 I UNIT HEATER IW I .,. .... , . „ ,� _ ... UNVENTED ROOM HEATER . . __ _1 -. , _.. i ..... ..:�.... __J .o.�, J ___ . WATER HEATER .. __..I I ......� . „ , ,__ I _1 _I ...__ _I. ,.. .. OTHER I , . .. . . .. � f : I ___J �. . I . i 1 ...._.. L ______I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ife NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY :v/. OTHER TYPE INDEMNITY BOND L. 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 ' ,:' AGENT 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. uleil" 444 PLUMBER-GASFITTER NAME George Fotopoulos II LICENSE # 10477 - SIG TURE MP V, MGF JP JGF LPGI i CORPORATION 1# PARTNERSHIP ,;# I LLC # COMPANY NAME: JSN Services, Inc. € ADDRESS 193 Holyoke Street CITY Ludlow I STATE MA ' ZIP 01056 1TEL 413-583-2227 FAX I CELL I EMAIL w. ._....................„1 55i