HomeMy WebLinkAboutG-14-452 0.111 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTHJ MA DATE sizz_zral PERMIT16 )4— PSZ—
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TYPE
OCCUPANCY TYPE COMMERCIAL[] EDUCATIONAL Q RESIDENTIAL
CLEARLY NEW:Dr RENOVATION:❑ REPLACEMENT:[3 PLANS SUBMITTED: YESE NOUV
APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER r �...- 1. te a € i+ it
CONVERSION BURNER ± = '
COOK STOVE .,x-,n _r.erg .r r
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DRYER _.. .m
FIREPLACE ' •_ ' •:" r .
FRYOLATOR fi , :r .p ,
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FURNACE
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GENERATOR f r ._ ,
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INFRARED HEATER
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LABORATORY COCKS
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P a i tr , !
MAKEUP AIR UNIT
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OVEN t
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POOLHEATER € i r
ROOM ISPACE HEATERN
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ROOF TOP UNIT 1 HEATER ,
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UNIT HEATER
UNVENTED ROOM HEATER
WATER 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 (±2 NO LI
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [3 OTHER TYPE INDEMNITY U BOND LI
• 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 0 AGENT El
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 best of m nowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliant= " ith all Pertinent pro ': •. of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r
PLUMBER-GASFITTER NAME[KEVIN LAMOUREUX ~J LICENSE#15383 S.- • E - P
MP 0 MGF❑ JP 0 JGF[I LPG'[3 CORPORATION Li# PARTNERSHIP p# 1 LLC D# �I
COMPANY NAME:I KEVIN LAMOUREUX PLUMBING ADDRESS,61 JOBYS LANE ________________II
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CITY OSTERVILLE J STATE MA IZIP`02655 ITEL[ 08.420-2068 --
FAX 508-420-7992 CELLI508-292-5085 !EMAIL lamoureuxplumbing d verizon.net — ___I l
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
p6 k- ems OK 0/2 hi it/a01 Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT# .-
PLAN REVIEW NOTES - /
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