HomeMy WebLinkAbout121 Camp St Treatment Plant Building PermitsPlans Submitted Yes ❑ No ❑
APPLICATION FOR PERMIT TO DO PLUMBING
TOWN OF YARMOUTH(OFFICE USE ONLY)
BFee: $ �3 UU
PERMIT NO.Datte20Building Owner'sAT. Location T Name�I�D �62Type of Occupancy New Renovation ❑ Replacement ❑T����C"Irl�
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0Check One:
nstalling Cc any Name25- � /L ❑Corp.
Address ❑ Partnership N, r �OPA iG3� rm/Company ,�l�BusinessTelephone 31 d �SQ Name of Licensed Plumber 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 ❑ 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.
Signature ofOwner 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 on
License Number
Type: Master El Journeyman
OF, y,9
TOWN OF YARMOUTH
W.y ACHEESE
Am
APPLICATION FOR PERMIT TO DO PLUMBING
( FICE USE ONLY)
By
Fee: $
PERMIT NO.
Building Owner's
AT: Location �� Name_
Date
Type of Occupancy
New Renovation ❑ Replacement ❑
Yes❑ No
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Business Telephone �y V/�=ame of Licensed Plumbert/�mscr-
INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent. Check One: Yeses �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 voerage 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 on Owner
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License Number
Type: Master Journeym�
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f�2f1�u//N�
TOWN OF YARMOUTH
APPLICATION FOR PERMIT TO DO GASFITTING
(OFFICE USE ONLY)
Fee: $ a6 . ffl)
PERMIT NO. Gr D � 7 /�
Date
Building ,p Owner's
AT. Location f Name
—/ Type of Occupancy
New Ve3" Renovation ❑ Replacement ❑ -TM
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Plans Submitted Yes ❑ No ❑ Iv 1 � V
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
3I0P11NT9
AI5talling
Address
&MAJS&rC- 4- CLEAMP-co;
Check One:
Business Telephone
Name
Name of Licensed Plumber or Gasfitter
INSURANCE COVERAGE:
❑ Corp.
❑ Part Ip
Firm/Company
NOV 3 0 2004
;hecl ne )�,
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. j ,
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.
Signature of Licens d
Plumber or Gasfi er
23r9 ?
License Number
PE LICENSE:
Oplumber t5eGasfitter ❑ Master ❑ urneyman