HomeMy WebLinkAboutP-11-716 ArrucAlwN FUR PERM!I lu IA)run/mint'
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PERMIT NOMI - 7 I &
Date S / 0//
Building Owner's
AT: Location y 3 nY 5 e4Py 1M- Name 1-to SCocec
Type of Occupancy 71&-S/ a✓7Yii-C
New 0 Renovation: Replacement 0
!01 Pla 43 Submitted Yes 0 Nom
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SUB-BSMT.
BASEMENT
1ST FLOOR l i / /• J 1
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) Check One:
Installing Company Name 2%,- C�9(rr ` t,"73,wo- (aCorp. ' ft)
AddreIs,s, 3 Ale/221751' iPt.� fly 0 Partnership
fro A&ea I/MA- Mein 0 Firm/Company
Business Telephone 7Pl-- 133->4100 Name of Licensed PlumbepOaars O £cWAtc ) th9 ciz-v4
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent Check One: Yes Ygl No 0
If you have checked YES,please indicate the type of coverage by checking the appropriate box.
A liability insurance policy021*---- 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. General Laws, and that my signature on this permit application waives this requirement
Check on Owner 0 Agent 0
Signature of Owner orOwner's Agent
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I herebycertifythat 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 L'S 7V
pertinent provisions of the Massachusetts State Plumbing Code and License Number
Chapter 142 of the General Laws. Type: Master Journeyman 0