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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING
c.Wle CC TOWN OF YARMOUTH - 7_�f
r=¢ CITYROWN ., ( STATE.MA APPLICATION DATE:'„
b'".'°' JOB ADDRESS:L IcnZ,.SP/ iiwee_„Jane
GOCCUPANCY TYPE: COMMERCIAL RESIDENTIAL ` PLANS SUBMITTED: YES EI NOD
NEW❑ALTERATION❑ REPLACEMENT❑ REMOVAIJDEMOLITIOND
r NATURAL& LIQUEFIED PETROLEUM GAS: PIPING-EQUIPMENT-APPLIANCES-SYSTEMS 1
ENTER TOTAL AMOUNT FOR EACH SELECTION(LIMITED TO FIVE(5)NUMERALS
AIR ROTATION UNIT I FURNACE: ALL TYPES I TEMP HEATING EQUIPMENT I.
BOILER:ALL TYPES GAS PIPING I THERMAL OXIDIZER .
BOOSTER GENERATOR(STATIONARY ENGINE) I TURBINE r
BROILER — ILLUMINATING APPLIANCE UNIT HEATER j- J
BURNER: ALL TYPES —. INCINERATOR I WATER HEATER: ALL TYPES V---`7
CO-GENERATION UNIT INDUSTRIAL AIR HANDLER F EQUIPMENT OVER 12,500MBH
COFFEE ROASTER INFRARED HEATER J (OTHER NOT LISTED1 I
COOK APPLIANCE HOUSEHOLD KILN!GLORY HOLE/CRUCIBLE f —" "")
COOK APPLIANCE COMMERCIAL LABORATORY COCKS
DECORATIVE APPLIANCE MAKEUP AIR UNIT i lj R"E �'- --1_� _ L�_ r__
DIRECT VENT APPLIANCE / MECHANICAL EXHAUST EQUIPMENT 1 I � "" _ 1
4.
DRYER: ALL TYPES OVEN: ALL TYPES 1 I I i 'r f
FIREPLACE:VENTED!UNVENTED POOL HEATER I I I
', _
FRYOLATOR ROOF TOP UNIT ( j rU1111-INGAEPT: I -__6
FUEL CELL -- _ _ ._ __..... _
- - J ROOM HEATER-VENTEDNENTLESS (- ] ay I 1
PLUMBING I GAS FITTING FIRM INFORMATION CHECK ONE ONLY
LAMOUREUX PLUMBING 61 JOBYS LANE 1 ❑Corporation Business# --.---I
NAME ADDRESSa ,,_�
CITY; OSTERVILLE A STATE:i M?)ZIP 102655
❑Partnership Business#
❑LLC Business#L--_J
TEL 508-420 2068 1 FAX:�420 7992 EMAIL: LAMOUREUXPLUMBING@VEI
❑DBA/Unincorporated
NAME OF LICENSED PLUMBER 1 GAS FITTER: /,may n/i'mafj(
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy❑✓ Other type of indemnity❑ 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 ❑✓ - _- - -- AGENT ❑
Signature of Owner or Owner's Agent
OWNER'S NAME: iKEVIN LAMOUREUX i TEL 1 508-420-2068 S FAX i 508-420-7992 I
I hereby certify that all of the details and information I have submitted(or entered)regarding this permit application is true and accurate to
the best of my knowledge.I certify that all plumbing work and installations performed under the permit issued,will be in compliance with
all pertinent provisions of the Massachusetts Uniform State Plumbing Code,and Chapter 142 of the General Laws.
(OFFICE USE ONLY) Type of License:
Permit • - `3 k El Plumber ❑Gasfitter .uq,,.�
I '�\ ✓❑Master ❑✓ Journeymanignature of tensed Plumber/Gas Fitter
Inspector A �►a. ,
�r 65r ❑Undiluted LP Installer License Number: _ S
15383
Fee: '
❑Limited LP Installer
ti ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes
THIS APPLICATION SERVES AS THE PERMIT•
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cTP th 9 J FEE: $ 5-0 'O O PERMIT 1`C/(-??9
PLAN REVIEW NOTES
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