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HomeMy WebLinkAboutBLDG-23-003722 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK / CITY YARMOUTH MA DATE January 09,2023 PERMIT# BLDG-23-003722 JOBSITE ADDRESS 303 ADMIRALTY HEIGHTS VILLAGE OWNERS NAME FRANKLIN MICHAEL C G OWNER ADDRESS FRANKLIN JILL H 1 LEXINGTON CIR CANTON MA 02021 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ 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 DRYER FIREPLACE 1 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 El 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 IKEVIN LAMOUREUX LICENSE# Massachusetts SIGNATURE MP 0 MGF ❑ JP 0 JGF 0 LPG' 0 CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: IKEVIN LAMOUREUX PLUMBING I ADDRESS. 161 Jobvs Lane, CITY (Osterville STATE MA ZIP 1026553518 TEL I FAX I CELL I I EMAIL I