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Home My WebLink AboutBuilding PermitsOFTOWN OF YARMOUTH Building Department BUILDING + _ _ _ _ _ _ _ _ _ (508) 398-2231 ext.1261 PERMIT NO B-12-1382 _ = = PERMIT ISSUE DATE ; _ _5/2/2012_ _ ; PROPOSED USE ; APPLICANT " Be'nt ---'•"" JOB WEATHER CARD ... AT (LOCATION) 10034HATCH RD ktZNG SUBDIVISION MAP LOT BLOCK 1089.18 BUILDING IS TO BE: LOT SIZE two replacement doors REMARKS PERMIT TO Alterations TRIC R-40 Bldg. Type: Residential CONST TYPE 6-6USE GROUP R-3 AREA (SO FT) EST COST ($ $800.00 PERMIT FEE ($) $40.00 OWNER 1PUCHALSKY, DAVID H BUILDING DEPT BY ADDRESS 10034 HATCH RD South Yarmouth I MA 102664 CONTRACTOR LICENSE 15578 Bent, Allen 46 Winsome Road South Yarmouth MA 02664 5083947709 PHONE 15083946668 INSPECTION RECORD FIELD COPY Date Note Progress - Corrections and Remarks Inspector R E C I V S D Lu . 'MAY 02 012nths from IL I E ARTMENT tw: EXPRESS BUILDING PER.NIIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRFSSt ASSESSOR'S INFORMATION: OWNER: Map: ,Q I I Parcel: PRESENT TEL uV;14e6ff CONTRACTOR: lZf ISA a' P!�2A) 4- W, Aj f fV:5nm £ /2X 77O NAME MAIL NU ADDRESS TEL N Residenti Commercial 0 ESL Cost of Construction $ �6 d House Improvement Contractor Lia it / D S7 ! Construction Supervisor Lie. Workman's Compensation Insurance. (c ck en 1 am the homeowner 1 am the sole pruprieto I have Worker's Compensation Insurance Insurance Company Name Worker's Comp. Polkyr 0 Tent (Fire Rclxdaw Cuttfkm w-%.hcsl) YORK TO BR P . FO M p ❑Wood Stove Shred O Sldin11: N of Square.s 0 Replaarttsrt windows; N OReplacement dooss N- , 0 Electrical Permit r 0 Re -roof; N of Square 0 Insulation () Suippla11 old shim• () 9011311 over ---- Iayers of exlstinr roof ❑ Old Klop Hithway/Hlstorie District ( / c, RoofIn11/Sldia11(Llke for Like) 'The debris will be disposed of at: L )=Ion or Fact y I ill bel under aforpenalties W cc my that the sLussnee ereln contained are tnw sad correct to the best of my knowledge and belief. I understand that any raise answers) will be Just cause for tkalal a rev atlon f my posecvtbn urrkr M QL CL 268. SeedOo t. ApplkaW's Sl11nanua Data I Z Q Owners Sl11mture (or sltschmsnt) Date.. Approved By: uIWDate Dla11 Offklal (or dal11uce) Zoning Historical District Yes lik, Flood Plain Zone: Yes Water Resource Protection District W No Within 100 It of Wetlands Ya 31)1 The Commonwealth ofMauachuseth Department of lndrrrtrlal Accldentr Office ofLtveJNgadons 600 Washington Sheet Boston, MA 02111 Workers' m oIWIRM� IUcaat iatoruadlon8nsurnce AlMdviBulldenCo4tractors Ktrfclana/Plumben Name City/State/Zip: 5o Are yon as employer? Cbeek the appropr(aa box Phone k I.0 1 am a employer with 4. 13 1 am a genua( contractor and I employees (Ml and/or part time).