HomeMy WebLinkAboutBLDG-20-002770 611)
. \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH 1 MA DATE f/—7 9 PERMIT#, aO'O618
JOBSITE ADDRESS
�' 6 D reLKe S-Ire .,* OWNER'S NAME alt.Ui� -ia
GOWNER ADDRESS TEL 7$(-577-fr2g? FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL n EDUCATIONAL r I RESIDENTIAL
PRINT
CLEARLY NEW:, RENOVATION: REPLACEMENT:B PLANS SUBMITTED: YES LI NOI
APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTERIII i
CONVERSION BURNER
COOK STOVE 1 11111 Itouno (DIRECT VENT HEATERDRYER � tY
FIREPLACE
FRYOLATOR �i1 ICIFURNACE
GENERATOR
GRILLEjINFRARED HEATER I
LABORATORY COCKS (
MAKEUP AIR UNIT j f
OVEN
POOL HEATER
ROOM I SPACE HEATER
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ROOF TOP UNIT I j _I( -��,�-.
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
I ER IIFIIIIIII
E • 1 1 RE
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I _ I , � I I III
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I I NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [ I OTHER TYPE INDEMNITY n BOND P1
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 I AGENT Li
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best• my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance ith all Pertinent • ovi-ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX L LICENSE# 15383 '`�N•TURE
MP[° { MGF—1 JP C JGF ri LPGI H CORPORATION(l# PARTNERSHIP(—]# LLC D#
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATINGU ADDRESS 61 JOBYS LANE I
CITY OSTERVILLE STATE MA ZIP 02655 1TEL 508-420-2068 I
FAX 508-420-7992 i CELL 508-292-5085 'EMAIL lamoureuxplumbing@verizon.net
1`ft
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 / � /77 /9.