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HomeMy WebLinkAboutBLDG-22-004404 Y N • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _` � CITY YARMOUTH MA DATE February 08,2022 PERMIT# BLDG-22-004404 1i JOBSITE ADDRESS 31 ASPINET RD OWNER'S NAME DOOLAN GRAHAM J G OWNER ADDRESS DEMPSEY MARY 31 ASPINET ROAD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:0 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 GENERATOR 1 GRILLE INFRARED HEATER • LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER 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❑ 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© MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC 0# COMPANY NAME: BENJAMIN DIAMANTOPOULOS ADDRESS. 25 ANTHONY RD, CITY W YARMOUTH STATE MA ZIP 026733776 TEL FAX CELL EMAIL 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 - , • A'• MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `d^ Jy 11 PERMIT ZZ 9'1G�1 war CITY /, - Zv1O 1)7 MA DATE JOBSITE ADDRESS S I /apt T OWNERS NAME D - l Al G / OWNER ADDRESS -AM r. TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO V APPLIANCES i FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 -13 1! BOILER BOOSTER CONVERSION BURNER _ COOK STOVE DIRECT VENT HEATER DRYER I FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT1 : . OVEN L__ POOL HEATER • CEIVE ROOM I SPACE HEATER ROOF TOP UNIT TEST . ._ EB - UNIT HEATER UNVENTED ROOM HEATER , I, RI www nisi TMF T _ WATER HEATER By: OTH&Ew e 7-Ca, INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of 1 GL.Ch.142 YES EairEl I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE NECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ I • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the I Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 4- I hereby certify that all of the details and information I have submitted or entered regarding this application are true and acc rate 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 wi all Pertinent provision of the �'` Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER AME n ATTorc I(OD/".-- SIGNATURE MP MGF JP JGF LPGI CORPORATION 1F PARTNERSHIP f ❑ ❑ � � ❑�� LLB❑# COMPANY NAME / O.LMfLi PH1 ADDRESS tDD 4- / \J T�V/V Y RI CITY ffilf--141) STATE-_= __ ZIP 0 / 5 TEL FAX CELL 51 5‘U 3q'1 EM U V ,, ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTE Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 • FEE: v PERMIT ft PLAN REVIEW NOTES • •