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Home My WebLink AboutBLDG-23-001871 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `••;C7—„,.7,11=--r- _`t CITY YARMOUTH MA DATE October 07,2022 PERMIT# BLDG 23 001871 JOBSITE ADDRESS 39 WEST WOODS VILLAGE OWNER'S NAME COHEN HAROLD(LIFE EST( G OWNER ADDRESS COHEN JACQUELINE 39 WEST WOODS YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:0 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 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY❑ BOND 0 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 plurr bing 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 Q MGF 0 JP 0 JGF 0 LPG! ❑ CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: EENJAMIN DIAMANTOPOULOS ADDRESS. 25 ANTHONY RD,25 ANTHONY RD CITY W YARMOUTH STATE MA ZIP 026733776 TEL FAXCELL EMAIL bendiamantopoulosa(gmail.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 MASSA HUSETTS UNIFORM APPLICATION FOR A P RIM TO PERFORM GAS FITTING WORK 77/ i:47 „�"' 1�4P, DATE �� PERMIT ( �f 7/ l If Z3 - - fi ,, NAME t OWNERJAD RESS ,/ j Buit DING CLwAt�rr�,�NT ' " t.'li TEL ��r 17`.F6�....2 a yTYPE_OR p T TYPE COMMERCIAL❑ EDUCATIONAL ] RESIDENTIAL 2-- — CLEARLY NEW:E RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES- FLOORS-4 BSM 1 2 ; 1 5 6 7 BOILER 8 5 11 11 12 '13 BOOSTER CONVERSION BURNER '— COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE --' - FRYOLATOR FURNACE 3r GENERATOR GRILLE —� INFRARED HEATER LABORATORY COCKS — -- MAKEUP AIR UNIT —� OVEN I POOL HEATER ROOM;SPACE HEATER — i ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATEF —• - I OTHER I INSURANCE GE I have a current Iiabiii insurance policy or its substantial equivalent which me is the requirements of MGL.Ch.142 YES NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVER , jy CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [r 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 Gancral Laws,and that l-ny signature on this permit application waives this requirement, SIGNATURE OF OWNER OR AGENT ONE ONLY: OWNER ❑ AGENT ❑ I hereby certify that all of the details and information I have submitted or entered regarding this application are true and a urate 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 ith all Pertinent provision of the '` IVMassachusctts State Plumbing Code and Chapter'142 of the General Laws. ,LjL PLUMBER-r, FIT rEF FLAME / LICENSE# l C SIGNATURE MPML;F Ea- JP JGF LPGI ❑ CORPORATION El# PP,R NERSHIP # COMPANY NAM- . �' /��/ � 1 EnLLC Cl � /�/'? It ADDRESS �� /'��)�� 7 �� CITY �/ i �/ C/ STATED ZIP /�75 , _ ,�,,.. ( ' -' TEL �- J J q j FAX CELL EMAI /Ltn )/ki a I C, eti)C-r ROUGH GAS INSFEGTION IVOTtES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES •