HomeMy WebLinkAboutBLDG-15-003075 51-0
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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ops; CITY !YARMOUTH I MA DATE( j/z/- i9 PERMIT#411&1 3075
JOBSITEADDRESS Lia . ticrRocfC.L %Y tOWNERSNAMEI /� 7L,10�( -�� -
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OWNERADDRESS 1"------------- T
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TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL II RESIDENTIAL`1!
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CLEARLY NEW: s RENOVATION:LI REPLACEMENT:( PLANS SUBMITTED: YESEJ NO F!
APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER ,,
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER /
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
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GRILLE '
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT ;
. . OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT -
TEST .
UNIT HEATER
UNVENTED ROOM HEATER f: 6 -
WAT RHEAT£FT47Of01_g.- , , :,
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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 ELI NO U
!IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Ej OTHER TYPE INDEMNITY j-i 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 r-i 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 bes f my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian with all Pertine .• • ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. v
PLUMBER-GASFITTER NAME 1 KEVIN LAMOUREUX i LICENSE#115383 a IATURE
MP:,..:LI MGF D JP' JGF PI LPG!i CORPORATION lI #I_______I PARTNERSHIP #; J LLC LAI
COMPANY NAME:AMOUREUX PLUMBING I ADDRESS]61 JOBY'S LANE' —,
CITY l OSTERVILLE I STATE MA !ZIP 02655 _ iTELI508-420-2068 �1
FAX 508-420-7992 'CELLI 508-292-5085 LEMAIL!lamoureuxplumbing o@verizon.net
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ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY - FINAL INSPECTION NOTES
Yes No
• THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES