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HomeMy WebLinkAboutBLDG-22-003873 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1p kzir CITY 'YARMOUTH I MA DATE 'January 11,2022 'PERMIT# BLDG-22-003873 JOBSITE ADDRESS 745 ROUTE 6A OWNERS NAME LUNNY FRANCES J G OWNER ADDRESS LUNNY JAMES E 745 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL©' PRINT CLEARLY NEW: m RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES NOQ 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 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 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY 0 BOND 0 OWNERS 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 at 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 win be in compliance with at Pertinent provision of the Massachusetts State Plumbing Cade and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 'KEVIN Lamoureux 'LICENSE E 'MA SIGNATURE MP 0 MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP 0# LLC❑#I COMPANY NAME: ' 'ADDRESS. 161 Jobys Ln, CITY 'Osterville 'STATE MA ZIP 102655 'TEL ' FAX 1 10ELL' 'EMAIL ' S310N M3IA32J NVld #lJV 2d $ :333 0 El 1I11H3d 3141 SV S3A213S NOI1VOIlddV SIHl oN saA S310N NO1103dSNI 1VNld /ONO3Sfl O103dSN12 0d 30Vd SIH1 S310N NOI103dSNlSVD HOf102i