HomeMy WebLinkAboutP-11-256 -di•••
' 1 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
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c-="(;i=bisM � City/Town: y ARrYlOU ,MA. Date: // h--I/O Permit# V1 1 - `-tet!/
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Building Location: 4.3 POMPANO Thia Owners Name:
Type of Occupancy: Commercial❑ Educational 0 Industrial❑ Institutional 0 Residential 2---
New:
v]"TNew:p Alteration:❑ Renovation:❑ Replacement:2-- Plans Submitted: Yes❑ No 0
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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: 7744704350 Fax: 774470-1350
0 Firm/Company
Name of Licensed Plumber:
- -- 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 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 0 Agent ❑
Signature of Owner or Owners 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
pe of License: P
Pertinent provision of the Massachusetts StatePlumbingCode and Chapter 142 of the Grineral Laws.By T '\fj t[/(//
Title
I0 Plumber Signare�of Le ed Plumber
City/Town ®haste y License Number: 11305
4 APPROVED(OFFICE USE ONLY) ❑.iourn¢ man
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FINAL INSPECTION BELOW FOR OFFICE USE ONLY -- - PROGRESS INSPECTION(S1 I.
FEE S PERMIT#
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APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OFt BUILDING - - - -
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LOCATION OF BUILDING J
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•PLUMBER p
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LICENSE NUMBER
PERMIT GRANTED ' DATE: - C
PLUMBING INSPECTIOR
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