Loading...
HomeMy WebLinkAboutBLDG-22-00209 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'Ar CITY YARMOUTH MA DATE October 12,2021 PERMIT# BLDG-22-002092 li 4� JOBSITE ADDRESS 3 HARBOUR HILL RUN OWNER'S NAME DUNPHY CAROL A G OWNER ADDRESS 3 HARBOUR HILL RUN SOUTH YARMOUTH MA 02664 _ _ TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:D REPLACEMENT:0 PLANS SUBMITTED: YES 0 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 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 0 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© MGF 0 JP❑ JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 61 JOBYS LANE, CITY OSTERVILLE STATE MA ZIP 02655 TEL FAX CELL EMAIL S310N M31A321 NVId #1IIJ d $:33d ❑ ❑ 11M3d 3H1 SV S3A1,13S NOIlVOIlddV SIHl oN sai S310N NO1103dSNI IVNId AINO 3Sfl NO103dSNI 210d 30Vd SIH11 S310N N01103dSNI SV91-10noa g) --- _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '-.' = = _1 CITY FARMOUTH MA DATE `p -4-ma / PERMIT # JOBSITE ADDRESS 3 1 -r,4D a/j OWNER'S NAME Jc7 rl, t c; GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO Y APPLIANCES Z FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER , BOOSTER ,_ J CONVERSION BURNER L. ( ;� r _ 1 COOK STOVE - __..F_L _ I._'______ _l�]�DIRECT VENT HEATER � � i �^���.� ��� _ DRYER ��,,.. ]� , _ I FIREPLACE __II 1, 17 —IL ' _ (_ �_I ._. ,. FRYOLATOR II__"_ - - —' _ _II ==_I._ -�= L__ FURNACE II Ii I� �(- I_,__J,_ I GENERATOR �=.,__I_ (___ __ GRILLE 1 ,.. —._J, _IL: ,r _____11___- , .. i= I i INFRARED HEATER L _I[ L. ] _-__ I 1.--- LABORATORY COC'<S --. __ . _1 111 ilL ..11____-��1 NEMNINIWININIIMMINDIMILMIONIIMMI MAKEUP AIR UNIT ^=® I _, i.......11--�_I_ _____] I._.� ' OVEN �— -� I I POOL HEATER ,==1, _._._.I LI E J,_____1 = _ ]�.= 1.- ROOM / SPACE HEATER '____I) I_ II____, ]L___-J(_____ J I_I._ I ROOF TOP UNIT 7L__I,—..IL____]—iL____ IL_,_I ".- 1 I _ _ TEST ._..�.. J I. _-._.I_I L—.�r_ _ UNIT HEATER 1 II L I li l y r UNVENTED ROOM HEATER - � II II J WATER HEATER OTHER I IL� _J�, U _ �I I I 1- 1IJ _ L. __J U ii ,_ INSURANCE COVERAGE I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES v NO 1__- 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 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 p V ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME KEVIN LAMOUREUX 1 LICENSE # 15383 S NATURE MP MGF JP 0 JGF LPGI '� CORPORATION # PARTNERSHIP #j LLC („�;#1 _Y COMPANY NAME4KEVIN LAMOUREUX PLUMBING & HEATING ADDRESS 61 JOBY'S LANE1 CITY OSTERVILLE STATE MA ZIP 02655 JTEL 508-420-2068 1 FAX 508-420-7992 I CELL 508-292-5085 EMAIL(Ia�mo"ureuxplumbing a©verizon.net I 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