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HomeMy WebLinkAboutBLDG-19-0029554 ....CO UElMASSACHUSETTS UNIFORM APPLICATION:FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE //- 7y 4 PERMIT#/1A96-/9_OOo2? G JOBS1TE ADDRESS Fr c craPrnia Way ¶OWNER'S NAME i :JB�jn Mg(II�! OWNER ADDRESS , TELl 37 Q FAX TYPE OR OCCUPANCY TYPE COMMERCIAL° EDUCATIONAL{_] RESIDENTIAL PRINT �/ CLEARLY NEW:u RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO APPLIANCES 7 FLOORS-• SW t 2 3 4 5 6 7 8 9 10 ti 12 13 14 BOILER 1 i ',r 1 BOOSTERa II CONVERSION BURNER 1 1����1 I 1 if COOK STOVE I I I I , , I DIRECT VENT HEATER / DRYER , I;FIREPLACE it____ FRYOLATOR I I I 1 l !II FURNACE I GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS 41 , 1 ii , II MAKEUP AIR UNIT OVEN I' i I, II Il iF-17-1 ; POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATERI I d OTHER rI .--1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 'Q NO El I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ID 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 theme-.-y of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp6--ce with all Perbr•r . • inion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. : d , . . tido.... , . 40 PLUMBER-GASFITTERNAME 4KEVINLAMOUREUX I i LLICENSE# 15383 rSI NATURE MP 0 MGF 0 JP 0 JGF 0 LPG!0 CORPORATION 0# PARTNERSHIP 0# LW 0# COMPANY NAME:KEVIN LAMOUREUX PLUMBING& H ADDRESS 61 JOBYS LANE CITY OSTERVILLE STATE MA j ZIP 02655 fTEL 508-420-2068 FAX 508-420-7992 CELL 508-292-5085 EMAIL Iamoureuxplumbing@verizortnet `L 17 ROUGH GAS INSPECTION NOTES THIS P,tS_E FOR INSPECT(IR USE ONLY FINAL[KITCTION NOTES• ___._ — r • — ' Yes No THIS APPLICAT ONJERVES AS THE'PE EMT: ❑ ❑ x — FEE: $ PERMIT! — PLAN REVIEW N(!T •-` —;r - y — _ �.. - ` _- -ti moi. .�J/ - -..... �� --.r