HomeMy WebLinkAboutP-12-300 APPLICATION FOR PERMIT TO DO PLUMBING
rti TOWN OF YARMOUTH (OFFICE USE ONLY)
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a DEC 12 2011
/'-�,/,�� PERMIT NO. r 12 36 0
.L�'50.0,NG DEfr �sz Date____ -07-1/_.I) T
Buildingu2 S C I. eV a I AM Vmt• owner's c`r K 1��15 e✓�
AT: Location v lame
�/ Type of Occupancy a-e s
New YQ Renovation❑ Replacement 0
Plans Submitted Yes No
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� 11� 3 ( W y y = 2 I- a w 0 (4 44 Lk a: q - EEC 1L2011
W O m C Q N K •� Q IT = 0 4 41 2 iL 2 Ei
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SUB-BSMT.
BASEMENT
1ST FLOOR 1
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) Check One:
Installing Company Name Rdat� 00fi -oe I r -t�J ElCorp.
Address 1 b 7 (Au cc, L1/1 0 Partnership
Isere, s f qb Le tin 02636 ❑ Fir cqmpany
Business Telephone 5D% -Zi 7—7109 Name of Licensed Plumber fjd4ri H U i i tp al
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes tI No 0
If you have checked YES, please Indicate the type of coverage by checking the appropriate box.
A liability insurance policy 0 Other type of indemnity 0 Bond 0
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 that my signature on this permit application waives this requirement.
Check on Ow er 0 Agen 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 -
7
under Permit Issued for this application will be In compliance with all J L St
pertinent provisions of the Massachusetts State Plumbing Code and License Nu
Chapter 142 of the General Laws. Type: Mestere- Journeyman 0