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HomeMy WebLinkAboutBLDG-19-000425 irt . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK nt . .a t C' '/ tat1 CITY YARMOUTH ��� MA DATE 7--/(a—,g PERMIT# r D�/?'orB 7 G JOBSITE ADDRESS 1 ?,2 CIL Oren arck iOWNER'S NAME W ,arocon OWNER ADDRESS TEL go-57g-174 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RES DENT PRINT CLEARLY NEW:Eer RENOVATION:9 REPLACEMENT:9 PLANS SUBMITTED: YES 9 NO ]i- APPLIANCES 1 FLOORS-. BSMt 2 3 4 5 6 7 8 9 10 it 12 13 14 BOILER Hf __, -1-1, i --- 1 -� _ - , ,- _ BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER 1 1 j DRYER i i i, i 1 1 FIREPLACE FRYOLATOR FURNACE i ME ,,111 GENERATOR GRILLEI' P INFRARED HEATER1 RI ii , : 1 . LABORATORY COCKSiiipti 11 i MAKEUP AIR UNIT OVEN - - - - . .. - -- POOLHEATER ROOM 1 SPACE HEATER 1 i i i i I I i ROOF TOP UNIT 1 I I I II TEST UNIT HEATER UNVENTED ROOM HEATER I I WATER HEATER I OTHER _ , asamaana, _,, illion,win I I I. I I I I I I I, , INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW I.IABIL:ITY INSURANCE POLICY 0 OTHER TYPEINDEMNITY 0 " BOND P OWNER'S INSURANCE WAIVER:lam 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 : knowledge and that as plumbing work and installations performed under the pewit issued for this application well be in compliance ' ad Pedinent• •v:'.- of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ PLUMBER-GASFITTER NAME KEVIN LAMOUREUX 1JCENSE it 15383 •TIRE MP 0 MGF 9 JP 0 JGF❑ .LPGI 9 CORPORATION❑# PARTNERSHIP 9# LLC❑# COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING ADDRESS 61 JOBYS LANE CITY OSTERVILLE STATE Q ZIP 02655 TEL 508-420-2068 FAX J508.420-7992 1 CELL 50&-292-5085 EMAIL lamoureuxplumbing©verizon.net • Ito KIR GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVgS AS THE PERMIT D ❑ 4 ' FEE: $ PERMIT d p PLAN REVIEW NOTES A rAt „„ . V