HomeMy WebLinkAboutPlumbing Permit �
? oF r,� ` APPLICATION FOR PERMIT TO DO PLUMBING
�' '`g ;t TOWN QF YARMOUTH (OFFICE USE
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. . Q � � CQ �' � � Fee: $ ��.bV I
SEP 2 O ZOOO PERMIT NO. �O�- � ��� ''
HEAL�'�-� DEPT. �ate �s
• Buildin Owner's �Q I.7rGC-C- I
AT Location��� '�� � � I ' � > ��.w„�` Name
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Type of Occupancy ' �(}-C__
New❑ Renovation G✓ Replacement❑
Plans Submitted Yes O No 0
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SUB-BSMT.
BASEMENT �
1ST FLOOR '
2ND FLOOR
3RD FLOOR I
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(PRINT OR TYPE) Ch@Ck 0�2: '
Instaliing Company Name ��'���C,p L7�Corp. a3�"'" `
Address � iM.�!-il�i �i'�C'� ❑ Partnership
- �1F"��' ����`S�_ O Firm/Company :
Business Telephone ��s�- �� Name of Licensed Plumber '
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes le� No ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy L'7 Other rype of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 am aware that the licensee dces 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
I hereby certify that all of the details and information I have submitted S at e of icensed
(or entered) in above application are true and accurate to the best of Plum er
my knowledge and that all plumbing work and installations performed '�
under Permit issued for this application will be in compliance with all �����"" i
pertinent provisions of the Massachusetts State Plumbing Code and !
License Number
Chapter 142 of the General Laws. Type: Master Q�' Journeyman❑ f
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