• 12.;6 I am a sole proprietor or parmer_ ship and have no employees working for me in any capacity. [No workers' comp, Insurance require&-] 3.0 100 a homeowner doing all work myself [No worker, comp. insurance required.] t 3a. ❑ 1 am a homeowner acting as a general cmuwtor (truer to M4) have hired the sub-contractoa listed on the attached sheet These sub -contractors have employees and have workers comp, instuancat s• ❑ we are a corporation and its officers have exercised their right of exemption per MOL C. 132, j 1(4), and we have no employees. [No workers, Co — 7 70.9 Type of prOJed (required). 6. 0 New construction 7 0 Remodeling 8. 0 Demolition 9. 0 Building addition 10.0 Electrical repairs or additions 11.0 Phunbing repairs or additions 12.0 Roof repair 13.13other Any appUced ►hat ctweb box al nnnt alp atI our din recr{oa blow tnstuaace [ Homwworrt *fro at mir shit wn&vk iodiatin 'dna dM* *orksm• Comp lod WWMUkmL 'Caaontelwa ttut chtek this Gas mut umchod ger i�didooul rhwt i6ow{q amt of Ow thom As=11coon a �+fMdarit indkaNna ac6 �e ran (ribs n tum �y nam po" fir . camst" of ant dota mddo have ln ----r-�••••.NKPiv►7a•IIfjINDMY77'CO/Ifj(JLTQ:joAw - jonnrafoK wwrtci jar my satpla; Bdonr b r�Me po!lcj, fob:Jti Insurance Company Name: Policy M or Self -ins. LIe. Job Site Addresa:3 /,�j�� Expiration Dam Attack a copy of the workers' comcV peasadoa C/S�p' 1 u i?ailure to secure covers as p°�7' deelandoa pap (showing the poUCY number and eaplrat(on date). g° tinder Section 23A of MOL c. 132 can lead to the impogt� of criminal tine up to S 1,300.00 and/or one•yar imPrlsortment. as well as civil penalties of a of up to $230.00 a day against the violator: Be advised that a c o� penalties in the form ora STOP WORK ORDER and a fine Invesdgadons of the DIA for insurance coverage verification. PY tatemeat may be forwarded to the Office of / d* Aereap eerO ruder rhe f e P o/P�+rf yFar ilia lirJoraretfoa prorla!t/obow !t dw oRl comm 5~o g 41 _ D QQlefat rare onljt Do not wr/le Gr this ars, 40 be coa+Dlelrd bJ' c!!J, or fbwn o,0%daL City or Towel Issuing Authors Permit/Llcense N I Board or Kealth( 2. Building Department 3. CitYfrowo Clark 3. Electrleal Inspector S. Pin 6� Other mbing Inspector Contact Perron.. Phone Mt I f rmattion and .Instructions n o ft&&UVB mawlawn Gemrs], L•w+chqw132 �ad a•'2awery oreaaadwWAW old. pt,,,t„d r this s� � fir'• � oral ar �rrittaa.• exPv" �P carpe ar other kp1 �hp or may At es faiay� b daoo.d ae "s mdbidad. ieebWPO "Saiddlosif oda dece•pd mar o of the Ebr+rtoiettd mpclaliot ar o tridr• tsst�at °l 'ecdoowes ole dwa11lei l�oeae bawd ttoe mac• tba. three ��°r ar rapt work oa t�trch dwalimt boap dwdliat 6ou• of another wbe e�ieye nd �:scl emPb3�� b• dcmrd to be c+ �Or?�- ac oaths seed• ar bdldkt cpP'�1e°c°t ,lull � W know • i3=. f 33�� t•Ile "av" atw at' bed ticea dm rpey lir so 'OACIL cbaPlrt . e.d.•... r atttrM biYc* tttt a rat•wd d • bested Perait d °Pcrs1• arlisw al essupdo t•• wM! the Imare.•e eanaratrubdit chat aPp11e•att t+tht bis Ed Pf e+'re'd aaaapleW "Rause the ace.rh► d H• poWical with the wo ursece I►d lfa a rtp, Mn• chosew 1329 IIXM " wait tmdl saceptebie "jams o(oomPW°°• COW low my Cc of tsi• cbPrr hsw�P� nth•coowft •• aPimanSingg chaclae6 Me boap that aPPt7 t• 7aer aidradat and, plop ftllad the send d % Phase mamba{c) coot twit! k emPfo�•f) 0( t� � aaeaaaae� L6j ac Lbd d Ltabiith► lartbsabiPe (>l.