HomeMy WebLinkAboutP-11-729 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
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Cit T (/i,1 mDVl,l ✓1 5)&t3111 Permit# PII " '727
=_�i(_ City/Town: , MA. Date:
&`YL Plebes
Building Location: a4 O �(,1,1 1 f P ( Owners Name:
P . Rp
+. T3
Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential
New: ❑ Alteration: ❑ Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ Not
FIXTURES
DEDICATED
SYSTEMS
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SUB BSMT. I - - R E C E I �d E D'
BASEMENT
15T FLOOR -
2ND FLOOR MA! L 5 2011
3RD FLOOR
4T"FLOOR
BU4rLvG rEPT
51"FLOOR By,
6'"FLOOR - —
7'"FLOOR
8r"FLOOR
W. Vernon WhiieleqInc Check OneOnly Certificate#
Installing Company Name: ) IYI
9t7 /�/� ��r-y� W.
(� _,,, '• inn Corporation
Address: aD VI II age lO 1.l) /Town: Clral-YIQ m State: II In
C V (�'f (,,�l''I,,-.,,, C ❑Partnership
Business Tel: 50S-145- II00 Fax: 502-(1(45-5J1j9 - ❑Firm/Company. _
Name of Licensed Plumber: W. -Thomas WhiteIN
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes It(No 0
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy Lv] Other type of indemnity 0 Bond 0 ,
OWNER'S INSURANCE WAIVER:1 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 0 Agent 0
Signature of Owner or Owner's Agent
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 permit issued for this application will be in compliance with all
/P ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
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By • �.. �` (�..�1 - --\ Type of License: (Z�rd
Title I IJS' C i I 0 Plumber Signature of Licensed Plumber
City/Town t . O • - ['Jlourer of
APPROVED(OFFICE US 7 ONLY) ❑Jouneyman N License Number: 1 r
FINAL INSPECTION • BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S1
FEE: S PERMIT#
APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OFUILDING
P►Pbecs re,5ienc )
LOCATION OF BUILDING
SKETCH a4$ p 8+. A�-.T3
•
(PLUMBER
W. V. Whiiel ) Inc..
LICENSE NUMBER: Mg 017 -
PERMIT GRANTED❑ DATE; -
PLUMBING INSPECTIOR