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Home My WebLink AboutBLDG-23-005912 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK � � CITY ['ARMOUTH MA DATE April 25,2023 PERMIT# BLDG-23-005912 JOBSITE ADDRESS 61 KATES PATH VILLAGE OWNER'S NAME GOETZ ARTHUR DECKER TRS G OWNER ADDRESS GOETZ SUSAN W TRS 61 KATES PATH VILLAGE YARMOUTH PORT 02675-1449 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: [n RENOVATION:❑ REPLACEMEN--:❑ PLANS SUBMITTED: YES ❑ NO 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 N. 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# 15383 SIGNATURE MP 0 MGF ❑ JP CI JGF❑ LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: I ADDRESS. 61 JOBYS LANE, CITY OSTERVILLE STATE MA ZIP 02655 TEL FAX 1 CELL EMAIL 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 = `, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK af_: - : (f --- CITY YARMOUTH II MA DATE - /- 043 PITSMITQ G - - - JOBSITE ADDRESS 6 f Ket-te Potill __. .OWNER'S NAME ,Th,,,iCr r 60 -.6 z GOWNER ADDRESS TEL WF TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL RESIDENTIAL I__ PRINT - CLEARLY NEW: ✓ RENOVATION: j__ ._. REPLACEMENT: PLANS SUBMITTED: YES NO 1' APPLIANCES Z FLOORS-0 BSM 1 2 3 4 5 I 6 7 8 9 10 11 12 13 14 BOILER n ___ BOOSTER J `__ C _ CONVERSION BURNER COOK STOVE _ ___:_t___ i DIRECT VENT HEATER ._ ,__. � DRYER - ..l__ i�F. ._ L I FIREPLACE I_ wt 11 I( � �` . FRYOLATOR I ''- I r------ -._. GENERATOR r_ il LL v. GRILLE — ...- _ - II_.__ INFRARED HEATER l — '--"_ { LABORATORY COCKS 177` MAKEUP AIR UNITT ---'r---. 1i. NMI OVEN POOL HEATER _ _ - I --`��_ ROOM 1 SPACE HEATER i MIMI - Mil ROOF TOP UNIT W * ii TESTSTAI N llirt MI _ _ UNIT HEATER MIIIIMIIIII-- � � e UNVENTED ROOM HEATER j '' o WATER HEATER MIIIIIIIIIM M 1.1111=MIEMMEM IBM OTHER mum IMMIII1111111111111 NMI -i_ _ i -_ -_- - -- -- - llAlwll ! INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES J NO '__ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 3i OTHER TYPE INDEMNITY ' 1 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 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 work and installations performed under the permit issued for this application will be in complian with all Pertin• t p •vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME [KEVIN LAMOUREUX LICENSE # 15383 at "IfG.NATURE MP f MGF ri JP El JGF n LPGI fl CORPORATION 0# [ -_ _ I PARTNERSHIP . ;# LLC Ir-..7# i COMPANY NAME:1LAMOUREUX PLUMBING AND HEATING ADDRESS 61 JOBYS LANE CITY FOSTERVILLE _ _ _ w_ I STATE MA ZIP 02655 TEL 508-420-2068 J{ .11 FAX 508-420-7992 1_ CELL 508-292-5085 @ .__ •I EMAIL LAMOUREUXPLUMBING VERIZON.NET t A ;