� �, t,fmird tiabilie� comv..+M � �, Il,. u.c a< LIl aa.• h.w ar p� *alt amt mphvd be „t�mad r the Depatmaot d iar3ratrid p,uty is tagateed. 9idviMd'h'` pi aci r s1P ad dw the xMrTIL id dmn'it'h°nld A«idalr fbe eoeArswlom d bps"a wwetetti� mr the ps ink or u ep is bated agra.rd tIRS o o the D.pahocat at1 b.:.raard n the dtf►� gv� - e• n mdMa the tswr or i[So..s n�iet+ n obtd.. wurida.' raidrrftlal Aeeidaad& at td arrs�bar ibpd bdo+a. °aa1e'I 'hOeV alrc their Im"MENSWUNIt�ateY; P� con the Dapartmar xs. c1gwTaweOOMM d rthotin-I e ,od prion d legi*. rio DePe� w pro "Wd'spece plop be am that the agd&vk to ' has r ceased � iSu"- of oho atm 7 e is ftri ad i• the awed the Offts of taraadtatiaee ouasbe which wW b• toad ar � XA" am a It hNnudot e�*d y Psmi1 7� wrier dig Madam t•��! ar (tlaae.ss7) pd u.dar "rah ser /W�hed' ams mw by � or cow. air be ruv d n the jvwPO" Wham", al the agl;d.V thrt hat bas ate! tWame, aaoat be I" aced soh r�Pod' hat. yaw Sak- h b an me atr !beech pamile poet ralwd pe a oommaefal veat� cM Wh W a haeme owa W or antes to e y NW �d r � � all hAL (Le. • dop Sam• or PsMk r bos loan ) UW pu" 711s 0fore al txnWpdoe• MUM IMS r thadt Yat - d adrnn ibr Your eaapara� � rho.fd Y's hawa icy 4e�DOe' pleaae d• act bod ar in fine as a cA t addta4 takpbuee ud nor numbs" rhe Dapa ?itt CammouwgAth at Usu chu•etb Dept of ft&dji•1 Aeddents Offer at It "tlpWtu 600 Wash n#cd Shed Boston6 MA 02111 Tel. S 611.121 � 900 cd 06 ? 1.177-MASS.t►FB Rswiaed 11-22-416 WWW.mass VvIdi- OF y4 g WTTKM[tS[ �.A O G TOWN OF YARMOUTH APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) By Fee: $ 2 PERMIT NO. Date /o /X7 0< - Building Owner's AT: Location -?!V /-14AC14 Q Name iAyt Gd Type of Occupancy New ❑ Renovation ❑ Replacement I)r Plans Submitted Yes ❑ No W (PRINT OR TYPE) Installing Company Name D�uF%tart �T/}/1l�C-C�Fri/e/ Address 6 Q lrii_ , Zc,e .00c�J' 2 JF 1;1A1f &, i c1,1 Ir14 0 %L Business Telephone 't�W- - ��/ 'r/mss Name of Licensed Plumber or Gasfitter Check One: ❑ Corp. ❑ Partnership L9"'Firm/Company CID n1f n " .IIID, U) Y f/dam N Y h JW Z F- ((( O Z ~ Lu U) '�'Wi Q� W H WZ U Q W x - vl W � Q~Q K W W W F= N 4. Z QW Q>� -J z Z a� Q m > LLp W W P W R g 0 0 5 O O x O a x O p 0 U x > p IL ►- SUB-BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Installing Company Name D�uF%tart �T/}/1l�C-C�Fri/e/ Address 6 Q lrii_ , Zc,e .00c�J' 2 JF 1;1A1f &, i c1,1 Ir14 0 %L Business Telephone 't�W- - ��/ 'r/mss Name of Licensed Plumber or Gasfitter Check One: ❑ Corp. ❑ Partnership L9"'Firm/Company CID n1f n " .IIID, INSURANCE COVERAGE: Check Cane have a current liability insurance policy or its substantial equivalent. Yes No ❑ I If you have checked yes, please indicat the type of coverage by checking the appropriate box. A liability insurance policy V 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. Check One: Owner ❑ Agent ❑ 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 