HomeMy WebLinkAboutP-14-011 s_ vy49 APPLICATION FOR PERMIT TO DO PLUMBING
g TOWN OF YARMOUTH (OFFICE USE ONLY)
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- - it E C E I t E D q � Fee: $
P [A,,,,,,,,,,,i ... PERMIT NO. / i/ Jo�/
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Building •wner's 6DIA3Al2D c.
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t Type of Occupancy ( a -
New❑ • Renovation ❑ Replacements'
Plans Submitted Yes❑ No,$
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SUB-BSMT. ,
BASEMENT f •
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) Check One:
Installing Company Name/d(, v cpn,Q'r F .LJMI ❑ Corp.
Address 2-112 IIPPER (?)JF 1 >4D El Partnership
D0aNRA pnitC MA Ola,?9 f Firm/Company
Business Telephone ( )7(pn-fr-la ( Name of Licensed Plumber7jCi-EAS •EacidiC
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes/16 No El
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
A liability insurance policyX Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of
the Mass. General Laws, and t t my signature on this permit application waives this requirement.
NJ Check on Owner 111 Agent 0
Signature 1 Owner or Owner's Agent
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I hereby certify that all of the details and information I have submitted —S g''re of License.
(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 21,0, 3
pertinent provisions of the Massachusetts State Plumbing Code and License Number
Chapter 142 of the General Laws. o ''
Type:f .uNB Master❑ Journeyman%