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HomeMy WebLinkAboutBLDG-22-005845 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE April 12,2022 PERMIT# BLDG-22-005845 -,..:;- -di 5 JOBSITE ADDRESS 5 OYSTER COVE RD OWNER'S NAME LAMPMAN JON N CO-TRS G OWNER ADDRESS LAMPMAN JANET A CO-TRS 2083 PIERCE CT EL CAJON CA 92019 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 0 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 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# MA SIGNATURE MP 0 MGF ❑ JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: KEVIN LAMOUREUX PLUMBING&HEATIN ADDRESS. 61 Jobys Ln, CITY Osterville STATE MA ZIP 02655 TEL 5084202068 FAX CELL EMAIL S310N M3IA32J NV-Id #1IW213d $:33d El El 1100:13d 3H1 SV S3A$3S NOI1VoIlddV SIH1 ON SOA S310N NO1103dSNI IVNId AINO 3Sfl 210103dSNI 2f0d 3OVd SIHJ. S310N NOLL3 dSNI SVO HOflOi1