Loading...
HomeMy WebLinkAboutBLDG-19-001870 6v • .� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ve, , ¢ CITY YARMOUTH MA DATE 7,26--/9. ' PERMIT#fthO6-il—aOJI7G JOBSITE ADDRESS c.3b /✓0[t�Gnc4[ TK-M 'OWNER'S NAME , 7a-74.,:c/,`,3„. ',,'Ce GOWNER ADDRESS TEL -SaC FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONALRESIDENTIAL f PRINT •Q CLEARLY NEW:[l.l'• RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES© NO[' APPLIANCES 7 FLOORS-. 8814 1 2 3 4 5 6 7 8 9 10 It t2 13 14 BOILER , BOOSTER CONVERSION BURNER it 1 'i— !I I COOK STOVE I i I , '. ' DIRECT VENT HEATER 1li ' DRYER li ' FIREPLACE , FRYOLATOR l I I II II I 1 I ' FURNACE 1 GENERATOR — GRILLE I INFRARED HEATER0 ' LABORATORY COCKS i i " MAKEUP AIR UNIT OVEN II 11---11-7 I —p 11-77 -- ' — POOL HEATER r - POOLHEATER , I I I I ROOM/SPACE HEATER — I1 I — I I I I ( I— h ROOF TOP UNIT I TEST ' —.._ UNIT HEATER ^li UNVENTED ROOM HEATER ' I WATER HEATER I I , I I-- OTHER i 'i 9 iI ''I 'I ''I 'II !I `I it N 'i�1l�:l INSURANCE COVERAGE ' I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES fl NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE INDEMNITY 0 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. • ' CHECK ONE ONLY: OWNER D 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 bes y knowledge and that all plumbing work and installations performed under the permit issued for this application wilt be in compian with aft Pertin LArain of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. AA Lt n ! 9 ! PLUMBER-GASFITTER NAME KEVIN LAMOUREUX LICENSE# 15383 1 r %r`A l! a'� MP E MGF❑ JP Q JGF❑ LPGI 0 CORPORATION p# PARTNERSHIP©# LLC Q# COMPANY NAME:KEVIN LAMOUREUX PLUMBING& H ADDRESS 61 JOBY'S LANE CITY OSTERVILLE STATE •n ZIP 02655 [TEL 508-420-2068 FAX 508-420-7992 CELL 508-292-5085 EMAIL Iamoureuxplumbing@verizon.net • tie I — 1 DOUGH GAS INSI'_,(TION NOTES THIS PAGE FOR INSPECTOR IJSE ONLY FINAL VIS 'XiCTION NOTES, _ Yes No THIS APPLICATQ SERVES ASTHE'PERJ, 0 _ ❑ ____ - - FEE: $ PERMR _� /ALL dirt__ _, PLAN REVIEW NOTF �t I — — — --; . • —r„a - .—fir - _. • —.^..L • Tom_ �_ —� �-.. -. , - I