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HomeMy WebLinkAboutG-11-862 r .ar 1 f I. 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO DO GAS FITTING —L$ CITYROWN: TOWN OF YARMOUTH I yil / STATE:MA APPLICATION DATE:i ta"eta- / C , 1 JOBADDRESS:12E2..=SEr,'yeR bene -_.Out)latt4 ,, G UPCOMMERCIAL REP✓✓LAT© ❑CEMENRESIDENTIAL REMOV�DEMOLITION❑ PLANS SUBMITTED: YES❑ NO❑✓ NEWI/ ALTERATION© t NATURAL& LIQUEFIED PETROLEUM GAS: PIPING-EQUIPMENT-APPLIANCES-SYSTEMS 1 ENTER TOTAL AMOUNT FOR EACH SELECTION(LIMITED TO FIVE(5)NUMERALS AIR ROTATION UNIT FURNACE: ALL TYPES TEMP HEATING EQUIPMENT BOILER: I THERMAL OXIDIZER BOOSTER � GAS PIPING GENERATOR(STATIONARY ENGINE) TURBINE J BROILER ILLUMINATING APPLIANCE Inn UNIT HEATER BURNER: ALL TYPES WATER HEATER: ALL TYPES "-"I CO-GENERATION UNIT EQUIPMENT OVER 12,500MBH 1 COFFEE ROASTER I INFRARED HEATER !OTHER NOT LISTED- ______ COOK APPLIANCE HOUSEHOLD n pin �q ` COOK APPLIANCE COMMERCIALLABORATORY a -'?;-�r-1 t1- T 1!!" DECORATIVE APPLIANCE �� DIRECT VENT APPLIANCE HMI 1�uNry11u DRYER: ALL TYPESr a i IN FIREPLACE:VENTED!UNVENTED a POOL M� , , , _y FRVOIATOR � ROOF r • � _- � I �"�__ r IM FUEL CELL ROOM HEATER-VENTEDNENTLESS (- ---- 1(- PLUMBING/GAS FITTING FIRM INFORMATION CHECK ONE ONLY LAMOUREUX PLUMBINGI [61 JOBYS LANE 1, ❑Corporation BusinessN NAME u ADDRESS: --- Partnershi Business It CITY L OSTERVILLE 4STATE:i MA°ZIP 102655 ❑ P ❑LLC Business If TEL:+508 420-2068 , FAX:'420 7992 1 EMAIL: LA MOUREUXPLUMBING@VEI] EDBA I Unincorporated NAME OF LICENSED PLUMBER I GAS FITTER: ii(e yir/1 AI tr1-0VPC!/J( 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 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 LC] AGENT ❑ Signature of Owner or Owner's Agent OWNER'S NAME: KEVIN LAMOUREUX J TEL..508-420-2068 FAX 1508-420-7992 f 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 US ONLY) Type of License: Permit . 0lumber ❑Gasfitter / %��..r.d-taa' • 51J 1I4 ❑ ❑ y Signature of Lensed Plumber!Gas Fi •r Inspector .-.. ' ' ✓ Master ✓ Journeyman Fee: r- - p• ❑Undiluted LP Installer License Number: ' 15383 .®_ , 0 Limited LP Installer I r ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES PYes No THIS APPLICATION SERVES AS THE PERMIT 0 0 1/ FEE: S .. PERMIT!GI1 —962— ;I PLAN REVIEW NOTES 1 1 i l 1 4