Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
BLDG-23-006019
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK %, CITY YARMOUTH MA DATE May 01,2023 PERMIT# BLDG-23-006019 JOBSITE ADDRESS 30 LUCERNE DR OWNER'S NAME RICCIARDELLI KEVIN G OWNER ADDRESS RICCIARDELLI LAUREE 5 WALNUT HILL RD MILLIS MA 02054 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ 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 DRYER FIREPLACE 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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 KEVIN LAMOUREUX LICENSE# 15383 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 61 JOBYS LANE, CITY OSTERVILLE STATE MA ZIP 02655 TEL FAX CELL EMAIL t.,...) MASSACHUSETTS S'UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY BARNSTABLE 3 MA DATES : .--oZ PERMIT#QL/J G-Z3 to p/9 JOBSITE ADDRESS'- 4.) �4.9 Dr:,e ire 'OWNER'S NAME r_ic.ei/ 'e e1>G ' i OWNER ADDRESS e TEL 677-242 -__o 1FAX1__ __A___ TYPE OR _-OCCUPANCY TYPE COMMERCIAL,-1 EDUCATIONAL f -- RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: __: REPLACEMENT: ✓ PLANS SUBMITTED: YES NO !/ APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 5 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE ` DIRECT VENT HEATER DRYER FIREPLACE , l!, !I FRYOLATORpi FURNACE i GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT 1 TEST 1 UNIT HEATER 1 r__._ II I UNVENTED ROOM HEATER 1 1 ' WATER HEATER — r - -�. —,, OTHER S fie ;/) I I 'i r. , e. ,i ,e/"' , . n __ .1. .4. ,iiinium,• . ..TV' T INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES NO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE:POLICY -` OTHER TYPE INDEMNITY BOND j 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 ;. I AGENT 1__--1 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 wiil be in oomph- with all Perti t pr,vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. iw ...1 /I 0,4 ,• . ./ PLUMBER-GASFITTER NAME IKEVIN LAMOU X 1 LICENSE#115383 "'I ATURE MP HI MGF 1 JP;1 JGF ri LPG'E ) CORPORATION 1#1 1 PARTNERSHIP 1 1# LLC rittr 1 COMPANY NAME:tKEVIN LAMOUREUX PLUMBING i ADDRESS 161 JOBYS LANE CITY OSTEIIVILLE R STATE. MA ,ZIP 02655 TEL'508-420-2068 FAX I508-420-7992j CELLI508-292-5085 JEMAIL I lamoureuxplumbinOverizon.net