HomeMy WebLinkAboutBLDG-19-005899 41)
_ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
4,41-1
"CINW CITY YARMOUTH MA DATE -/.3-/ / PERMIT# /l� '7?`00�g
er"CI
NW
ADDRESS j 7 /pye. /PG4d_ t OWNER'S NAME 72 /r/ x&ZSG(,rr c
OWNER ADDRESS C 741 'i/3i-->/� �/� TEL CZ '17.3 " `E A
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL_►,/-
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: 1-7 PLANS SUBMITTED: YES NO�✓
APPLIANCES 1 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 j
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
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 ID
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 best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in complian with all Pertinen r ision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME KEVIN LAMOUREUX LICENSE# 15383 A URE
MP I MGF JP II JGF D LPG!Lj CORPORATION®# 1 PARTNERSHIP jam# LLC 1#
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING ADDRESS 61 JOBYS LANE
CITY OSTERVILLE STATE MA ZIP 02655 ITEL 508-420-2068
FAX 508-420-7992 I 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 ❑ ❑
'U/// /
_ FEE: $ PERMIT#
IPLAN REVIEW NOTES