HomeMy WebLinkAboutP-03-044�d DPLUMBING�-3/7%J
��V MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO O
(Print or Type)
Yjq )2 ilti �(ti `r"fi Mass.
MA
AL New
City, Town
Building
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❑ Renovation R
FIXTURES
Date �18
Permit # /f' 0 /3 ` OCL
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Type of Occupancy & /
eplacement ❑
Plans Submitted Yes ❑ No ❑
(Print or Type)
Installing Com
Check One: fi
t� @Certicate
wn Corp. 9/�T'dic/ 17
❑ Partnership
30R-39�% %%%� ❑Firm/Company
Business Telephone Name of Licensed Plumber or Gasfitter
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a
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
sipura ce polic agent
1 have a curtent liability insurance policy to include completed operations coverage
By
Title
City/ Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber
*7p�e'/� .,�ytpe'of Plum�bi�n License
7 Number
L7 Master ❑ Journeyman
License Number
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(Print or Type)
Installing Com
Check One: fi
t� @Certicate
wn Corp. 9/�T'dic/ 17
❑ Partnership
30R-39�% %%%� ❑Firm/Company
Business Telephone Name of Licensed Plumber or Gasfitter
o
a
I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
1 have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
sipura ce polic agent
1 have a curtent liability insurance policy to include completed operations coverage
By
Title
City/ Town
APPROVED (OFFICE USE ONLY)
Signature of Licensed Plumber
*7p�e'/� .,�ytpe'of Plum�bi�n License
7 Number
L7 Master ❑ Journeyman
License Number
FINAL INSPECTIONS
BELOW FOR OFFICE USE ONLY
SKETCHES
FEE
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME A TYPE OF BUILDING
LOCATION OF BUILDING
PLUMBER
PERMIT GRANTED
DATE 19
PLUMBING INSPECTOR
PROGRESS INSPECTIONS
Building Location:
Owner's Name:
Owner's Address:
TOWN OF YARMOUTH
Owner's Telephone:
Plumber Name:
License Number:
Company Name:
Company Phone;
Building Department
Town Hall
Yamouth, MA 02664
(508) 398-2231 eA261
PERMIT TO DO PLUMBING WORK
(OFFICE USE ONLY
Recorded By:
PERMIT NO.
Permit Fee:
Payment Type: - ----
Check Number:
Issue Date:
Type of Work:
Comments:
INSPECTION RECORD
Date Note Progress - Corrections and Remarks inspector
Date Printed: 5/16/02