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HomeMy WebLinkAboutBldg-22-002488 ./ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK stte c' CITY YARMOUTH MA DATE November 01,2021 PERMIT# BLDG 22 002488 JOBSITE ADDRESS 745 WILLOW ST OWNER'S NAME Kevin Keating G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ID PRINT CLEARLY NEW: m RENOVATION:❑ 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 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 El 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© MGF ❑ JP❑ JGF 0 LPG! 0 CORPORATION 0# PARTNERSHIP 0# 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 ❑ 0 FEE:$ PERMIT# PLAN REVIEW NOTES i EltIT SACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ . i _ LayR•—=a r 11 _,. �_; Y ' AR OUTH _ - MA DATE,�'Q-27-; / 'PERMIT# ZZ- 2yg� r ,. r PRESSI7 - A/1610w cliv. OWNER'S NAME j 4-ae�J-..e ,cot,�''.� rl DE"gRTMENT _ t BUI ..RESS ___._____� ___ ,fQ$_ �Z _�1s'�_. FAX 'PE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL ! 1 RESIDENTIAL; h PRINT .. CLEARLY NEW:;.t RENOVATION:'._ REPLACEMENT: ` ' PLANS SUBMITTED: YES- NO " APPLIANCES Z FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER M--hIIIIII BOOSTER I CONVERSION BURNER IMTIMIMIIIIIIIIMIIIIIIIBIIMIIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIBNIIIIINIMIII COOK STOVE MINTIA f f DIRECT VENT HEATER 1�M- I' i --11111111111111IMMI DRYER MONIMIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIIIIIIINIIIMIIIIIIIIIIIIIIIIIHM FIREPLACE � �I FRYOLATOR FURNACE I I ''I 1 I GENERATOR nimMIM11111111111.11111111111M11111111.11.111.11111111111111110- GRILLE MMIFTNIMIIIIIIIIIIIIIIIIIIIIIMINITINIMINIMIIIIIIIIIINMON INFRARED HEATER IIIIIIIIIIIOIIIIIIIIIIIIIIIIIIIIIIIEIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIINIIIIIINIINIIA LABORATORY COCKS I I II I V I • MAKEUP AIR UNIT I^- II I I ( I OVEN I VINIS I Ii I IIii I FI POOL HEATER „f WB M L ROOM I SPACE HEATER IIIIMIIIIBIIIIMNNIBIIIBIIIIIUIIIIIIIIIIIIIIIIIIIIENIMIIIMIIIIIIIIIIIIIIIIII ROOF TOP UNIT luuuiMMTOMIMIIIIMINIIIIIIIIIIIIIallaillIllMillaillIlIllillMIIIII. TEST 111111111101111 I iiii UNIT HEATER FNM-T-M-IMIIIKETIWMTIIIIIIIIIIIIIIIIIIIIINIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII UNVENTED ROOM HEATER IM-IMBIMIIIMMITIMMIIIIIIIIIIIIIIIIIIIIIIIIONTIMMIINI WATER HEATER 1 ismi I-- ICI=1 I I I MfNNIMI OTHER I I IM1 'I �� I I I I ___ III (( 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 COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND [ ry • 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 `__, 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 •- of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli e with all Perti ' ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME KEVIN LAMOUREUX LICENSE# 15383 IG ATURE MP MGF it , JP [j JGF i a LPGI Ej CORPORATION:- ,# PARTNERSHIP' '#{ #LLC • - __ COMPANY NAME:ILAMOUREUXP__ ._._.._LUMBlNG AND HEATING ;ADDRESS'61 JOBYS LANE CITY OSTERVILLE STATE MA ZIP F02655 TEL 508 420 2068 IEMAIL LAMOUREUXPLUMBING VERIZON.NET FAX FAX 508-420 7992 CELL 508-292 5085 � I