HomeMy WebLinkAboutBLDP-20-004670 NIAS'.t, ;HL 'TS UNIFOR nil APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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INSURANCE COVERAGE:
have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 1,12. 'E;: , N0
'r'Oit( io ;KED YES,PLEASE INDICATE TIT TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
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" I' . . air. the IL:,I ,rU(IoeS I10_'lave A-10 itlyiir311C:'coverage rhCiLiri J oy Ct "Iptur 1.12 G' '.h9
1,,•, 1 t.Ln It-lr l l:i(;nature on .Ills puirnit application waives this requirement.
CHECK ONE ONLY. OWNER AGEi'.1
SI.;NATURE OF AWNS ( ";AGENT
,,;area .. 'i`) ,r i at of the det:uis and irk e lotion I have submitted or entered regarding this application are true and ke to to' es my kl r,4!.: Le_
.I. it J I ; .vc,k..nd II' '.11 atier- , orned unde, tiai;permit issued for this appticatlon vMill be in cosine <I r1_r-nt )ruv. ior
',...ssa.1_sots_,State Plumbing Coce and Chapter 142 of the General Laws.
-Jr'BE,R S NAME James Pazakis LICENSE+, 15030 SIGN URE
CORPORA-1ION " #, C-3984 PARTNERS P # LLC
DDI;E: _ 4 )In n Ro,i,d
STATE ZIP C2360 TEL 508 385-ti 127
CELL EMAIL
POI '- ';1'MBING INSPECT ION "i: - .' OFFICE LSE ON .l FIN ;k1. I\'Pi ' ON NOTES
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THIS APPLICATION .S AS THE PERMIT L
FEE: $ PERMIT#
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