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HomeMy WebLinkAboutBLDG-22-005285 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�'-� CITY YARMOUTH MA DATE (March 22,2022 I PERMIT# BLDG-22-005285 t,v JOBSITE ADDRESS 102 PHEASANT COVE CIR 7 OWNERS NAME COUGHLIN STEVEN G OWNER ADDRESS COUGHLIN JO ANNE L 102 PHEASANT COVE CIR YARMOUTH PORT MA 02675-1024 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: © 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 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❑ 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 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: KEVIN LAMOUREUX PLUMBING 8 HEATIN ADDRESS. 61 Jobvs Ln, CITY Osterville STATE MA ZIP 02655 TEL 5084202068 FAX r 1 CELL 5082925085 EMAIL I S310N M31A321 NVld #11M:13d $ : 33 ❑ ❑ 111%I3d 3H1 SV S3A2i3S NOI1d01lddtl SI1-11 oN so,, S310N NO1103dSNI 1VNId AlNO 3Sfl 210103dSNI 2JOd 39Vd SIH1 S310N NO1103dSNI SVO HJf102'