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Home My WebLink AboutBldg-22-001718 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK kt.e CITY YARMOUTH MA— DATE September 24,202 PERMIT# BLDG-22-001718 t, JOBSITE ADDRESS 359 ROUTE 6A OWNER'S NAME Claire Bourdeau G OWNER ADDRESS 359 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES ❑ 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 1 , DRYER FIREPLACE , FRYOLATOR FURNACE , GENERATOR 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 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 KEVIN LAMOUREUX LICENSE# 15383 SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 61 JOBYS LANE, CITY OSTERVILLE STATE MA ZIP 02655 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 CI ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 21111 CITY YARMOUTH MA DATE /- 2� PERMIT# 22— I I JOBSITE ADDRESS ',S" geole, jc, OWNER'S NAME Ll jajr-e, ....Eaurdifixij GOWNER ADDRESS TELL.75/-% " FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL LI RESIDENTIAL PRINT CLEARLY NEW:L RENOVATION: 71 REPLACEMENT:U PLANS SUBMITTED: YES D NO Er APPLIANCES 1 FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 III I U Ii 1 U IL t BOOSTER I I IL U. 11 U t_ U U U U Ii 1 U CONVERSION BURNER J U J U U I1J 1U U . ,. _IL COOK STOVE 1 .11 ,I D 11I . . .. . . I DIRECT VENT HEATER J r / U U, I. I1 U 1. ii 1.L II 1. DRYER 1.J II . U Ii FIREPLACE FRYOLATOR J. i U. U- I 1 U U II U IJ. - . U U FURNACE � ( I U . . . U U. _1_ 11 11 . .. II U U I GENERATOR � ([ ..... _J, _. 11 E1, 1 J ., U. U. i.. _ .I GRILLE -U U U U _ I. t U U U1J11 INFRARED HEATER U 1 U, 11 Ii _ U El U U 11„ - -� LABORATORY COCKS J 1 U, U U __ _ U U U U ) MAKEUP AIR UNIT 1M U .. . II _11 , .. .. .0 , I. \ OVEN I 11 I POOL HEATER _1 U U U- 11 II U. U U U U ROOM/SPACE HEATER 1 El E. 11 11 I U U U U 1 U U U U ROOF TOP UNIT U. 11 ._-._If U _ _U-_ U-..w,.J ter TEST - � _ . -. . ..0 _..,., _ U _._IJ. .. .. .... UNIT HEATER _. Ii U U U .. IL.. _ U U U U U I U1 UNVENTED ROOM HEATER I . I U U_ J1 ( U U U U_ II tl WATER HEATER U U U II i - U U U t 1 .. U OTHER U I U _ IL U ._ U. JJ I I I I- . 1_ 1 I 1 I I lI _ lI INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Li OTHER TYPE INDEMNITY J BOND Li 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 D 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance ith all Pertinent pr si of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME KEVIN LAMOUREUX 1 LICENSE# 15383 SI AT RE MP 0 MGF U JP 0 JGF[J LPG]0 CORPORATION 0# PARTNERSHIP D# LLC D# COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING ADDRESS 61 JOBY'S LANE CITY OSTERVILLE STATE MA ZIP 02655 TEL 508-420-2068 FAX 508-420-7992 CELL 508-292-5085 EMAIL lamoureuxplumbing@verizon.net 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