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HomeMy WebLinkAboutBLDG-23-006049 , MATSSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �� CITY YARMOUTH MA DATE May 03,2023 PERMIT# BLDG-23-006049 �I JOBSITE ADDRESS 47 NICKERSON FARM WAY OWNER'S NAME CHRISTOPOULOS DANIEL G OWNER ADDRESS 27 MAKEPEACE LN SOUTH DENNIS 02673-0000 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL III PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES ❑ NO FIXTURES FLOORS—> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 BOOSTER CONVERSION BURNER COOK STOVE 1 DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE GENERATOR 1 GRILLE 1 INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 1 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 0 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 of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME BRADLEY TOMASETTI LICENSE# 16544 SIGNATURE MP© MGF ❑ JP 0 JGF 0 LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: TOMASETTI PLUMBING ADDRESS. 103 UNION ST, CITY YARMOUTH PORT STATE MA ZIP 02675 TEL FAX CELL EMAIL tomasettiplumbinpAgmail.com s�* 4 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 4.,-Pip r,1'4 ice, DATE 5 2/Zo23 pEFt 1'"# 23"-c7 JOBSITE ADDRESS 7 n i�ki-- Yarn-. y OWNER'S NAME a As?I G1ffS a0Q, OWNER ADDRESS / TEL FAX TYPE CAR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALi' PRINT CLEARLY NEW:l,ENOVATION: 0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO❑ APPLIANCES 1 FLOORS—► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 i BOILER I BOOSTER CONVERSION BURNER - ] COOK STOVE 1 DIRECT VENT HEATER _L.__ DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR I. GRILLE / INFRARED HEATER 1 LABORATORY COCKS OVEN MAKEUP AIR UNIT _ �( � 0 POOL HEATER ) � _ _ ROOM I SPACE HEATER HAY a 2 tl ' i ROOF TOP UNIT TEST -. MEN i ... . .. . .__. . . . .. . .- ...._ ..-.._ It, �N�x UNIT HEATER Bu't>Dir ' - UNVENTED ROOM HEATER aY WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA Y 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 vl, 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 oomph with all Pertinent provision of `` Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �J PLUMBER-GASFITTER NAMEJ3-4,0(/c i-A- LICENSE#1/51141 SIGNATURE MP/GF❑ JP 0 JGF❑ LPGI 0 CORPORATION 0 it PARTNERSHIP❑# LLC❑# COMPANY NAME 0"4S'-4 * t4. ? J ADDRESS 3 1'f ,7 S f CITY-.-Tex.I '',y� / -/1Is STATE /1/4 ZIP .00673� TEL FAX CELL 5-0 i Z z L OII EMAIL ;c Se1T.-i0kte j 9014 d. Ce Psi 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 • • r