HomeMy WebLinkAboutBLDG-20-002568 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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w s CITY YARMOUTH 1 MA DATE /d o1-.-i9 PERMIT# G ''00,b74
JOBSITE ADDRESS /p 7 J/4 pr.kJ)1 A re OWNER'S NAME T /1q -:5A
GOWNER ADDRESS TEL,5-7)er-497 8073L `FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL H EDUCATIONAL 'E RESIDENTIAL[.
PRINT
CLEARLY NEW:l RENOVATION: REPLACEMENT:LI PLANS SUBMITTED: YES❑ N0[11-'
APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 7 8 9 i 10 11 12 13 14
BOILER r T 1 f f I
BOOSTER Ilim mm
f i I
CONVERSION BURNER III111111 •
COOK STOVE I 1 IEl
DIRECT VENT HEATER 1 j
DRYER 11
FIREPLACE 1
FRYOLATOR
FURNACE
GENERATOR
GRILLE j)
INFRARED HEATER 1 E
LABORATORY COCKS � i
MAKEUP AIR UNIT
OVEN
POOL HEATERII
1 ,,1 ,, Ili :
ROOM/SPACE HEATER 7I
ROOF TOP UNIT I .1 I �
TEST
UNIT HEATER 1 , •
UNVENTED ROOM HEATER
WATER HEATER
OTHER
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 3 OTHER TYPE INDEMNITY BOND ❑
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 Li
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 best of nowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance w' all Pertinent pr. .• of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX I LICENSE# 15383 I S e'/T le-" L" -
MP El MGF JP JGF^ LPG!—I CORPORATION n# PARTNERSHIP n# LLC❑# .
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING'ADDRESS 61 JOBYS LANE
CITY OSTERVILLE ' STATE MA ZIP 02655 ITEL 508-420-2068 I
FAX 508-420-7992 I CELL 508-292-5085 EMAIL lamoureuxplumbing@verizon.net
C4P/l-
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
/7/ 17