HomeMy WebLinkAboutBLDG-17-004065 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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,' CITY YARMOUTH 1 MA DATE 02-l-i 7 PERMIT# l b/7- V yQ���
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JOBSITE ADDRESS .36 Sct/ /I/i A-ad2c . OWNER'S NAME i :j w CCiGti-r11 i
GOWNER ADDRESS 13&a. rr,54 4v2M i. a1, RI `.TEIJ " l--e9 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL I__ I EDUCATIONAL 0 RESIDENTIAL(q
PRINT
CLEARLY NEW: v -- RENOVATION:I REPLACEMENT:L__J PLANS SUBMITTED: YES NO[ 3�
APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER -1 I I!" , ; 1. pi
CONVERSION BURNER r I U
COOK STOVE
DIRECT VENT HEATER I {� I,
DRYER I 1 1 I i 11FIREPLACE I i !IIII, i i i i ( J 1
FRYOLATOR L. U J_ I
FURNACE
GENERATOR ( III ( [ . Ij .
GRILLE 11 (' U J
INFRARED HEATER ( "rill I . p I ) I ,_
LABORATORY COCKS ` i J II l
MAKEUP AIR UNIT i t' )
OVEN
POOL HEATER U I
ROOM I SPACE HEATER j 11 11
ROOF TOP UNIT UL 1 J U 11
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' I 1 11 I 11 .
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TEST � 1 k I
UNIT HEATER j i
UNVENTED ROOM HEATER I _
WATER HEATER ( _ J ._.
OTHER
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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 P'
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY In OTHER TYPE INDEMNITY 19 BOND L
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 .I, AGENT I
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 bes 1 y knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian with all Pertinent ; ov-ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
Be- -7 r- / �'-e7-1�C!ifT«t,
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX I LICENSE# 15383 1 S ' ,TURE
MP I MGF JP n JGF U LPGI L] CORPORATION Q# PARTNERSHIP L # LLC L#[ 1
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING ADDRESS 61 JOBYS LANE
CITY OSTERVILLE STATE' MA I ZIP 02655 ITEL 508-420-2068 I
FAX 508-420-7992 CELL 508-292-5085 EMAIL LAMOUREUXPLUMBING@VERIZON.NET I
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ROUGH GAS INSPECTION NOTES THIS) AGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ J J� (0/
FEE: $ PERMIT# (/
PLAN REVIEW NOTES
02 /l /77