HomeMy WebLinkAboutG-11-679 y
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING
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~'!- City/Town: yARfY1�U MA. Date: 31211III Permit# G ll - ea
Building Location: "N WESTNA2mbLIS4F Rf . Owners Name: -6Le%) P/C-LW-6
Type of Occupancy: Commercial 0 Educational 0 Industrial 0 Institutional 0 Residential p---
New: ❑ Alteration:0 Renovation: Er Replacement: 0 Plans Submitted: Yes 0 No 0
FIXTURES
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SUB BSMT.
BASEMENT
1" FLOOR j
2"u FLOOR
3"u FLOOR
_41"FLOOR
5'"FLOOR
6'"FLOOR
71" FLOOR
8"1 FLOOR
Check One Only Certificate#
Installing Company Name: Aqua Services Plumbing and Heating LLC.
y 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: 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❑
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:1 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 ❑
Signature of Owner or Owner's Agent
By checking this box 0;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
co..• lance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
•••,.._' �� i I / i\. Toe of License:
By &... t �'
is, 11 Plumber l
Title , it. �,! I 0 Gas Fitter Sign• ! e-o LF: s-: Plumber/Gas Fitter
®Master
City/Town *L � ❑Journeyman License Number: 11305
APPROVED(OFFICE USE •NLY) 0 LP installer
•
FINAL INSPECTION BELOW FOR OFFICE USE ONLY PROGRESS INSPECTIONISI
FEE: S _ PERMIT#
APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
•
SKETCH
PLUMBER
LICENSE NUMBER:
PERMIT GRANTED DATE'
PLUMBING INSPECTIOR.