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HomeMy WebLinkAboutBLDG-22-002087 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE October 12,2021 PERMIT# BLDG-22-002087 JOBSITE ADDRESS 28 WINDJAMMER LN OWNER'S NAME Mick Mazur _ G OWNER ADDRESS 28 WINDJAMMER LN SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ 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 _ 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 0 JGF❑ LPG' 0 CORPORATION 0# PARTNERSHIP 0# LLC ❑# COMPANY NAME: [ ADDRESS. 61 JOBYS LANE, CITY OSTERVILLE STATE MA ZIP 02655 TEL FAX 7 CELL EMAIL S310N M3IA32!NVId #.II d $ 33A ❑ ❑ 11INH3d 3H1 SV S3AHH S NOI1VOIlddV SIHI oN saA S31ON N01103dSNI 1VNId AINO 3Sfl N0103dSNl 210d 30Vd SIHl S310N NO1103dSN1 SVD HJl02J 9 .. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '3 y :' CITY YARMOUTH MA DATE /D- r- pZ/ PERMIT # 2 Z - 7c)y 7 , r__ JOI3SITE ADDRESS y2g h � � r r- L- ipe- OWNER'S NAME /'4 g.'G /I4 14 ZL>le, G 1 OWNER ADDRESS T--- - TEL 11/3-L- 36w/0 __IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YESri NO " APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I ! BOOSTER Mr CONVERSION BURNER r COOK STOVE --1 F Imo( 1� DIRECT VENT HEATER 1I I —1 r- IIIIIIIIIIII DRYER FIREPLACE FRYOLATOR �I I FURNACE III GENERATOR -in lr- - MOM GRILLE Li INFRARED HEATER —1I-- LABORATORY COCKSMil MAKEUP AIR UNIT r - I - _,r __I L J�._ - - _____Li OVEN -1- r -`� POOL HEATER _ 111111111 ROOM / SPACE HEATER — r _ .111 ROOF TOP UNIT TEST 'Mil —1-11111MIMIIIIIIIIM UNIT HEATERIIIIMPIIIIIIIIIIIIIIMIMIMIIIII UNVENTED ROOM HEATER MI -1r----11- -1 WATER HEATER I I_ IIIIMIIINIIMIIII OTHER h I. J L. - INSURANCE COVERAGE I have a current liabiliy_insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO I IF YOU CHECKED YES PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY v 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 wok and installations performed under the permit ssued for this application will be in compliance with all Pertine' pr.vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i . 44 PLUMBER-GASFITTER NAME KEVIN LAMOUREUX I LICENSE # 15383 i SIG ATURE MP v j MGF JP Li JGF LPG' 0 CORPORATION J# 1 PARTNERSHIP _ # LLC #1 j COMPANY NAME: KEVIN LAMOUREUX PLUMBING & HEATINGI ADDRESS 61 JOBY'S LANE CITY OSTERVILLE I STATE MA IZIP 02655 1TEL 508-420-2068 I FAX 508-420-7992 I CELL 508-292-5085 EMAILClamoureuxplumbing@verizon.net 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