HomeMy WebLinkAboutBLDG-19-002201 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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"Flag CITY YARMOUTH MA DATE /0-41—/Y PERMIT# /H-J)&- --0o (
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JOBSITE ADDRESS L/ t� J-LL& ?OctcOWNER'S NAME I �ra �
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OWNER ADDRESS _ . . JTEL S5?--P(,2r,6?-,771a!)-7,57 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL❑ RESIDENTIALE
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CLEARLY NEW:V RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO a APPLIANCES 1
APPLIANCESI FLOORS-• SSM t 2 3 4 5 6 7 8 9 10 II 12 13 14
BOILER _t
BOOSTER >i
COOKR ION BURNER 1-'I 1 ;1i_ _ 1 !� ,�—'I1 I_
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DIRECT VENT HEATER , 1 I 1 G iJ 1
DRYER —I
FIREPLACE '.
FRYOLATOR !— 'I 4�1— _` I I—n 7-1
FURNACE I )__— _
GENERATOR
GRILLE I
INFRARED HEATER 1 9
LABORATORY COCKS i ' ' 1
MAKEUP AIR UNIT �, J ;
OVEN ... . ; ... j—.:_. . 1 - - 1 _ G-1— -- ,-
POOL ..R I I
ROOM,' 1-.,E HEATER If q
ROOF TOP UNIT
TEST f
UNIT HEATER 1
UNVENTED ROOM HEATERII '
WATER HEATER I I ,I 1 1 I I . 11
OTHER I
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES Q NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY 0 BOND 0
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 D AGENT 0
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 =ccurate to the best ,y knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compl- • with all Pertinen • of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. '`
PLUMBER-GASFI11t NAME KEVIN LAMOUREUX LICENSE# 15383 , 'NATURE
. MP Q NGF❑ JP❑ JGF❑ LPG!❑ CORPORATION❑# PARTNERSHIP❑#11111111111111111W 0#
COMPANY NAME:KEVIN LAMOUREUX PLUMBING& H ADDRESS 61 JOBY'S LANE
CITY OSTERVILLE STATE MA ZIP 02655 TEL 508-420-2068 1
' FAX 508-420-7992 CELL 508-292-5085 EMAIL lamoureuxplumbing@verizon.net
ROUGH GAS INSVESTION NOTES THIS P:4.GE'FOR INSPECTOR',ISE ONLY FINAL I V511-.:CTION NOTES
. . — -Yes No
THIS APPLICATO!, {SERVES AS THEPERME! 0 Cl- SitI 6043
FEE: $ PERMIT i�_�,
_ PLAN REVIEW NOTES Z----/
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