Licensed Plumber or Gasfitter License Number � / TYPE LICENSE: Plumber L'7 Gasfitter 0 Master 1` ourneyman rn IL m U D m O 2 F R O 4 TOWN OF YARMOUTH �FIELD--77COPY PS� • BUILDING PERMIT ( IN DATE A1Stt)at 11- 2001 PERMIT NO. B-02-141 APPLICANTDavid Com ADDRESP,O• B Z 401 S•Y. 02664 _100497 (NO.) (STREET) (CONTR'S LICENSE) PERMITTO—repairs I—) STORY (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) NUMBER OF DWELLING UNITS ZONIN AT (LOCATION) 34 Hatch Road S.Y. 02664 D STRICTR 40 (NO.) (STREET) BETWEEN AND (CROSS STREET( (CROSS STREET( SUBDIVISION "I'd LOT_ BUILDING IS TO BE FT. WIDE BY FT. LONG BY BLOCK SIZE_24 FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE 5B USE GROUP R4 BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS:re—roof 22 squares{ going over one lnyer. AREA OR PERMIT VOLUME ESTIMATED COST $ -3.000.00 FEE $ 25.00 (CUBIC/SQUARE FEET) / ^/ /) HatchADDRESS 14 1 • i INSPECTION RECORD DATE NOTE PROGRESS • CORRECTIONS AND REMARKS INI P TOR G—, EXP AUG 13 gA, CONSTRUCTION ADDRESS: BUILDING PERMIT API TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 (508) 398-2231 Ext. 261 Permit# 3-03-14Vj Fee $ Permit expaes 6 months hon issue date. ' Z4?D ASSESSOR'S INFORMATION: Map: rg Parcel: % NAM— PRESENT ADDRESS TEL # CONTRACTOR: L:S NAME MAILING ADDRESS TELJ identical 0 Commercial ESL Cost of Construction Home Improvement Contractor Lie. # /Z)/) �� Construction Supervisor Tic. # Workman's Compensation Insurance: (check one) 0 T am the homeowner 0 T am the sole proprietor 0 I have Worker's Compensation Insurance Insurance Company Name:: e UM22?.a &W,/ oL / L" Worker's Comp. P01iry# WORK TO BE PERFORMED 0 Tent (Fire Retardant Certificate attached) Donation ❑ Siding: # of Squares 0 Replacement windows: # D Replacement doors: # ❑ Re -roof N of Squares_ 0 C ' / () Stripping old shingles* ( ) going over layers of existing roof *The debris will be disposed of at: Location of Facility I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief: f understand that any false answer(s) will be just cause for denial or revocation of my license and for pro tion u der M.G.L. Ch. 269, Section 1. Applicant's Sig..= �fJ /� ////%�J�. tate: Owners Sigoaturo(or tutachment) JAf� �ZtA61L 9 / Date: Approved Zoning Distric Historical District: 0 Yes de"No Water Resource Protection District: ❑ Yes ❑ No Date: Flood Plain Zone: ❑ Yes 0 No Within 100 ft. of Wetlands: 0 Yes ❑ No 3ro1 F6 1 TOWN OF YARMOUTH -T 7'7.o6 0 Building AT. Location . w I& C4 A hl) APPLICATION FOR PERMIT TO DO PLUMBING (OFFICE By, gL ism Fee: $ PERMIT NO. Date 6 L— Owner's,_ vJ9- u IP - Name Type of Occupancy fi',r�iyl+v�l�C New ❑ Renovation ❑ Replacement Zi,� Plans Submitted Yes ❑ No ❑ (PRINT OR TYPE) Check One: Installing Company Name S& c� /t C&IM Jr6orp. —.2 -?QSr Address 350 fwl r/ s w&67— ❑ Partnership Lf)RST WAryID[ nt ln4 0 X 73 ❑ Firmnl/Company Business Telephone 77S �ffCo Name of Licensed Plumber - 2 « - INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent. Check One: Yes 