HomeMy WebLinkAboutBLDG-19-000650 le, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
„cmc,,
;WTI CITY YARMOUTH ' MA DATE f,fi i/-/7 PERMIT#,91/X7/7-97ad
JOBSITE ADDRESS ag 1 /e VtSJ ah 1_ ZIi t 1OWNER'S NAME Rnn flier w j j
GOWNER ADDRESS TEI1,2g --q/ IF Ax .
TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL❑ RESIDENTIAL[W
PRINT
CLEARLY NEW:[11/ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO Ej-
APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 ' 8 a 10 11 12 13 14
CONVERSION BURNER I
BOILER
BOOSTER I 1111111111
� I I,
i H —`I �
COOK STOVE I _ .-.
DIRECT VENT HEATER i
DRYER I. t l
FIREPLACE 1 i
FRYOLATOR I
FURNACE J
GENERATOR i .
GRILLE p I)
INFRARED HEATER I 1 f t
LABORATORY COCKS I; I
MAKEUP AIR UNIT f—I I
OVEN _ y, it
POOL HEATER
ROOM l SPACE HEATER I If
ROOF TOP UNIT 1 1
TEST '
UNIT HEATER i; i. r i� 6 •
UNVENTED ROOM HEATER I I I I I i '
WATER HEATER / i I I 1i r I i
OTHER '
i; i t
I II
I
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0140 0
t IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY D BOND Q
OWNER'S INSURANCE WAVER: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 peri application waives this requirement
CHECK ONE ONLY: OWNER ❑ AGENT
SIGNATURE OF OWNER OR AGENT
1 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 t knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in•. ., •• with a8 Pertinent of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. L
. PLUMBER-GASFITTER NAME yXEVIN LAMOUREUX LICENSE# 15383 S r>r T RE
MP Q MGF❑ JP Q JGF❑ .LPGI❑ CORPORATION❑# PARTNERSHIP❑# 11C❑#
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING ADDRESS 61 JOBYS LANE
CITY OSTERVILIE I STATE MA ZIP 02655 TEL 508-420-2068
FAX 508-420-7992 I CELLl508-292-5085 EMAILJIamoureuxplumbing@verizon.net '
Z.le 4L
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USI:ONLY FINAL INSPECTION NOTES
Tet . No
THIS APPLICATION SERVIS AS THE PERMIT 0 U //9--•
FEE: $ PERMIT00 -. _ z-/ n a /6 A
PLANJtEVIPW NOTES
I
•
- I
7