HomeMy WebLinkAboutBLDG-19-004902 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
"gg CITY YARMOUTH MA DATE
I -1.5 PERMIT#*1,6-1Q-67419D.z
JOBSITE ADDRESS 7 y ?Z,9i_c itfrniv e// OWNER'S NAME 77i)eL
77V 0- 62.IFAX
OWNER ADDRESS I TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 1 RESIDENTIAL
PRINT
CLEARLY
NEW:1_ RENOVATION: REPLACEMENT: n PLANS SUBMITTED: YES r'I NO
APPLIANCES 7 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
CONVERSION BURNER i P
COOK STOVE 4,(,
DIRECT VENT HATER AL -it
-itDRYER _
FIREPLACE r
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
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 . OTHER TYPE INDEMNITY BOND
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 AGENT
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 of y knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian with all Pertine provis. n of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX I LICENSE# 15383 N TURE
MP MGF JP JGF LPG!LI CORPORATION PARTNERSHIP 0# LLC ®#
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING I ADDRESS 61 JOBYS LANE
CITY OSTERVILLE I STATE MA ZIP 02655 ITEL 508-420-2068
FAX 508-420-7992 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 ❑ ❑
OM/ FEE: $ PERMIT#
L/27/ �2///7°
PLAN REVIEW NOTES