HomeMy WebLinkAboutP-11-685 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
__lif$ City/Town: 149.11Wlinf- ,MA. Date: Z If Permit#l1) -&oSSC
Building Location: 189 slag,ki f/rr.c_ (Auk-- Owners Name: )4✓F.e((L Jo►f/t(
PType of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential[]�
New:❑ Alteration:❑ Renovation:E---Replacement:❑ Plans Submitted: Yes❑ No p
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FIXTURES
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SUB BSMT.
BASEMENT
15T FLOOR I I
2HD FLOOR I I • , I .
Sao FLOOR
4T"FLOOR
5T"FLOOR
61"FLOOR
7T"FLOOR
8T"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
0 Partnership
Business Tel: 774-470-1350 Fax: 774-470-1350
0 Firm/Company
Name of Licensed Plumber: Doug Langtry
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes ® No 0
If you have checked Yes,please Indicate the type of coverage by checking the appropriate box below.
A liability insurance policy ® 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 ❑ Agent 0
Signature of Owner or-Owner's Agent
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 compliance with all
Pertinent provision of the Massa ,usetts State Plumbing Code and Chapter 142 of the Gener L.
By . i0 r_ _ , Type of License: / i L /
Title (MS F [ , ❑plumber Sig ...Tie • L'/e.se. 'lumber
City/Town License Xi Master 11305
APPROVED(OFFICE USE ONLY)
❑Journeyman License Number:
J
FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(S1
FEE: S PERMIT#
APPLICATION FOR PERMIT TO DO GAS FITTING
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
SKETCH
PLUMBER GASFITTER LP INSTALLER
LICENSE NUMBER:
•
PERMIT GRANTED❑ DATE:
GAS FITTING INSPECTIOR