HomeMy WebLinkAboutG-12-002 I sog - .2 2 1 ---7 1 t j �/r
_.-.___tom__... MASSACHUSETTS-UNIFOR IO
CATNFOR-PERMITITTIFTG
__
1, t� -
City/Town,Yarmouth MA. Date: 06/6/11 Permit# G�� 60 Z
Building Location:245 Blue Rock Road M#101 P#157 Owners Name: lodice 111121a5
G Type of Occupancy: Commercial 0 Educational 0 Industrial 0 Institutional ❑ • Residential
New: Et Alteration: 0 Renovation: 0 Replacement: 0 Plans Submitted:.Yes o No Er
FIXTURES
1Z I
�� °� IL
co
re co o rn E y en R CEIVEDJ
m 2 U'0 IL w } C' Z to O N re 2
� a o z g Z o IX IL �W oL' UL ° ' 20fl
(sr;\ ' C en th
V z COal re OF W to i_ uJ W G 2 LI
vwA ``\�pi j V W Z f7 1251 FW- f. O Z . J t9 u- to 2 z W W yr r FRILIDINO DEFT.
ICY o it ; E a it w 11 5 o °a ga 2 I" > > 3 0
U O O ti t9 t7 2 2
SUB B"SMT. ,
BASEMENT
irr-FLOOR 1
2N'PLOOR
3ReTC0OR
-4T"FLOOR"......__.
67"-F'C'O-OR .
6Te FLOOR ,.
V"FLOOR
8'"FLOOR
Check One Onlyl C rtificate#
Installing Company Name: Hall Plumbing&Heating, Inc.
corporation C-2803
Address:447 Old Chatham Road City/Town:South Dennis State:MA
o Partnership
Business Tel: 508-385-9127 Fax: 508-385-6604 i
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 ® No 0
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy L- 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 ❑ Agent 0
Signature of Owner or Owners Agent
By checking this box U I hereby certify that all of the details and Information I have submitted(or entered r-•arding this application are true and
accurate to the best of my Knowledge and that all plumbing work and Installations performed und:- e pe t Issued for this application will be in
compliance with all Pertinent provision of the Massachusetts State Plumbing Code a.• apter ,- of the G; eral Laws.
By ��� i�' T pePlumber of License: '
1h�
Title 1k15Psczrt� Gas Fitter
IC-Master : of an umber/Gas Fitter
City/Town • 0 - LP Insta 'cense Number: PL-15030-M
APPROVED(OFFICE U: ONLY)
p