HomeMy WebLinkAboutG-20-2776 e ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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iuE�- CITY YARMOUTH I MA DATE //- 7—/fr PERMIT#, b--g$0-00 ("
JOBSITE ADDRESS yr --;`,4 5-1a j/ o t.d OWNER'S NAME fit___As;C ;a_ cr i'a-1
GOWNER ADDRESS , . .,. .,on,.in TEL fig_ &ey_ 12,27 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL n RESIDENTIAL n
PRINT
CLEARLY NEW:I 1 RENOVATION: REPLACEMENT:Li PLANS SUBMITTED: YESL, NOLJ
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER II 1
CONVERSION BURNER 11 ((
COOK STOVE
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DIRECT VENT HEATER I i/ j no
DRYER
FIREPLACE i I I (( 1 I ,
FRYOLATOR
FURNACE I U U I 11 I :.�_
GENERATOR I I I U u J
GRILLE
INFRARED HEATER
LABORATORY COCKS I 1 r
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MAKEUP AIR UNIT 1 U U :
OVEN 1 (1 (J
POOL HEATER _ ' _
ROOM/SPACE HEATER 4
ROOF TOP UNIT �( 0 u
TEST I U II U II I
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UNIT HEATER 1 U (( I U U
UNVENTED ROOM HEATER I i 6.4I i
WATER HEATER 1
OTHER I L U U i II U II t _ _
U U ( �
1 1 11
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES []NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ' OTHER TYPE INDEMNITY n BOND n
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 0 AGENT U
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 • my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian with al Pertine • • ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX I LICENSE# 15383 I 4-1 'ATU E
MP - MGF JP n JGF^ LPGI n CORPORATION 1 1# PARTNERSHIP n# LC 0#
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING(ADDRESS 61 JOBYS LANE
CITY OSTERVILLE 1 STATE MA ZIP 02655 ITEL 508-420-2068 1
FAX 508-420-7992 1 CELL 508-292-5085 ,EMAIL lamoureuxplumbing@verizon.net
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT# -/ ° 1 0
PLAN REVIEW NOTES