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MASSACHUSETTS-ONIFORM71PPLIC"ATION`FORTERMITTO DOTGAW FITTING
kit� ,;, City/Town,Yarmouth MA. Date: 1/19/12 Permit# G I2— Y5.
GBuilding Location: 55 Bob O Link M#49P#158 Owners Name: Manning
Type of Occupancy: Commercial ❑ Educational 0 Industrial 0 Institutional 0 Residential LK
New: 0 Alteration: 0 Renovation: 0 Replacement: ® Plans Submitted: Yes ❑ No
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-SUB BSMT. •
BASEMENT 4
-151-F L-0-012--
2N0 FLOOR
-3 rrceitOR 1 .
'4TH FLOOR..-. _....._ee-......�........, _...
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-5"-PCOOR
7"1"-FL-OOR - .
8'"FLOOR
Check One Only Certificate#
Installing Company Name: Hall Plumbing & Heating, Inc.
O Corporation C-2803
Address: 447 Old Chatham Road City/Town:South Dennis State:MA
0 Partnership
Business Tel: 508-385-9127 Fax: 508-385-6604
0 Firm/Company
Name of Licensed Plumber/Gas Fitter: James Pazakis
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes iia No 0
If you have checked Yes,please Indicate the type of coverage by checking the appropriate box below.
A liability insurance policy E... 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 tilt
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner 0 Agent ❑
Signature of Owner or Owners Agent
By checking this box Q I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the best of my Knowledge and that all plumbing work and installations performed under the •- ed for this application will be In
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and C :: r 14 : I "ws.
By ` T,YY,,pe of License: _�
pSPlumber
LU Gas Fitter
Title RI.Master : of ar ber/Gas Fitter
City/Town Journeyman icense Num: -15030-M
LAPPROVED(OFFICE U$E.QNLYl 0 LP Installer