Loading...
HomeMy WebLinkAboutBLDG-23-001500 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK rp`tht�ry �,'" CITY YARMOUTH MA DATE September 20,202 PERMIT# BLDG-23-001500 r`'` JOBSITE ADDRESS 3 DEBS HILL RD OWNER'S NAME HAMEL CAROL A G OWNER ADDRESS 6720G 186TH LN FRESH MEADOWS NY 11365-3628 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 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 El NO El 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 El MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: KEVIN LAMOUREUX PLUMBING&HEATIN ADDRESS. 61 Jobys Ln, CITY Osterville STATE MA ZIP 02655 TEL 5084202068 FAX CELL EMAIL S310N M3IA3H NVld #11Wa3d $ 333 11 11INIEd 3H1 SV S3AH3S NOI1VOIlddV SIH1 oN saA S31ON NO1103dSNI 1VNId AlNO 3Sfl 210103dSNI 21Od 39Vd SIH1 S31ON NO1103dSNI SVD HOl021