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HomeMy WebLinkAboutBLDG-22-003670 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE December 30,2021 PERMIT# BLDG-22-003670 ti JOBSITE ADDRESS 8 CANARY LN OWNER'S NAME LETSON JOHN J JR G OWNER ADDRESS MYERS BARBARA F 4 WASHINGTON HILL RD NEWTOWN CT 06470 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES 0 NO El FIXTURES FLOORS BSM 1 2 3 4 5 6 7 s 8 9 s 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 I 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 0 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# MA SIGNATURE MP© MGF ❑ JP 0 JGF 0 LPGI 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: KEVIN LAMOUREUX PLUMBING&HEATIN ADDRESS. 61 Jobys Ln, CITY Osterville STATE MA ZIP 02655 TEL 5084202068 FAX CELL 5082925085 EMAIL S310N M3IA321 NVId #IIW2i3d $:33A ❑ ❑ 1I01213d 3H1 SV S3AZI3S NOIiVOIlddV SIHJ oN seA S31ON NOI103dSNl l`dNld AlNO 3Sfl O103dSNl 210d 3OVd SIH! S310N NOI103dSNI SVJ HJflO J