HomeMy WebLinkAboutP-11-095 MAP PAR
•
4 �' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING •
• .(Pr•int or\fype) ((.695
• (I2Y)W'A ' • , Mass. Date 77 ' ,R• 0• /0 ' Permit#
Building Location 149-ICI S€Av'� A'F Owner's Name t-
fi':4
RED ad( etmton
SGUvla4i '4 R 9 w Type of Occupancy New°17 lage)Renovation ❑ Replacement Q Pians Submitted: Yes ❑ No, =–" • FIXTURES
• •
z � � z
(LU
e
tip J UJ 0 Z 6
S
m W In = d t-- 0 W 1 cc oo O t C d
0 ^ c: m tsC4 w } 5 F D3 z pc- N C'3 .ca = O 1
_ b s - po ± -3ooni- c :cocc CI El c c
ajO w
uu _
sC < K2 �' - rtd0 � � c ¢ [[ cc Ops 1-2
I Y J [D CO 0'0 J S 2 I-- CG, u- C7 = O < CC CO O
• SUB-BSMT.
u • BASEMENT
1ST FLOOR
:p.i •' 2ND FLOOR '
I 3RD FLOOR
•
• I 4TH FLOOR n
I 5TH FLOOR aC Er E5 if
6TH FLOOR • ....,•-•"''''.°9—�� • 7TH FLOOR
8TH FLOOR
Check one: Certificate
Installing Company Name Rusty 1 s Tnc. g.Corporation 1 762
Address ' 222 Mid–Tech Drive 0 Partnership
West Yarmouth •❑ Firm/Co.' '
Business Telephone 508-775-1'R03 ' .
Name of Licensed Plumber Frank W. Roderick
• INSURANCE COVERAGE:
I have a currant liability policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
• Yes No ❑
If you have checked yes,'please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy I. Other type of Indemnity 0 Bond ❑
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:
Signature of Owner or Owner's Agent Owner 0 Agent 0
• 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 with all pertinent provisions of the Massachu tts State Plumbing Cade and Chapter 142 of the General Laws.
By Guc% u� r'cic - J
Title Signature of Licensed Plumber
Clty/Town Type of License: Master 22----- Journeyman 0
AP PROVED (OFFICE USE ONLY) License Number 7794