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HomeMy WebLinkAboutBLDG-15-003153 s� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK a� air 15-003/53 n '_gam W � CITY YARMOUTH MA DATE PERMIT#b I S�SI53 JOBSITE ADDRESS r1? i6c&Shaa__�OWNER'SNAMEarior-�,4e,eStifaziefjsi GOWNER ADDRESS —1 TEL JFAX1- 1 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Q RESIDENTIAL[. PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT:Q PLANS SUBMITTED: YES NOLO! APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER • 1 I tq E r ' CONVERSION BURNER I ice r It t ti o s.._ =I COOK STOVEt DIRECT VENT HEATER t •Y Y hR"'""'- "..1 F - `Vi" - t 1 C".: NY r.� x 'a9W'Y =1. "•^t DRYER ,s•m.-.. y,.w�t t FIREPLACE FRYOLATOR FURNACE € GENERATOR • .. _ ,.._.. ,. 'rw. r vs .. ._ aa: • GRILLE o. INFRARED HEATER a: t p H LABORATORY COCKS 5t t t i +StYw _.a9 _ dTA•1 _ .. .�... MAKEUP AIR UNIT = � _,...,ti �. .., . OVEN 4 POOL HEATER �` ,.,,.• ._.. . ..... +,w-rr,�-i ,•rvrc 'a,-rs .-=a«— .'16-.`" ..lc,: . ,v,^..-- ROOM I SPACE HEATER 1 t r ¢ i'I,.,. " t I ROOF TOP UNIT �i i tf. fl t� v -. f g' c` TEST , , 'v.y _... ..... ... UNIT ktEAT€R r ' ^¢� '"re '^It _"---* —tr _'i' - flat 9^',1" -^ UNVENTED ROOM HEATER' Lt." L1 f ` WATERFEAT • 0 OTHE R 4 �_ I ._... It t, J � QT f mit:. ... •�••�---•• -._ jirn IMENT t r�e• ., l' ( H F, 1 -- INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES G]NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q 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 Q AGENT 0 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 Pertin vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' PLUMBER-GASFITTER NAME[LEVI LAMOUREUX 'LICENSE# 15383 I NATURE MP Ej MGF[a JP Q JGF Q LPG'Q CORPORATION Q# PARTNERSHIP©#E !LLC Q# COMPANY NAME: KEVIN LAMOUREUX PLUMBING J ADDRESS61 JOBYS LANE 1 CITY LOSTERVILLE STATE MA ZIP 02655 TEL 508420-2068 --! . FAX 508-0202992 CELL 508-292-5085 EMAIL IamoureuxpIumbing@verizon.net f Il ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 ❑ FEE: S PERMIT# PLAN REVIEW NOTES