HomeMy WebLinkAboutBLDG-19-002637 Sa
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
alsl_ s CITY YARMOUTH MA DATE /Q 47 PERMIT#ftAD b”-/7-00Ae07
JOBS1TEADDRESS s, au& 6A ,OWNER'S NAME iii/Lerj stiaricicy
GOWNER ADDRESS TEL3Q3-5-o1rI^1-33
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: C RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO[L]"
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER —1 ��I SII I I-- 1 ail
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE �
FRYOLATOR ,f II :i I I Ir
FURNACE
GENERATOR 1'
GRILLE
INFRARED HEATER
LABORATORY COCKS i i—
MAKEUP AIR UNIT
OVEN ^I' f"Ilit—�
POOL HEATER 1 I I 1 �, r
ROOM/SPACE HEATER 1 1 I I I 1
ROOF TOP UNIT
TEST
UNIT HEATER -1 I
UNVENTED ROOM HEATER
WATER HEATER I
OTHER
1 1 ii 1 II
• 4 '11 .1
INSURANCE COVERAGE
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES ID NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY 0 BOND
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 ❑ 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 of my knowledge
and that all plumbing work and installations performed under the permit issued for this appfwation wilt be in comp with all Pertinent• . .ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - -
TU�g //
acico
PLUMBER-GASFITTERNAME KEVIN LAMOUREUX LICENSE# 15383 ATURE�� •
�
MP El MGF❑ JP Q JGF❑ LPG!❑ CORPORATION❑# PARTNERSHIP❑# LLC❑#
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 Iamoureuxplumbing@verizon.net
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECT(IR IISE ONLY FINAL I V ?CTION NOTES
Yet No
THIS APPLICAT 045ERVES AS THE PI RNA"'
0 0
w
. - FEE: $ PERMIT H.__ , // �
__� _ PLAN REVIEW NOT , V _
___
- _:i _ -
- T
_•r ^tea
,,r