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HomeMy WebLinkAboutBLDG-19-002355 co • n=" le_el MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ti"gr CITY YARMOUTH MA DATE .90-/G`/y PERMIT# / ,D(sy7-000 JOBSITE ADDRESS 025 Sr;i tieR L,aP Ante lOWNER'S NAME I �M is j y esp 5 G OWNER ADDRESS TEL 603-337-9.253 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL0 EDUCATIONAL fl RESIDENTIALQ' PRINT CLEARLY NEW:[( RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO Q APPLIANCES 7 FLOORS-• BSM 1 2 3 4 5 6 7 8 9 - 10 11 12 13 14 BOILER , II C---- BOOSTER CONVERSION BURNER . .1 I i i COOK STOVE i I l i i I i I i i i DIRECT VENT HEATER r r DRYER ' ' FIREPLACE FRYOLATOR J 1 1-----1 I I 1 FURNACE GENERATOR -- i GRILLE INFRARED HEATER 11 LABORATORY COCKS MAKEUP AIR UNIT d OVEN r----s Ih— 1— , I I II—II I ! i POOL HEATER i , IF , I I ROOM I SPACE HEATER — I 'r1 i�I rI 1 1 �I I F , ROOF TOP UNIT I TEST UNIT HEATER I; I', 1 I; ' UNVENTED ROOM HEATER WATER HEATER mgI r 1 I ,i I I I I- ., OTHERIta 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 El NO ❑ 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: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 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 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 p • of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.. PLUMBER-GASFITTER NAME :KEVIN LAMOUREUX LICENSE# 15383 SI rfr" RE f A 4 MP 0 MGF 0 JP 0 JGF Q LPGI© CORPORATION[# PARTNERSHIP Ott LLC p# COMPANY NAME: KEVIN LAMOUREUX PLUMBING& H ADDRESS 61 JOBY'S LANE CITY OSTERVILLE STATE MA ZIP 02655 TEL 508-420-2068 FAX 508-420-7992 CELL 508-292-5085 EMAIL Iamoureuxpiumbing@verizon.net g)UGH GAS INSPECTION NOTES THIS RAGE FOR INSPECT(lRVSE ONLY FINAL K VS I;CTION NOTES Yes No THIS APPLICATpASERVESASTHE PiRM(I. 0 0 FEE: $ PERMIT iI 0,4dpr. . PLAN REVIEW NO+LQ •