HomeMy WebLinkAboutP-11-179 MAP of S PAR /93 \.
' MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
, _ ,(Print,or Type)
- 1akMW`tC_1 �iauMass. Date 930 • 20 /o Permit#P((^ irri
• 1. Building Location Wel -/S) Oereu) Aye.- Owner'st INA/
Name EDE2fCk POto
a", g_412 IIL Soo n414 rvtav 1 ' Type of Occupancy -Ret
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NeVdJCTag.` Rencvation 0 Replacement Plans Submitted: Yes 0 No E---.
• FIXTURES
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SUE-BSMT, I I I I I I _,_ I I_._ I._. I I I
F4 • BASEMENT I I 1 I
1ST FLOOR II
w 2ND FLOOR] I I "
• • i 3RD FLOOR I I I I I
4TH FLOOR I •
, 5T1-1 FLOOR
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L., 6TH FLOOR . I i.
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. C ._ 7TH FLOOR I I
. - - 8TH FLOOR' I- I I I I'
Check one, Certificate
Installing Company Name. Rusty ' s Tnr. Corporacion ' ' 1762
•
Address - , 222 Mid-Tech Drive -- - - 0 Partnership
West Yarmouth •❑ Firm/Co '
Business Telephone 508-775-1303 • ACCEPTED
Name of Licensed Plumber Frank W. Roderick •
• INSURANCE COVERAGE:
I have a curlent liability policy or its substantial equivalent which meets the requirements of MGL Ch, 142.
YesA, No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box,
A liability Insurance policy K 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 one:
Signature of Owner or Owner's Agent --- -. Owner 0 Agent 0
1-.1 hereby tarty that Ell of the details and Information I have submlted (or entered)in-above applloation 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
B p provisionsie Plumbing Cbde and Chapter 142 of the General Laws,,
I be In cam Vance.wub all per hent Ofss
the upaC U iSe " �2 i 1 . i '� i .
BY
u/Qvc(.r Uatl .r�.
Title -" - Signature of Licensed Plumber_
City/Town Type of License: Master 61---" Journeyman ❑
APPROVED (OFFICE USE ONLY) License Number 7794