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HomeMy WebLinkAboutBLDG-22-001717 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE September 24,202 PERMIT# BLDG-22-001717 JOBSITE ADDRESS 8 TELEVISION LN OWNER'S NAME William Cooper G OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL En PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO 0 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# 15383 SIGNATURE MP© MGF 0 JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: ADDRESS. 61 JOBYS LANE, CITY OSTERVILLE STATE MA ZIP 02655 TEL FAX CELL EMAIL S31ON MIA NVId #1IV d $ 333 ❑ ❑ 1IV d 3H1 SV Sa/VES NOI1VOIlddV SRL oN saA S310N NO1103dSN11VNId AINO 3Sfl N0103dSNI 210d 39Vd SIH1 S310N N01103dSNI SVO HJfOH MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK lllimr.7=e -- 77-i" F1 y•-,,,Z/-07/ CITY YARMOUTH I MA DATE PERMIT # 2 Z - I ) I�4 JOBSITE ADDRESS Sr er,,,`e,44 _r 4...,,,,,) t OWNER'S NAME , JaJ/ 0.IY1 e0e3i3Oer- GOWNER ADDRESS TEL D FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Ti RESIDENTIAL ' PRINT CLEARLY NEW: ✓ RENOVATION: Li REPLACEMENT: PLANS SUBMITTED: YES -I NOI kr-- APPLIANCES -1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER11111111111111 II. IMIIIIMMIL BOOSTER —lino, 11111i _1__1nii111111_ CONVERSION BURNER 1.011.111111 �_- COOK STOVE �— -'— DIRECT VENT HEATER Will IMIIIIIIIII --IMITINIIMMIMIIMIFIM DRYER m IMO =n- -V. 1 1_ 1 1 FIREPLACE MI I IiiI1111•7 i_ ® FRYOLATOR ! --Im IMI '—'ff61111rTNI! FURNACE :MI INN GENERATOR MI GRILLE Mall .1.75111 Mann INFRARED HEATER r fr LABORATORY COCKS _ MAKEUP AIR UNIT FilliFIFilliillIninillip OVEN I 1I . (IIIIII NIIII mow - -__ _ - POOL HEATER _ I, MI ROOM I SPACE HEATER II �� ROOF TOP UNIT II_ I�II I IIIIIIIIIIIIIIIIMIIIIIM TEST IIIIIT- Mimi FM _MN MN UNIT HEATER MEI_ UNVENTED ROOM HEATER Imi lill001 1111111111,manwinsw,l, WATER HEATER �,—� j 1111111 OTHER i �I_� `MlI Mill I. II®1 111•MII IImI I II II - 111MIE —In 1 1 INSURANCE COVERAGE I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 7 NO 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 • y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliar�ae with all Pertinent - ovi- on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. // PLUMBER-GASFITTER NAME KKEVIN LAMOUREUX I LICENSE # 15383 d r . NA A.URE 4 " P MP v d MGF JP Q JGF L., LPGI j CORPORATION ®# _ ¢ PARTNERSHIP D#F I LLC _ 4r COMPANY NAME: KEVIN LAMOUREUX PLUMBING & HEATINGI ADDRESS 61 JOBY'S LANE CITY OSTERVILLE , STATE MA ZIP 02655 TEL 508-420-2068 FAX 508-420-7992 I CELL 508-292-5085 1EMAIL)amoureuxplumbing@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