Plumbing Permit ,� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Ip, .w 1 / TOWN OF YARMOUTH,MA 02664 Date 1/ 35 4 c)ac:c' Permit# f DO^1.23
ice— y Building Location 4`i 5 al,.c, )c e.c *ç € 2.0... Owner's Name.+:i a AA_ $41 e
'• 'J'rq r o Type of Occupancy ))w e(I:-k- \
New 0 Renovation 0 Replacement Plans Submitted: Yes 0 No 0.
FIXTURES
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SUB—BSMT.
BASEMENT '
.-
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
, -
STH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR t
Installing Company Name 4 1 C l 0..‘..b-';--,\ Check one: Certificate
Address td 4. /4.e,..•.5 i3c,z+e 2cQ 0 Corporation
e.�.44..-, rvt- ..,. 0 Partnership
Business Telephone —5%•c'-' 1.2 SS 0 Firm/Co.
Name of Licensed Plumber d.P�.1. lis t&i at- (Ne,
INSURANCE COVERAGE:
I have a curve lability 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 coverage by checking the appropriate box
A liability insurance policy 0 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 one:
Owner 0 Agent 0
Signature of Owner or Owner's Agent
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I hereby certify that all of the details and information I have submitted(or entered)in above 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 provisions of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
BY i de : i4ea,,(e__ e
Signature of Licensed Plumber
Title ' $ .
INAT J
Type of License: Master Er- Journeyman 0
City/Town
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FINAL INSPECTIONS SKETCHES
FEE
No. -13
APPLICATION FOR PERMIT TO DO PLUMBING
NAME &TYPE OF BUILDING .cs C‘(;v_
LI47L.A. Seg
LOCATION OF BUILDING
5A-4,kex ose V40.
PLUMBER i-1 C '?t M8•"-P-
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weon ,e-'_ C,c 0 2-� c .
PERMIT GRANTED
DATE 19
611‘e.,e4
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PLUMBING INSPECTOR