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Home My WebLink AboutBLDG-22-002293 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �`- CITY YARMOUTH MA DATE October 21,2021 PERMIT# BLDG-22-002293 .,F JOBSITE ADDRESS 595 ROUTE 6A OWNER'S NAME Geoffrey Higgins G OWNER ADDRESS 595 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 6 _ 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 ❑ 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 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# 15383 SIGNATURE MP 0 MGF 0 JP❑ JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME: ADDRESS. 61 JOBYS LANE, CITY OSTERVILLE STATE MA ZIP 02655 TEL FAX CELL EMAIL . . S310N M3IAJN Ndld #11W2�3d $ :33d ❑ ❑ 1IW213d 3H1 SV S3AH3S NOIlv011ddd SIHl oN saA S310N NO11O3dSNI 1VNIH AINO 3Sfl N0103dSNI 210d 39b'd SIHI S310N NO1103dSNI SVO HDflOH _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK -'1 = CITY YARMOUTH MA DATE 1'4�- /g-Of ' PERMIT # 2.-Z. - 22- (I JOBSITE ADDRESS[S /t'Ijtil e OWNER'S NAME �t49W /71 t �,S I G OWNER ADDRESS [ TEL 7 , S TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL V PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: i- PLANS SUBMITTED: YES -1 NOV APPLIANCES -1 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 I. 1.-J I I _ `_(i .J I� I I (_.r._J�_ FIREPLACE FRYOLATOR r- Ma' ' ! — FURNACE j_____ - -1 l u U L 11 Ii 1 1 _ GENERATOR _ GRILLE - _ I II I] ii 1 I) iI ti 7 INFRARED HEATER I J II II II 11 U LABORATORY COCKS --1! U U _ II O I1 MAKEUP AIR UNIT _ _I( OVEN ____L___ —I I ——,_______:_____,__+— .... POOL HEATER F-1 ROOM / SPACE HEA rER 1 Il I' .,_____ALQ=1F ROOF TOP UNIT TEST l UNIT HEATER I L _a1J_____I (-__L __ — L_ UNVENTED ROOM HEATER I II —Ir _... I Ir ( I WATER HEATER -- ��'- I I OTHER I I� i _ I __ . JJLj ___i i I� ir in i t --,r L......r..l— i INSURANCE COVERAGE I have a current IiabiliYinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES v NO I I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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. CHECK ONE ONLY: OWNER AGENT ED 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 b of my knowledge and that all plumbing wok and installations performed under the permit issued for this application will be in complianc with all Pertin t ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME KEVIN LAMOUREUX I LICENSE 415383 I T MP ' MGF j JP Q JGF [ LPGI El CORPORATION J# _ —1 PARTNERSHIP Elk_ _ LLC Di COMPANY NAME: KEVIN LAMOUREUX PLUMBING & HEATINGI ADDRESS 61 JOBY'S LANE i CITY OSTERVILLE I STATE MA ZIP 02655 ITEL 508-420-2068 r FAX 508-420-7992 I CELL 508-292-5085 EMAILIlamoureuxplumbing@verizon.net 1 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