HomeMy WebLinkAboutBuilding Permit BackfileTHE COMMONWEALTH OF MASSACHUSETTS
02 TOWN OF YARMOUTH
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Fee................. No.......................
OCCUPANCY PERMIT
"No building nor structure shall be erected, and no land, building or structure shall be used
for a new, different, changed, or enlarged use without a Building Permit therefor first having
been obtained from the Building Inspector. No building shall be occupied until a certificate of
occupancy has been issued by the Building Inspector."
Issued to:... ...... ,..Y .. ...........
Wiring Inspectq .. .... .. .. .:. .. .......inspection Date..-
Plumbing
ate..Plumbing Inspe c21X.-1 ........Inspection Date,,l....................
Fire Department...... f . fl.r.. .....:.. f .....:...... Inspection Date ?�1 ..�[J....................
,4,rf Building Inspector....... . � IN .. afC ... Inspection Date.... ..3 . . ....................
Assessors....................................................................................Inspection Date.........................................
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED
BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS.
Date:.... 3A/ ) �...... Building Inspector
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TOWN OF YARMOUTH
APPLICATION FOR PERMIT TO DO QUITTING
(OFFICE USE ONLY)
By D
T
$
PERMIT NO.
Building
AT. Location & 1114
Lqeozeg
New ❑ Renovation ❑ Replacement
Plans Submitted Yes ❑ No ❑
Date //%<�19 �' —
Owner's
Name
Type of Occupancy-1U2EV-2 J6
(PRINT OR TYPE) ' / Check On
U/JIISL
Installing Company Name E F & P ZI'IOIR1105- f/r/�J Coro. J1%- -jCzJ7-11-693
Address EB��/y�/�'-G� El Partnership T
n''
S,1:1 Firm/Company
Business Telephone 3� 21NEr
Name of Licensed Plumber or Gasfitter G. "r fy/NSLD�r2—'
INSURANCE COVERAGE: Check O e
I have a current liability insurance policy or its substantial equivalent. Yes No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
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.
Signature of Owner or Owner's Agent
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 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.
Check One:
Owner ❑ Agent ❑
Signature of Licensed
Plumber or Gasfitter
License Number
TYPE LIC
ENSE:
❑ Plumber ❑ Gasfitter ❑ Journ=eyman
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SUB-BSMT.
BASEMENT
IST FLOOR
2ND FLOOR
3RD FLOOR
(PRINT OR TYPE) ' / Check On
U/JIISL
Installing Company Name E F & P ZI'IOIR1105- f/r/�J Coro. J1%- -jCzJ7-11-693
Address EB��/y�/�'-G� El Partnership T
n''
S,1:1 Firm/Company
Business Telephone 3� 21NEr
Name of Licensed Plumber or Gasfitter G. "r fy/NSLD�r2—'
INSURANCE COVERAGE: Check O e
I have a current liability insurance policy or its substantial equivalent. Yes No ❑
If you have checked yes, please indicate the type of coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
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.
Signature of Owner or Owner's Agent
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 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.
Check One:
Owner ❑ Agent ❑
Signature of Licensed
Plumber or Gasfitter
License Number
TYPE LIC
ENSE:
❑ Plumber ❑ Gasfitter ❑ Journ=eyman