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HomeMy WebLinkAboutBLDG-15-000277 - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `,'"NIS Jt CITY YARMOUTH • —1 MA DATE[7-, J9 !PERMIT# X�NNob")6�Va77 JOBSITE ADDRESS ,(() _ i OWNERS NAME(�L' ,, g�,r�'on4-1 I G OW - --- OWNER ADDRESS ]TELJ J_ JFAX TYPEORPRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL CLEARLY NEW: RENOVATION:L] - REPLACEMENT:© PLANS SUBMITTED: YES❑ NOj,a„G'/ APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER s _...' CONVERSION BURNER i COOK STOVE .a-. -v; �u.,/.e r. t,; - :u,xl.Y. r t:- _-,t . ym+ae:: ax �•::__..en..x .—,— ! DIRECT VENT HEATER l _ "". ° -mr r ,��, x.aax �. - 'r xv 7 sr_ ., c ' .-_ -• DRYER , — 1 f • FIREPLACE = j FRYOLATOR I I ... I .... ,� FURNACE I da r :wax-e a44I -ate ' x+r• r.':;:o,+re ;cr•�1.. . ' ._. .... GENERATOR GRILLE .,..-,...�' il•`1•`• 1dd I4^ti INFRARED HEATER t ? ... t' r: LABORATORY COCKS ' . �.. . . . . .,u. _., .. w MAKEUP AIR UNITI I' , OVEN POOL HEATER ROOMI SPACE HEATER -- r .�.xdw',w. �_.‘in, u'•any�„ea«r r__..,..t V r a ROOF TOP UNIT i .• - �� TEST UN1 -MEAIEQ I c Q UNV gTEORQOTAIfkTE D x. r r.m aswu i t449 tea✓ s �. r a i 4 ¢' WV 'H _ . ®®�® � � � omnaallIllimmmeIIIIImesllPMallnammvllIlllisIIIIIIIImsIIIIIIIma I V.... ___.11111111111111111111111111111111111111111111111111111 BJUILDING 14F Tri NT ..... _. 111111111111111.11 .. uy Yl) INSURANCE COVERAGE I haves current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO Li I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY U OTHER TYPE INDEMNITY Q BOND Q 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 Li AGENT Q SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this application are two and accurate to th; •= of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in complia• e with all Pe •.rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. e PLUMBER-GASFITTER NAME KEVIN LAMOUREUX �ILICENSE#'L15383 IGNA U•E MP Q MGF Q JP a JGF Q LPG!Q CORPORATION C1'1#C 1 PARTNERSHIP Q# ._.___.I LLC Q#€ COMPANY NAME: KEVIN LAMOUREUX PLUMBING I ADDRESS[61 JOBYS LANE CITY OSTERVILLE ' I' STATE MA ZIP 02655 ' ITEL 508-420-2068 , FAX 508-420-7992 CELLI508-292-5085 'EMAIL lamoureuxplumbing2verizon.net I ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: S PERMIT# PLAN REVIEW NOTES -