HomeMy WebLinkAboutP-11-202 ^r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type) PR �J
;`f RrLwtOUTh Mass Date10/8/10 20 10
Permit* �`'z--
Building Location 28 Standish Way Owners Name Sheerin
West Yarmouth`M#30/P#143 1 Type of Occupancy Res
New 0 Renovation 0 Replacement a Plans Submitted: Yes ❑ No
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SUB-BSMT.
'�' BASEMENT 1 _
' 1ST FLOOR
44-it .-2ND FLOOR
3RD FLOOR
4TH FLOOR
5Th FLOOR . • ACCEPTED
6TH FLOOR
7TH FLOOR
8TH FLOOR -. - -
Installing Company Name Hall Plumbing&Heating,Inc. Check one: Certificate
Address 447 Old Chatham Road C-2803
South Dennis,MA.02660 Dorporaton
Business Telephone 508-385-9127 nsrtnership
Name of Licensed Plumber James Pazakis
plirm/Company
INSURANCE COVERAGE:
I have a current liabilit insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes ✓ No
If you have rd yes, indicate the type of coverage by checking the appropriate box.
A liability Insurance policy Other type of indemnity❑ Bond f '
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 O Agent 0
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 tru= -•: : . o tt6t he best of my knowle nd that at plumbing
work and installations performed under the permit issued for this application will be in compliance with . ••rtin =visions of the Massach s State Plumbing Code and
Chapter 142 of the General Laws.
/
By
Tye Signa ..41 license. 'umber
City/Town ype o ' • e: Master C✓ Journeyman E
APPROVED (OFFICE USE ONLY) License Number PL-15030-N