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Home My WebLink AboutBLDG-23-001980 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `;" CITY YARMOUTH MA DATE October 13,2022 PERMIT# BLDG-23-001960 U JOBSITE ADDRESS 443 STATION AVE J OWNER'S NAME MARTIN JOHN F JR TR G OWNER ADDRESS WAREHOUSE NOMINEE TRUST 47 FARM LN SOUTH DENNIS MA 02660 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL J❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 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 2 • FURNACE 2 - GENERATOR - GRILLE 1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN 2 POOL HEATER ROOM(SPACE HEATER • - ROOF TOP UNIT TEST 1 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 ❑ NO 0 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 plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision al the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Benjamin Diamantopoulos LICENSE# 15496 SIGNATURE MP 0 MGF❑JP 0 JGF 0 LPG( ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: BENJAMIN DIAMANTOPOULOS ADDRESS. 25 ANTHONY RD,25 ANTHONY RD CITY W YARMOUTH STATE MA 1 ZIP 026733776 TEL FAX CELL EMAIL bendiamantopoulosaomail.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 ' MASSACHUSETTS UNIFORM APPLICATION FOR A ERMIT O PERFORM GAS FITTING WORK . ��" CITY Ylif(2-1nn/'� ,_. "l V �� MA DATE /O/, / ERMlT fr z- 9 S V JOBSITE ADDRESS r r AINER'S NAME —D GOWNER ADDRESS TEL FAY, TYPE PRINT OCCUPANCY TY COMMERCIAL E itLNT DUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW: RENOVATION: ❑ REPLACEfvMENT: ❑ PLANS SUBMITTED; YES IVO❑ APPLIANCES 1- FLOORS-4 BSM 1 2 3 4 5 6 7 BOILER 8 9 to 11 12 13 tp BOOSTER CONVERSION BURNER COOK STOVE - MI DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE r9— - GENERATOR GRILLE - INFRARED HEATER Aj LABORATORY COCKS MAKEUP AIR UNIT --. OVEN --f POOL HEATER • ` r' ROOM I SPACE HEATER ROOF TOP UNIT i r A - TEST �/ 1 " pCyr .1 l,1 li UNIT HEATER _ iP— UNVENTED ROOM HEATER - " .. WATER HEATER �l! i'ir�G =rAK a n, I OTHER • �' - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equ' lent which meets the requirements of MGL Ch.142 YES J NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE GE BY 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 my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ J 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 wit rtinent provision of the �`` Massachusetts State Plumbing Code an Chapter 142 of the General Laws. Lo /�/ PLUMBER-GA TTEP AME LICENSE# /5-ei, SIGNATURE MP Z] v1GFAe, JGF f I❑ CORPO TION❑# feA.R #� LLC❑# COMPANY NAME q r ADDRESS --/-i Rrt 9 g 11.,P f r CITY Y412.1ttt Ii1 j- STATE G ZIP TEL 5 ./ FAX CELL EMAIL �� LOL;tvse YV c, cr ti I I i G1 0 • 1 2 11 rat co-.1 ,....1 I 1 1 i ; ,.❑ z ISO �' • U: G'1 0 w G Gx1 h S Ra E-- rat G C. co co 14 us �" a.. dam• i 1 i I �, I 0 . G 1 .. 0 iE 1 I cri C. I