HomeMy WebLinkAboutG-19-2744 MASSACHUSETTS UNIFORM APPLICATION FOR A:PERMIT TO PERFORM GAS FITTING WORK
kl) CITY YARMOUTH MA DATE /O-30-/$ PERMIT# 8 Y"iQ-00017 9
JOBSITEADDRESSj9J ,/I/A(M Cal Line jOWNER'SNAME 'rano Rs' ,e4T n
G , OWNER ADDRESS TEL 79'/-7fl SD FS- FAX!
TYPE OR OCCUPANCY TYPE COMMERCIAL° EDUCATIONAL Q RESIDENTIAL[
PRINT
CLEARLY NEW:E' RENOVATION:E REPLACEMENT:Q PLANS SUBMITTED: YES Q NO[
APPLIANCES 7 FLOORS-• &SM $ Ern 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER �.�111111L1111111011111111anientrall10111
CONVERSION BURNER
COOK STOVE Ii10.1 -1�l_I�I_l�
DIRECT VENT HEATER
DRYER rniSlairr,Welar H— t
FIREPLACE
FRYOLATOR INS mMION iIMININSI'M F
FURNACE ! 111111111111SIEMIMIli_Th!�!�
GENERATOR
GRILLE Mala' 1 F I Ia._ilt_1 1
INFRARED HEATER IMM aianal ialaV ll111i
LABORATORY COCKS �'���� '� r������
MAKEUP AIR UNIT s',aw_ntscr�•' •.
OVEN �I •• I' 1 I' It --
POOL HEATER I, i ' III ]�I,� ,
ROOM I SPACE HEATER" IM
ROOF TOP UNIT
TEST IMMIIII_ INNI1111111111111111111111111111>'i111111111111111111111111111
UNIT HEATER 7 it iiaMWESIMI IIMIN• I�
UNVENTED ROOM HEATER
WATER HEATER ,����������O��i�
OTHER AM I-1=,1 ;M
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INSURANCECOVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.942 YES 'E]NO Q
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY Q 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 ❑ 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 • of my knowledge
and that all plumbing work andinstallations performed under the permit issued for this application will be in compfra••- with all Pe • ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
•
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX LICENSE# 15383 "SI NATURE
MP I] MGF 0 JP Li JGF Q LPGI❑ CORPORATION Q# PARTNERSHIP[3# LLC Q#
COMPANY NAME;KEVIN LAMOUREUX PLUMBING& H ADDRESS 61 JOBY'S LANE
CITY OSTERVILLE 1 STATE CB ZIP 02655 Ta 508-420-2068
FAX 508-420-7992 CELL 508-292-5085 EMAIL larnoureuxplumbing@verizon.net
ROUGH GAS INSPECTION NOTES THIS P.1.6 E.FOR INSPECT(iRJZSE OAT Y FINAL X igly.CTION NOTES
— Yes No
THIS APPLICA[ON ERVFcSASTHtPIRSI If 0 ❑
...-:a __,... - _ FPE: $ .ter_— PERMIT I�� • /! "`
_ PLAN REVIEW N(flJ
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