HomeMy WebLinkAboutP-19-2208 $> MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK
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CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT: 1r PLANS SUBMITTED: YES 0 NOEL"
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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 0 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABIUTY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND
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 tto -• t of my knowledge
and that all plumbing work and Installations performed under the permit issued for this application will be In compliance h WI •> •- •-.t provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R PETER CHECKOWAY LICENSE# 13417 I `,Lc r URE
MP O JP❑ CORPORATION .❑# 4008 PARTNERSHIPQ# LLC D#
COMPANY NAME BOUROUE 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 inf• •thou •eheatin•andcoolin•.com
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