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HomeMy WebLinkAboutP-12-135 MASSACHUSETTS UNIFORM APPLICATION F� PERMIT TO DO PLUMBING Wr J /01-100-11 , Mass. Date 9 /3 i f Permit# lel 2– J'3 ,BL/S4 �" !! Building Location (�a CLfC of y8 Nc 049 Owner's Name RAN ,BL/S4&11I Owner's Phone# ne? 77/ (p 7�.o\— Type of Occupancy Residential PNew 0 Renovation Q Replacement QX Plans Submitted: Yes 0 No 12 JG W // \ F— J fn Z W Q OL�/l rn z w _ rn Z CK o Z z Z a n �J EIin Wm rn v� x o F"' U W cn Y a u_ a ¢ l� V z 2 03 W W LU ¢ w Z p J Z g a Q O u. p w Q = (31:3t Y a p L- Q m w ti Y w vxi • `1 g m m 0 5 2 I– ca LL C7 D 0 Q m O I-- SUB-BSMT. BASEMENT —1ST FLOOR 2ND FLOOR 3RD FLOOR _ 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Bath Inc./Area Plumbing Check one: Certificate Address 25 Turnpike Street © Corporation 2430 West Bridgewater, MA 02379 Partnership Business Telephone ' 508-521-2700 1.1 Firm/Co. _ Name of Licensed Plumber Jeffrey Carlson INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL ch. 142. Yes EX No❑ If you have check yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy EX Other type of indemnity ❑ Bond E 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 one: Owner Q Agent In Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted(or entered)in above 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 Iwth all pertinent provisions of the Massachusetts State Plumbing Code and Chapert 142 of the General Laws. By C �.s✓r� Title Signature of Licensed Plumber City/Town Type of License: Master MX Journeyman El APPROVED(OFFICE USE ONLY) License Number: 8932