2" No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy IEI� 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 or 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 ❑ Agent ❑ ' 7nat re of Licensed Plumber License Number Type: Master Journeyman 0 z i rn ti y p Y V Lu Lu D Y z J F tn Q Q W U co Z = Z r7 y a Q JUN//�� N rA cn F¢- Q = c Q ui N N Y Z Q N t= a. LL Q a Q d 3 Y Lid M W Q (Wn e: Q W O Q N Z O 0 U. W S 3 3 O Z S 3 Y a Q f' Q Y Q W LL Y W IN' 1 By ) 1- Q U C F- O= N a a7 N F g S Z O O rn Z Z W F O U= 49 m O O 3 H W 0 LL0 M O Q ¢ M 0 SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE) Check One: Installing Company Name S& c� /t C&IM Jr6orp. —.2 -?QSr Address 350 fwl r/ s w&67— ❑ Partnership Lf)RST WAryID[ nt ln4 0 X 73 ❑ Firmnl/Company Business Telephone 77S �ffCo Name of Licensed Plumber - 2 « - INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent. Check One: Yes 2" No ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. A liability insurance policy IEI� 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 or 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 ❑ Agent ❑ ' 7nat re of Licensed Plumber License Number Type: Master Journeyman 0 U TOWN OF YARMOUTH cF1— APPLICATION FOR PERMIT TO DO GASFITTING (OFFICE USE ONLY) M Fee: $ 15. PERMIT NO. a "Od" Y'oo Date-t8,2a22_ Building Owner's AT: Location LM7W AOF}D Name >,W1ZA Lj&T SocIT1-J- y�MOJf�f Type of Occupancy ^_WAV12u&lli/`K- New ❑ Renovation ❑ Replacement Ql Plans Submitted Yes ❑ No ❑ (PRINT OR TYPE).nn Checck�kOne: Installing Company Name (4123 e14"Cn C�Corp. <:930_S7 - Address 35-6 'sD& n'If ld SH4j-�4 ❑ Partnership 40&7- �/Ai2MG1 M*- 09673 ❑ Firm/Company Business Telephone V7_ —gka Q Name of Licensed Plumber or Gasfitter l� GKit/ INSURANCE COVERAGE: Check One 6! I have a current liability insurance policy or its substantial equivalent. Yes No ❑ If you have checked yes, please indicate th"pe of coverage by checking the appropriate box. A liability insurance policy L[Y 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. Check One: Owner ❑ Agent Signature of Owner or Owner's Agent e 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. 'of Licensed or Gasfitter License Number TYPE LICENSE: ❑ Plumber ❑ Gasfitter aster ❑ Journeyman N CCN Y Z ¢ NMo¢ u1 D W O U m C N Q = to cc JUN U 8e Z O m W W Q ¢ cc p 5 a w W o a¢ p w W Q / W W z a= N W° W= x B I(� IJ Y Z ~ W Q ¢ t F- } ul m Z O W W J y W w W M Z 4 0: 4 O O 3 g O r- xu.M 0a Ou o: >ca► -o SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR (PRINT OR TYPE).nn Checck�kOne: Installing Company Name (4123 e14"Cn C�Corp. <:930_S7 - Address 35-6 'sD& n'If ld SH4j-�4 ❑ Partnership 40&7- �/Ai2MG1 M*- 09673 ❑ Firm/Company Business Telephone V7_ —gka Q Name of Licensed Plumber or Gasfitter l� GKit/ INSURANCE COVERAGE: Check One 6! I have a current liability insurance policy or its substantial equivalent. Yes No ❑ If you have checked yes, please indicate th"pe of coverage by checking the appropriate box. A liability insurance policy L[Y 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. Check One: Owner ❑ Agent Signature of Owner or Owner's Agent e 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. 