HomeMy WebLinkAboutBLDG-18-001295 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
ri CITY YARMOUTH MA DATE - OZ'J /7 PERMIT# 9/7/g``(f01 o�9
JOBSITE ADDRESS // r;� t,5tiIf r , _ OWNER'S NAME Da i) ;6/k E/dr^-ec/ '
GOWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL L/
PRINT
CLEARLY NEW: L/ RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO L/
APPLIANCES 1 FLOORS-4 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 I SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER
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
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY - OTHER TYPE INDEMNITY BOND I
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 my knowledge
and that all plumbing work and installations perforated under the permit issued for this application will be in complian ith all Pertinent oviiiion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - J
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PLUMBER-GASFITTER NAME KEVIN LAMOUREUX LICENSE# 15383 ATURE /7C!
MP MGF JP - JGF LPG! CORPORATION # PARTNERSHIP # LLC #
COMPANY NAME:LAMOUREUX PLUMBING 'ADDRESS 61 JOBYS LANE
CITY OSTERVILLE STATE MA ZIP 02655 1TEL 508-420-2068
FAX 508-420-7992 , CELL 508-292-5085 EMAIL;Iamoureuxplumbing@verizon.net
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES