HomeMy WebLinkAboutG-14-681 'V
CS‘ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
3N3 CITY LYARMOUTH I MA DATE - 6- /f IPERMIT# Es9-6Si
JOBSITEADDRESSLia,w„_ 'air ysb» RcI. IOWNER'SNAMEiCIn k. C.o1C P . I
GOWNER ADDRESS Lsoidit y/4 Wit TELT [FAX---lI
TYPE OR OCCUPANCY TYPE, COMMERCIAL 9 EDUCATIONAL 9 RESIDENTIAL LE('
PRINT
CLEARLY NEW:LV RENOVATION:® REPLACEMENT:❑ PLANS SUBMITTED: YES9 NOB
APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER i ;
BOOSTER „t, r
CONVERSION BURNER 6I r+ r q � III 4
COOK STOVE 1 '
DIRECT VENT HEATERa :1,
1 '
DRYER
r =v+u ,v "Alai' ".4 a '",,,,, fl W— ^i i�n. I,VP," -r<ro it.'"... '"?..,":2,P r 9
FIREPLACE ,
FRYOLATOR
FURNACE
GENERATOR N r. ,.. ` _... f. , __,. . i
GRILLE r ;i .
INFRARED HEATER
LABORATORY COCKS
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MAKEUP AIR UNIT
OVEN ,. . a r
POOL HEATER
ROOM I SPACE HEATER t_._ i i ' 1
ROOF TOP UNIT r� I _ i ., r,
..�� as ��.. _ .�,..... � r---
TEST € »,. .» 1
UNIT HEATER i I 1 r+ a, i i
UNVENTED ROOM HEATER 1»
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WATER HEATER 1
OTHER
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YIP I� I� ii1! LP t
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INSURANCE COVERAGE ' ° ' ' - ' ' '
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MG Ch.142 YES +4NO 9
EU ILDI 'G L_. 7
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELO By .7fe7
UABILITY INSURANCE POLICY (i+ OTHER TYPE INDEMNITY Li BOND D 86-0,co
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 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 be f my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be in compile with all Pertine vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME[KEVIN LAMOUREUX _-_--I LICENSE 14-i-5NATURE ���r
MP 0+ MGF® JP 9 JGF 9 LPGI❑ CORPORATION Ej# PARTNERSHIP D#j I LLC D#
COMPANY NAME: KEVIN LAMOUREUX PLUMBING I ADDRESS 61 UOBYS LANE
CITY OSTERVILLE I STATE Liik-Aj ZIP L0265,5 (TELL508-420-2068 —,,I
FAX 508-42007992 CELL 508-292-5085 ]EMAIL lamoureuxplumbin9(�laverizon.net
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
FEE: $ PERMIT#
PLAN REVIEW NOTES