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Home My WebLink AboutBLDG-22-002371 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK g CITY YARMOUTH MA DATE October 25,2021 PERMIT# BLDG-22-002371 I JOBSITE ADDRESS 14 WOLFSON RD OWNER'S NAME Roxann Lareu G OWNER ADDRESS 14 WOLFSON RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED:YES El NO El FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 , DIRECT VENT HEATER 1 DRYER 1 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 1 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 0 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 I LICENSE# 115383 I SIGNATURE MP El MGF El JP❑ JGF❑ LPG!0 CORPORATION❑# PARTNERSHIP 0# LLC❑A COMPANY NAME: I ADDRESS. 161 JOBYS LANE, I CITY IOSTERVILLE I STATE MA ZIP 02655 I TEL I I FAX 1 1 CELL 1 1 EMAIL 1 1 S310N M2IA32:1 NVld #iJWHl3d $ :33d ❑ ❑ 111Nind 3H1 SV S3AH3S NOLLVOIlddv SRL ON SOA S310N N01103dSNl 1VNId A1N0 3Sfl 2-10103dSNI 2:10J 3OVd SIH1 S310N NOI103dSNI SVO HOl02 g2-- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK mm Y:�la "�1 CITY YARMOUTH MA DATE r/0�-02 D - .Z f PERMIT # 27- 23 ( JOBSITE ADDRESS / No l sen OWNER'S NAME RC 1(ee.r7/le /....44--r),/ GOWNER ADDRESS TEL 779.,206 -d d 6FAX TYPE OR OCCUPANCY TYPE COMMERCIAL - EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: Lk/RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO P----- APPLIANCES Z FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER :-] BOOSTER I — F 1.{- ' = . CONVERSION BURNER C ___ II Ir IF ._ _ COOK STOVE II � _ I DIRECT VENT HEATER 11-----_ 1-1 ____II I DRYER ------L_I I II _I(_ _!I. I__. in- --. 1 FIREPLACEnor -1 - ______A FRYOLATOR L._...._ ---I -I L.._. IL. 'r— ___Ii ---,L- F_I I J FURNACE GENERATOR v y i _ -`I1 - r fl GRILLE i �___i-�r INFRARED HEATER L--____L___._i __IL____ r-= - _ _- -1, LABORATORY COCKS L—._. Ii _�L __IL..__i -I .- MAKEUP AIR UNIT J L I. I. t—1 -�, OVEN 1 1.I , L I, _ POOL HEATER �' 11 ROOM / SPACE HEATER ROOF TOP UNIT i i L —F--_ 1, TEST UNIT HEATER F— . ( L i I UNVENTED ROOM HEATER WATER HEATER OTHER I J U -71 II 1J II U IT _ - ' 11 �1 ll _ U f 1L 11-- -1r '7 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES LI NO 0 I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY I j 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. CHECK ONE ONLY: OWNER H AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all cf the details and information I have submitted o- entered regarding this application are true and accurate to the b= .f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian with all Pertin- p •vision of the Massachusetts State Plumbing Code and Chapter 142 of the General L.aws. f ., 0 PLUMBER-GASFITTER NAME KEVIN LAMOUREUX 1 LICENSE # 15383 GNATURE MP v I MGF JP 0 JGF 0 LPGI fl CORPORATION ;# 1 PARTNERSHIP , #1 , LLC L.. #1 COMPANY NAME: KEVIN LAMOUREUX PLUMBING & HEATING' ADDRESS 61 JOBY'S LANE r CITY OSTERVILLE I STATE MA ZIP 02655 TEL 508-420-2068 I FAX 508-420-7992 1 CELL 508-292-5085 EMAIL lamoureuxplumbing@verizon.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES