HomeMy WebLinkAboutBLDG-20-001451 . , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
� I�• CITY YARMOUTH I MA DATE 2--//-/9 PERMIT#1.4aa9' ''ocf'57
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JOBSITE ADDRESS 3/ eacrvoic c.I, jOWNER'S NAME I Tct//'‘'e/el "Mgryf.p�/ 1
GOWNER ADDRESS TEL 77S s-�p-/t f f2 FAX /-
TYPE OR OCCUPANCY TYPE COMMERCIAL n EDUCATIONAL pi RESIDENTIAL(1-
PRINT
CLEARLY NEW:li-- RENOVATION:U REPLACEMENT: I PLANS SUBMITTED: YES NO111__-
APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 1 13 14
BOILER
BOOSTER ` fl J ) --
CONVERSION BURNER 1 J[ [
COOK STOVE — _
DIRECT VENT HEATER J / ' I _ �[
DRYER I J (I l II I 1 I lI_- ..I —
FIREPLACE .___1 J I 0 1 I .�I
FRYOLATOR
FURNACE J
GENERATOR
GRILLE I
INFRARED HEATER -- j A J - _ 11I
LABORATORY COCKS
MAKEUP AIR UNIT I
OVEN MR
11011® f_ I ___I J
POOL HEATER -
ROOM/SPACE HEATER
ROOF TOP UNIT
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TEST
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UNIT HEATER [ [
UNVENTED ROOM HEATER I 1 j 1 fM
WATER HEATER I I ' I [
OTHER 1 t I EI 1
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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 .NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY EI OTHER TYPE INDEMNITY —1 BOND
OWNER'S-INSURANCE WAIVER:Ism--aware that the licenseedoes--rot 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 _J 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 b- t of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compli with all Pertin= p ovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Iil9i-G. j GZZA -LL.GG6 7
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX l LICENSE# 15383 I IGNATURE
MP - I MGF n JP C JGF LPGI CORPORATION E# PARTNERSHIP❑# LLC❑#
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING ADDRESS 61 JOBYS LANE I
CITY OSTERVILLE I STATE MA I ZIP 02655 ITEL 508-420-2068 9
FAX 508-420-7992 I CELL 508-292-5085 EMAIL 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 ❑ El
FEE: $ PERMIT# ‘7;17 V
PLAN REVIEW NOTES
0
77?