HomeMy WebLinkAboutBLDG-22-003015 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
.: CITY 'YARMOUTH I MA DATE (November 23,202'I PERMIT# BLDG-22-003015
II
-Jf_. JOBSITE ADDRESS 137 CAPT NOYES RD I OWNER'S NAME IMCNALLY WILLIAM J TRS
G OWNER ADDRESS IMCNALLY RAYANNE TRS 37 CAPT NOYES RD SOUTH YARMOUTH MA 02664 I TEL I
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL 0
PRINT SUBMITTED:YES❑ NO 0
CLEARLY NEW: 0PLANS SUB :RENOVATION:0 REPLACEMENT:❑
FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER 1
DRYER
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM/SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
OTHER
OTHER DESCRIPTION:
INSURANCE COVERAGE:
I have a current lability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER OF INDEMNITY El BOND ❑
OWNERS 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.
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 best of my
knowledge and that all plumbing work and installations performed under the permit issued for this application will be In compliance with all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME kevin Lamoureux LICENSE# [MA SIGNATURE
MP 0 MGF 0 JP❑ JGF❑ LPG( 0 CORPORATION❑# PARTNERSHIP ❑# LLC❑#r
COMPANY NAME: KEVIN LAMOUREUX PLUMBING&HEATIN ]ADDRESS. 61 Jobys Ln,
CITY Osterville STATE MA ZIP 02655 TEL 5084202068
FAX CELL EMAIL
S310N M2IA]H NVld
# S :33d
11W2f3d 3Hl SV S3A13S NOLLVDllddd SIH1
ON sail
S310N NOI103dSNI lYNId NINO 3Sfl N01.03dSNI 210d 39Vd SIHI S310N NO1103dSNI SV9 HOf1ON