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HomeMy WebLinkAboutBldg-22-002257 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I ,e CITY YARMOUTH MA DATE October 19,2021 PERMIT# BLDG 22 002257 ` JOBSITE ADDRESS 39 VIOLET GLEN RD OWNER'S NAME peter karalexis G OWNER ADDRESS 39 VIOLET GLEN RD SOUTH YARMOUTH MA 02664-1718 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO❑ FIXTURES FLOORS--0 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 0 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 KEVIN LAMOUREUX LICENSE# 15383 SIGNATURE MP❑ MGF ❑ JP 0 JGF❑ LPGI 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 61 JOBYS LANE, CITY OSTERVILLE STATE MA ZIP 02655 TEL FAX CELL EMAIL S31ON M3IA3d NVld #JIV i3d $ :33d ❑ ❑ ±I1A1b3d 3H1 SV S3ANRS NOLLV3flddV SIHl oN s2A S310N NO1103dSNI 1YNId JCINO 3Sfl HO103dSNI H10d 30Vd SIHI S310N NO1103dSNI SVO HDflOH ce MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK � w 1 =:6.1�htiti�r6 ��= G CITY YARMOUTH MA DATE / /V:r f PERMIT# ZZ- ZZ C-J JOBSITE ADDRESS .37 1/70/e Cieh !s • =OWNER'S NAME /tee i(x4rtilel #+, GOWNER ADDRESS TEL 4l-7_iNia`0 37 FAX - TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL Li RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:L REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO liEr APPLIANCES-1 FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I 11Il U U II —! BOOSTER . . 1 . - 11 [ 1 . . . _..._ . .._ 1 IL I CONVERSION BURNER t . . .. ( ILt I 1 II I Ii -_ , COOK STOVE 1 i U . _ Il 11 ll ll ll . ll DIRECT VENT HEATER 1 B . / _ 1 I DRYER _ . ,' - I. t 11JI FIREPLACE L t ' II t 11 11 ._.. FRYOLATOR .. . _ - 1. FURNACE J U I IU - . GENERATOR I iL 11 __ _ _ . GRILLE I II. 11 11. INFRARED HEATER I r 11 IL_ - j.._ L LABORATORY COCKS I I II _ it MAKEUP-AIR-UNIT t -1 } II OVEN [ IJ I. L 1 J POOL HEATER . ___. . JI U _ ROOM/SPACE HEATER 11 I. _11... _11 _ l ROOF TOP UNIT ( 11 LIL .4_II� .� TEST llEt ... .__ - UNIT HEATER 11 _ Il _ II UNVENTED ROOM HEATER .. _ _1 ,. 111 WATER HEATER II ,1_ _ _ _ J I OTHER .�I �J II Il - Y JI I l iJ i l 1 U I iJ I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY Li BOND [ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts GineraTLaws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 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 complian - ith all Pertinent pr. isio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .�. _ / i , PLUMBER-GASFITTER NAME KEVIN LAMOUREUX I LICENSE# 15383 Sl L TUR MP EJ MGF JP U JGF© LPGI 0 CORPORATION Q# PARTNERSHIP L1# LLC Q# 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 1