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HomeMy WebLinkAboutBLDG-19-002953 go C MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS.FITTING WORK .? kret,all& 4 CITY YARMOUTH MA DATE /1-7/y' PERMIT# thOf I9 Ot7o2Q6) ' JOBSITE ADDRESS I /.?p W lc./10 Weati !OWNER'S NAME patty 41/445 GOWNER ADDRESS TEL 5 7-Ja-y9'# FAX TYPE OR OCCUPANCY TYPE COMMERCIAL° EDUCATIONAL 0 RESIDENTIAL©- PRINT CLEARLY NEW: RENOVATION:Q REPLACEMENT:Q PLANS SUBMITTED: YES Q NO Er APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER r-- r-I _ I-7 I - 1 r j 1 1, . BOOSTER CONVERSION BURNER (—^I Illi 1 1 i ii 1 1 I —11 1---in— COOK STOVE 1 I i i d DIRECT VENT HEATER DRYER REPLACE 1 [ FRYOLATOR I Ii I'1 1 ^J I-1 I -- FURNACEl ! _ GENERATOR I , I I� r GRILLE I l 1 INFRARED HEATER _ 1 LABORATORY COCKS MAKEUP AIR UNIT !- OVEN 1t1 — —1�I�I POOL HEATER __- , r - - , 1 ROOM/SPACE HEATER 1—.11----II F r---IH I ,i--11 —1 ROOF TOP UNIT —' TEST UNIT HEATER . I, ¢ 1 UNVENTED ROOM HEATER J i , WATER HEATER 1N 4 I I I I i ' OTHER r �� I p —I —1 1 1 I i 1 1 I INSURANCE COVERAGE ' I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES E]NO ° I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Et OTHER TYPE INDEMNITY 0 BOND OWNER'S INSURANCE WAIVER:l 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 0 AGENT D SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information!have submitted or entered regarding this application are true and accurate to the 12:-. , knowledge and that all plumbing work and installations performed under the permit issued for this application wilt be incompf-••: ' all Pert --, • • ion of the. Massachusetts State Plumbing Code and Chapter 142 of the General Laws. A . , d . . /iA -lit' . , PLUMBER-GASFITTER NAME KEVIN LAIVIOUREUX LICENSE# 15383 r SI ATURE MP jj MGF❑ JP a JGF❑ LPGI❑ CORPORATION Q# PARTNERSHIP Q# LLC Q# COMPANY NAME KEVIN LAMOUREUX PLUMBING& H ADDRESS 61 JOBY'S LANE CITY OSTERVILLE STATE m!ZIP 02655 TEL 508-420-2068 FAX 508-420-7992 CELL 508-292-5085 'EMAIL lamoureuxplumbing@verizon.net (/ i�- • _8././01 1/ ^ 17 S3�TON M2IAMI NVid — / 77�/ —,if1IWN3d $ :334 0 0 .1rid,3HlSVS3AH3SN5AVOIlddVSlat ON saA .. . S3.LON NOIIJ;4 Sr 'IVHI d AiN0 3S7 N4).L.13dS.MII ROd 39t'd SIH,L S3.LON NIOLCIaliSNI SVD HOI10a