HomeMy WebLinkAboutP-14-490 -! MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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®; CIN 4 6464-1-4 I MA DATE /l Ili�l �I PERMIT# PIV-
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TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
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CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:E PLANS SUBMITTED: YES❑ NO®'
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INSURANCE COVERAGE: II
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I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL .142.'YES❑ NO 0 W
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW BUILD: 'G DEPT
LIABIUTY INSURANCE POUCY❑+ OTHER TYPE OF INDEMNITY El BOND ❑ Dy1 d " w,
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the W
Massachusetts General Laws,and that my signature on this permit application waives this requirement
CHECK ONE ONLY: OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR 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 PeitIn5rd provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBERS NAME Kevin J.Sullivan - LICENSE# 13041 /•St6NATURE
MPID JP❑ --.---- CORPORATION❑# 2433 PARTNERSHIP❑# LLCQ#
COMPANY NAME Ready Rooter,Inc. ADDRESS P.O.Box 371
CITY Sandwich 1 STATE MA I ZIP 02563 TEL 508-8881055
FAX 508-888-0242 CELL EMAIL kjs@readyrooter.com