HomeMy WebLinkAboutG-11-351 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
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C%Pr''s 3 City/Town: 1/4,410M1-1— , MA. Date: 11171/6 Permit# G (L-35i
Building Location: /50 6640(Lt) Alt Owners Name: Me yfi l— I11K-rC�e,C_
G Type of Occupancy: Commercial 0 Educational ❑ Industrial Institutional 0 Residential
New:❑ Alteration: 0 Renovation:0 Replacement: L7Plans Submitted: Yes 0 No❑
FIXTURES
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SUB BSMT. _ _
BASEMENT
1" FLOOR
2N"FLOOR
3N)FLOOR ,
4'"FLOOR
51"FLOOR i . 0 WED
6'"FLOOR I ..--er
7'"FLOOR
8 FLOOR
- -. - . . . - Check One Only ' Certificate# -
Installing Company Name: 'Aqua Services Plumbing and Heating LLC.
®Corporation 3081
Address: 350 Main St. Unit A City/Town:West Yarmouth State: MA
❑ Partnership
Business Tel: 774-470-1350 Fax: 774-470-1351
❑ Firm/Company
Name of Licensed Plumber/Gas Fitter:
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 Yes® No❑
If you have checked Yes,please Indicate the type of coverage by checking the appropriate box below.
A liability Insurance policy in 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
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner 0 Agent 0
Signature of Owner or Owner's Agent
By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this 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 1
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and chapter 142 of the General Laws. _Type of License: Signature c n� s Pl�iber/Gas Fitter By - Plumber
Title ❑Gas Fitter g
®Master
City/Town ❑Journeyman License Number: 11305
APPROVED(OFFICE USE ONLY) ❑LP Installer
FINAL INSPECTION BELOW FOR OFF CE USE ONLY PROGRESS INSPECTION(S)
FEE: S :PERI) T#
APPLICATION FOR PERMIT Z`O DO GAS FITTING
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
SKETCII
_ PLUMBER GASFFITER LP INSTALLER
LICENSE NUMBER.
PERMIT GRANTED❑ DATE '.
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GAS FITTING INSPECTIOR
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