HomeMy WebLinkAboutBLDP-19-001185 _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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JOBSREADDRESS 3b I r ,Yt �� ( OWNER'S NAME l�OGGO I�O(I/In IS
P OWNER ADDRESS I S Ca1.c0441-01 cti� Xdgnt N H ( TEL 603•S(s O' hd/ 'FAX I I
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIA421
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CLEARLY NEW:CI RENOVATION:El REPLACEMENT:I '1 PLANS SUBMITTED: YES❑ NOEfi
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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 a NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABIUTYINSURANCE POLICY❑. OTHER TYPE OF INDEMNITY 0 BOND 0
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 0 AGENT 0
SIGNATURE OF OWNER OR AGENT i
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurateto •- •–t of my knowledge
and that all plumbing work and Installations performed under the permit Issued for this application will be in compliance all P- t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R PETER CHECKOWAY LICENSE# 13417 401 URE
MPD JPD CORPORATION Q# 4008 PARTNERSHIP❑# LLC❑#
COMPANY NAME BOURQUE HEATING&COOLING CO ADDRESS 1199 PITCHERS WAY
CITY HYANNIS STATE MA ZIP 02631 TEL 508-790-2887
FAX 508-771-9696 CELL 508-735-9993 EMAIL Infoibou •eheatin.andcoolin..com
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
' Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
• FEE: S PERMIT# /_'
• PLAN REVIEW NOTES Orr !r` .
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