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Home My WebLink AboutBLDG-22-000508 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k-1,16IL. BLDG-22-000508 ,ii, CITY YARMOUTH MA DATE July 27,2021 PERMIT# Q` JOBSITE ADDRESS 10 DEBS HILL RD OWNER'S NAME MAYHEW MARY C G OWNER ADDRESS 10 DEBS HILL RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 111 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 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 1 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# MA SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: KEVIN LAMOUREUX PLUMBING&HEATIN ADDRESS. 61 Jobys Lane, CITY Osterville STATE MA ZIP 02655 TEL 5084202068 FAX CELL EMAIL S31ON M3IA32!NVId #11W213d $:33d ❑ ❑ 111183d 3E41 SV S3Ai13S NOI1V3IlddV SIHL oN soA S310N N01103dSNI 1VNId AlNO 3Sfl 2l0103dSNI NO3 30Vd SIHL S310N N01103dSNI SVJ HJl02!