HomeMy WebLinkAboutPlumbing Permit� ` r � �
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� �, °F r4,�; �' ' ' APPLICATION FOR PERMIT TO DO PLUMBING
� �' g TOWN OF YARMOUTH
1 = (OFFICE USE ONLY)
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Fee: $ �� �
PERMIT NO. ' C��Q�
D � D>!I
Building U � Owner's
�,� A • Location �d �i9 /�j,PT,J/;U�-,�N/S �,�� Name .s'//j?/f✓ / ,,8��,�,-
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New O Type of Occupa�y ����E3�.t/C�
Renovation I� Replacement O �,�
Plans Submitted Yes❑ No O y
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SUB-BSMT.
BASEMENT
1 ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) Check One:
Installing Company Name�-`L_ //✓S4/c,l /Di�'����j Corp.
Address �l �/�i��iy C/,�cL.d' ❑ Partnership
_�S'au7-/f� !/�/T d�t��—��;� D o�(�G 5�
❑ Firm/Company
Business Telephone-��� ���'7�76� Name of Licensed Plumber- �� �/�/S�or,�
INSURANCE COVERAGE: I have a current liabiliry insurance policy or its substantial equivalent.Check One: Yes 1� No ❑
If you have checked YES, please indicate the rype of coverage by checking the appropriate box.
A liabiliry insurance policy❑ Other type of indemnity ❑ Bond ❑
OWN�R'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement. ,
Check on Owner ❑ Agent ❑
Signature ofOwnerorOwner'sAgent
� A
I hereby certify that atl of the details and information I have submitted
(or entered) in above appl(cation are true and aecurate to the best of Signature of Licensed
my knowledge and that all ptumbing work and installations performed Plumber
under Permit issued for this application will be in compliance with all ? 9� �
pertinent provisions of the Massachusetts State Plumbing Code and — � '
Chapter 142 of the General Laws. License Number
� Type: Master� Journeyman❑