HomeMy WebLinkAboutP-11-206 APPLICATION FOR PERMIT TO DO PLUMBING
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a gTOWN OF YARMOUTH (OFFICE USE ONLY)
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Fee: $
PERMIT NO. P I —'7�t (o
Date _ 20 /0
Building n Owner's 6),'W er9i(/�1,J
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Type of Occupancy ASE
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New❑ Renovation ❑ Replacement Er- /,
Plans Submitted Yes 0 No Ir. t,/f
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR I.T:IT 9 "2.
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firs
(PRINT OR TYPE) Check One:
Installing Company Name 3 c6 r��g ,o, 0 • E rp. Y97e.
Ai� /P
Address / 4i,zi 4' A . :It 0 Partnership
jP"N/r/'TT,, o Py 7-27, . 6 ,,7/n..ft 0 Firm/ ompany
Business Telephne ‘6it.-w— 3c9'/&me of Licensed Plumber /26 5/4ycefPefo •kr•
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: YesNo 0
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
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 Mass. General Laws, and that my signature on this permit application waives this requirement.
Check on Owner 0 Agent 0
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have submitted ,k?� Si re�6f L rased
(or entered) in above application are true and accurate to the best of Plumber
my knowledge and that all plumbing work and Installations performed
under Permit issued for this application will be in compliance with all i,, 8-7a02.
pertinent provisions of the Massachusetts State Plumbing Code and License Number
Chapter 142 of the General Laws. Type: MasteRa Journeyman❑