HomeMy WebLinkAboutP-13-325 r—
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f , TOWN OF YARMOUTH (OFFICE USE ONLY)
By
=' C r t 54II Fee: $ ✓� 2
' 2 012 u PERMIT NO. Q ( J ' %
NOV 20 2012
PgUILptNGOEPT Date fg/� 20 /a
Building By Owner's �/s ti"'�r/-N
AT: Location tot0etutriLiRO f� Name /
Di i '1ArwtPa ilk_ ,,`
Type of pccupancy
Newf� Renovation 0 Replacement(W
Plans Submitted Yes❑ No❑
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SUB-BSMT.
BASEMENT
1ST FLOOR L I t l I ! / I
2ND FLOOR
3RD FLOOR
ijjFr � ,�/
(PRINT OR TYPE) Check One01
Installing Company Name X E/1/ rJ elf' H 0 Corp.
Address 6/ 4-F f c R/- /re-EA/ E A VE 0 Partnership
, c Usit/VF T M A LAS FirndCompany
Business Telephone CO 3. ? TO O 397 Name of Licensed Plumber HAW CR R e. a N
C C/L $08 `TS/ /259
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent.Check One: Yes 0 No 0
If you have checked YES,please Indicate the type of coverage by checking the appropriate box.
A liability insurance policy 0 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 Mass. rat Laws, a d that my signature on this permit application waives this requirement.
./iSigI wner �— Check on Owner- Agent ❑
SignatureorOwner„%/�wner'sAgenr
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L - "' -i I hereby certify that all of the details and information I have submitted Signature of Licensed
(or entered) In above application are true and accurate to the best of Plumber
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 Plumbing Code and License Number
Chapter 142 of the General Laws. Type: Master EV. Journeyman 0
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