HomeMy WebLinkAboutBLDG-20-002772 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
AlL CITY YARMOUTH I MA DATE 10_ 7---/7 PERMIT# / /''o2D'°D,277Z
JOBSITE ADDRESS ?3? G( e$/yAinfoo> 1 Rd, OWNER'S NAME ?a r7-e/6t._ f?..eiC)
GOWNER ADDRESS TEL 342_,gf3 j FAX ,
TYPE OR OCCUPANCY TYPE COMMERCIAL u EDUCATIONAL a RESIDENTIAL Lj -
PRINT
CLEARLY NEW: RENOVATION:U REPLACEMENT:❑ PLANS SUBMITTED: YES U NO[r
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER r
BOOSTER lI I _
CONVERSION BURNER III
COOK STOVEDIRECT VENT HEATER 1 I !
DRYER IFIREPLACE IiFRYOLATOR
FURNACEGENERATOR
GRILLE
I
INFRARED HEATER II In
: 1
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LABORATORY COCKS 1,
MAKEUP AIR UNIT I 11 ! 1
OVEN I I [ �I
POOL-HEATER1
IIII
I �1 I it — ,I lie
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST 1I I
UNIT HEATER
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UNVENTED ROOM HEATER I I
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WATER HEATER I
OTHER , I ,�
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Li 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 I _I
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 an• accurate to the b-• • my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli- - with a I Pertine' pr.-ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
A _ _ ,e _ .t
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX LICENSE# 15383 IGNATURE
MP .1 I MGF JP n JGF n LPG] CORPORATION n# PARTNERSHIP I I# LLC #
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING ADDRESS 61 JOBYS LANE I
CITY OSTERVILLE ® STATE MA ZIP 02655 ITEL 508-420-2068 I
FAX 508-420-7992 I CELL 508-292-5085 IEMAIL lamoureuxplumbing@verizon.net 1
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ ^ D
FEE: $ PERMIT# Lie/7Z // `e
PLAN REVIEW NOTES