HomeMy WebLinkAboutP-11-586 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
L ='•`i_® Ci /Town:ty 1ARMOLf }l- , MA. Date: 3IZ€1Iit Permit#TI/
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Building Location: 113 Y'toT yr ibtxir0 kb Owners Name: Y 1 Roma
PType of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential Er-
New:❑ Alteration:❑ Renovation:[- Replacement:❑ Plans Submitted: Yes❑ No❑
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- Check One Only Certificate#
Installing Company Name: Aqua Services Plumbing and Heating LLC.
III Corporation 3081
Address:350 Main St. Unit ACity/Town:West Yarmouth state: MA
0 Partnership
Business Tel: 774470-1350 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 ❑ 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 ❑
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 Massachusetts-- _ State Plumbing Code and Chapter 142 of the General Laws. - - --
e( �-�P \ Type of License: . / `
Tide 110T),Os/�� II N
0 Plumber Signet-773f is "n;.-d P mber
City/Town Ate�yn ®Master License Number: 11305
APPROVED(OFFICE USE ONLY) ❑�oumeyman
•
FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION(SI
FEE: $ 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