HomeMy WebLinkAboutPlumbing Permit „,,,O,,,,,,__
•+ , ` ' APPLICATION FOR PERMIT TO DO PLUMBING
s ` �� TOWN OF YARMOUTH (OFFICE USE ONLY)
RECEIVED By
; Fee: $ G5 0-0
1
�� APR 0 6 2010 PERMIT NO. l d S. '77 )O
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i S DEP Date Li 44. 20 je)
By:
Building Owner's .1-100h
fir;` •T Location $ � .(411^0- Name 1411/7/
Type of Occupancye5.
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New[ii Renovation C1' Replacement❑
/ : ans Submitted Yes❑ No
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SUB-BSMT. _ /
BASEMENT e
1ST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) Check One:
Installing Company Namec�.:6,en4-ew--5e.5 t--t-C., L'orp. i3
Address t-15c.71(Z '4(wxxOth C Ct.2L)?f ❑ Partnership
❑ Firm/Company
Business Telephone ` "-{ 15' —(-{()'LC( Name of Licensed Plumber
sic sow- (A • a mt
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yes No ❑
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy t`J” Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance voerage required by Chapter 142 of
the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check on Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
ij
I hereby certify that all of the details and information I have submitted ign ture of Licensed
(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 '- `Sc t 3- wl
pertinent provisions of the Massachusetts State Plumbing Code and License Number
Chapter 142 of the General Laws. Type: Master LW Journeyman❑