HomeMy WebLinkAboutP-12-014 ArrLI:AUUN FUR PERMII lu LA)rLVm:m ita
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; TOWN OF YARMOUTH , - ,e
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;:,, ,;:. Fee:$
PERMIT NO. 1 2- a 14
/ Date 20 11
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Building /� , t ' t [� Owner's Vtratint t Ll
AT: Location a3 LS a h U6(Yc (SGL.:. Name �J
_O tL 5irvvt (.04--• , I
cJ Type of Occupancy P.S'lelLLAX--
New❑ Renoovvaa''on❑ Replacement g.
Plans Submitted Yes❑ Nold
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rla Ne n Ne 4 s Y S a rn =O f7 CO W m JUL 1 1 2011 1
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_ ¢ °o ¢ rn to ¢ 3 ~ w y i o B JILDING DE n
FW. U a 0 S a0. 2 y Y a ¢O y 2 CC 0 2 w u. Y W c.t$r ;y_
3Y5 7000 s 3I I-- ...1 Cooa3itmoq
SUB-BSMT.
BASEMENT I 1
1ST FLOOR
2ND FLOOR
3RD FLOOR
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(PRINT OR TYPE) Check One:
Installing Company Name ft" .ti d _,1,17. : s .! !., U I ..Corp.
Address 10 L ct 0 ittiSA l)r1JP. 0 Partnership
00 . F y1,ckoafk, ON Oass(o 0 Firm/Company
Business Telephone <67-q 1 S 3 Cot Name of Licensed Plumber &ona d 134r-car
INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent.Check One: Yes LN No 0
If you have checked YES, please Indicate the type of coverage by c eking the appropriate box.
A liability Insurance policy • 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 or Owner's Agent
I hereby certify that 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 t-(oQa-
pertinent provisions of the Massachusetts State Plumbing Code and License Nu er
Chapter 142 of the General Laws.
Type: Master Journeyman 0