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G-19-2952
J J 1: , MASSACHUSETTS UNIFORM APPLICATION FOR A.PERMIT TO PERFORM GAS FITTING WORK '@ _=parras • VIN,� CITY YARMOUTH MA DATE /1-7-/P PERMIT# 0.1-/,� (" �9'017`• ' f`I JOBSITE ADDRESS „7,5- L7r:✓,`vcar �irC,/e OWNER'S NAME ; }7�,.r7L /1•�,�r�t•m nG OWNER ADDRESS TEL net-,23,)^ref q FAX i TYPE OR OCCUPANCY TYPE COMMERCIAL° EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:El REPLACEMENT:[12. . FLANS SUBMITTED: YES 0 NO{0- ' APPLIANCES Z FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER , t CONVERSION BURNER 1 :1 �I �I 1 1 II .I I I 'I 'I 'I I I COOK STOVE 1 I I DIRECT VENT HEATER DRYERI ' FIREPLACE FRYOLATOR 1I 1----‘1 FURNACE GENERATOR GRILLE �� p INFRARED HEATER I 11 LABORATORY COCKS • MAKEUP AIR UNIT OVEN � —I( i.—I 1 lin POOL HEATER ' I 1 ' 1 ROOM/SPACE HEATER —71---.1 I I I I ROOF TOP UNIT TEST UNIT HEATER 'V UN VENTED ROOM HEATER WATER HEATER I I I I 1 I 1 I 1 OTHER , 1 � I 1 - p �. ii is � 11 1—i �I 1 I m I_i FM q r. I: I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO 0 IIF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 1 . flA. ftfl INSURANCE POLICY a OTHER TYPE INDEMNITY D BOND D ' 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 Q 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 besm knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compf- with all Pertinent ' i of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER-GASFITTER NAME KEVIN LAMOUREUX LICENSE# 15383 #1 ee4141“e AT�UR� ��t// ' MP Q MGF 0 JP 0 JGF Q LPGI 0 CORPORATION Q# PARTNERSHIP 0# LW 0# COMPANY NAME:KEVIN LAMOUREUX PLUMBING& H ADDRESS 61 JOBY'S LANE CITY OSTERVILLE STATE 11E31 ZIP 02655 TEL 508-420-2068 FAX 508-420-7992 CELL 508-292-5085 EMAIL lamoureuxplumbing©verizon.net i • A)UGH GAS INS1,ECIION NOTES THIS P,1GE FOR INSPECT(IR I,ISE ONLY FINAL I SarI,CnoN NOTES __ Yes No J THIS APPLICATOI,SERVESASTHE FERMIT; ❑ 0 _ FEE: $ _ PERMIT ti �s�76/e2/ " !d � C� lf7GG _ PLAN REVIEW N(iT>� Gw II 'ter ^-,