HomeMy WebLinkAboutBLDG-19-002955 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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TA aje ;t /3 CITY YARMOUTH MA DATE //-719 PERMIT# rir/9-10t1Q9s;
JOBSITE ADDRESS[JD t'emK'`a'e Li%«/t° !OWNER'S NAME 1, Wail&to rrrORjo
GOWNER ADDRESS TEL 'FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL U.—
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CLEARLY NEW:[7 RENOVATION:9 REPLACEMENT:9 PLANS SUBMITTED: YES 9 NO[rte
APPLIANCES 1 FLOORS-. - BSM 1 2 3 4 5 6 7 8 9 to ft 12 13 14
BOILER Irtr
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BOOSTER t
CONVERSION BURNER • 11 1 II V i I 'I I
COOK STOVE /"--\ MI , , I
DIRECT VENT HEATER i...... t I i i1 1 '
DRYER II '
FIREPLACE
FRYOLATOR ® I—� 'I I 1 1
FURNACE
GENERATOR ,f I/
GRILLE
INFRARED HEATER it 1, 'I
LABORATORY COCKS t , i
MAKEUP AIR UNIT ,
OVEN I^ I, it �, ISM I, t
POOL HEATER � I
ROOM I SPACE HEATER I III____,. .._,
tROOF TOP UNIT —'TESTUNIT HEATERUNVENTED ROOM HEATERWATER HEATER
\ OTHER
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 9
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE Of COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY a 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 9 AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information 1 have submitted or entered regarding this application are true and accurate to the best :y{-It, knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compr with alt Pertinen n of the
Massachusetts State Plumbing Code and Chapter 142 of the General taws. �_,�11
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PLUMBER-GASFITTER NAME KEVIN LAMOUREUXLICENSE# 15383 'Sr-- RE /
MP 0 MGF 9 JP 0 JGF 9 LPG!❑ CORPORATION 9# PARTNERSHIP❑# LLC 9# •
COMPANY NAME:KEVIN LAMOUREUX PLUMBING& H ADDRESS161 JOBY'S LANE
CITY OSTERVILLE STATE MA !ZIP 02655 17EL 508-420-2068
FAX 508-420-7992 CELL 508-292-5085 EMAIL lamoureuxptumbing@verrzon.net
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DOUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECT(il JSE ONLY Kati., J tCTION NOTES
Yes No
THIS APPLICAT ON SERVES AS THE PE M?C 0 ❑
— FEE: $ _ PERMIT i ( WG 6 /, (9-6-e.�_ - PLAN REVIEWN(31.:M; �d ' ! f77✓v f1