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Home My WebLink AboutBLDG-23-004084 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK " 'F CITY YARMOUTH MA DATE January 24,2023 PERMIT# BLDG-23-004084 JOBSITE ADDRESS 4 WHALE RD OWNER'S NAME BARRY JAMES J TR G OWNER ADDRESS JAMES J BARRY TRUST 2005 35 JACKSON CIR MARLBOROUGH MA 01752 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: D RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO 0 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 I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER 1 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 ❑ 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 El MGF ❑ JP 0 JGF❑ LPG! ❑ CORPORATION El# PARTNERSHIP 0# LLC 0# COMPANY NAME: BENJAMIN DIAMANTOPOULOS ADDRESS. 25 ANTHONY RD,25 ANTHONY RD CITY W YARMOUTH STATE MA ZIP 026733776 TEL FAX CELL EMAIL bendiamantopoulos(a.pmail.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES _1_ _-. r (5 4Att)__ MASSACHUSETTS UNIFOR APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Iij___.. _ (s 1 �� CITY \-/ L1ti c— �%=-_s <' k�, D/AT�E L_P._RIvIITJ Z3 1/�(U'sf`I ' JOBSITE ADDRESS I t' / l vE ! OWNER'S NAME (��o�v GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL [] EDUCATIONA RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION: REPLACEh1ENT: PLANS SUBMITTED: YES❑ N0❑ APPLIANCES 1 FLOORS BSIul t 2 3 4 5 5 7 g 9 10 1 11 12 13 1 11 BOILER BOOSTER CONVERSION BURNER �-- COOK STOVE DIRECT VENT HEATER t --� DRYER ____________I FIREPLACE FRYOLATOR — FURNACE GENERATOR. GRILLE INFRARED HEATER I LABORATORY COCKS • MAKEUP AIR UNIT iji101. , „OVEN POOL HEATER 1 'f i ROOM(SPACE HEATER , 1 JAN 2S0 ZOO ROOF TOP UNIT - - L. i , [ , I TEST • . . . .._ . . . _. — pp BUILDING u=Msi+�:MErdll f .. -- UNIT HEATER f 'w. .— — UNVENTED BOGY`! HEATER WATER HEATER OTHER t------- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES RlO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF CoVEr2AG CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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 ray signature on this permit application waives this requirement, -, CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT `'t-• I hereby certify that all of the details and information I have submitted or entered regarding this application are true and curate 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 ' all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 'L PLUMBER-GASFITTER NAME LICENSE t,' /�� SIGNATURE I I,�.3 MP F E P.Er"--GF LPG!❑ i, ORATION❑fi PARTIVE ,SHIP El 4t LLC COMPANY NAME �V /' f� ADDRESS �,/ `,�j� /4 CITY YZj ' v T'' STATE / IP__27 J TEL" ' f C( FAX CELL EMAIL .7076 /a r Z A 0 ,c)0 , ie ?tWa( C- LC b cb (Iv, ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No • THIS APPLICATION SERVES AS THE PERT iIT ❑ 0 • • • • FEE: $ PERMIT# PLAN REVIEW NOTES