'of Licensed or Gasfitter License Number TYPE LICENSE: ❑ Plumber ❑ Gasfitter aster ❑ Journeyman v. i1. r r.. .. .: .A.-..-,. i. r`. '1:<i /_\... ... .. � .: ,, E• , w�.-.,+.: '+'.nor JC.: rIt^r.--...� APPLICATION FOR PERMIT TO DO PLUMBING TOWN ,OF YARMOUTH f (OFFICE USE ONLY) .By Fee: $ /�15 t PERMIT NO -00 3h i Date_t Building 1 _ Owner's-h�wA- [S j AT Location �,1?� <Fl �f A) Name Type of Occupancy_/r'Sirui✓�� New ❑ Renovation ❑ Replacement Plans Submitted Yes ❑ No ❑ (PRINTORTYPE)��•>•; Check One: Installing Company Name WW LJ <AW. -O (!�. 26orp. r'2?tj Address 3J0 M811+/ S'TPZirl ❑ Partnership lc)FST Vrl�?i,�Ol�i�l /Ylf� o�z3 • ❑ Firm/Company _ ' Business Telephone %J%�rs(XJ Name of Licensed Plumbers INSURANCE COVERAGE: I Yve a current liability insurance policy or its substantial equivalent. Check One: Yes Ey No ❑ If you have checked YES, please Indicate the type of coverage �by/checking the appropriate box. ``A liability insurance policy L7 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 or Owner or Owner's Agent i 1 hereby certify that all of the details and Information I have submittedSionattrre 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 i under Permit Issued for this application will be in compliance with all ��— pertinent provisions of the Massachusetts State Plumbing Code and 'cense Number Chapter 142 of the General Laws. Type: Master Journeyman 0 Z Z N N y O N - �-.Cn Y J !� Q V Q Z ` C7 yCC a M 0 Z rn Cn W FQ' W 0: ~ _ ~' W Cl) Q 0. - Z Z Z V Zj Z 0 m N 2 2 N Q W Q Q �". fn N Y Z M l] Q rA z Q M a 0. Q Q - li w= Q= 3 3 o z = 3 Y a p tom- a X 0 LL. LL W CC W I , NI U) Cn ►W- 3 FE 3 Y J .m N 0 O Q J S F N LL a� O Q� rt m O SUB-BSMT.' BASEMENT 1ST FLOOR . 2ND FLOOR 3RD FLOOR (PRINTORTYPE)��•>•; Check One: Installing Company Name WW LJ <AW. -O (!�. 26orp. r'2?tj Address 3J0 M811+/ S'TPZirl ❑ Partnership lc)FST Vrl�?i,�Ol�i�l /Ylf� o�z3 • ❑ Firm/Company _ ' Business Telephone %J%�rs(XJ Name of Licensed Plumbers INSURANCE COVERAGE: I Yve a current liability insurance policy or its substantial equivalent. Check One: Yes Ey No ❑ If you have checked YES, please Indicate the type of coverage �by/checking the appropriate box. ``A liability insurance policy L7 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 or Owner or Owner's Agent i 1 hereby certify that all of the details and Information I have submittedSionattrre 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 i under Permit Issued for this application will be in compliance with all ��— pertinent provisions of the Massachusetts State Plumbing Code and 'cense Number Chapter 142 of the General Laws. Type: Master Journeyman 0 �..w..y,.r-_...,.�.�'.r.Wrwa.a..-...�.. .ori :F .,. .... �-. _..r ;'.. a ..•. .. .. •.. ..u._. _�.�. .•. ll. ... �i 1... .. . . ..�✓-a.{. OF r49 - . ' ` '; APPLICATION FOR PERMIT TO DO GASFITTING ? �g TOWN OF YARMOUTH a (OFFICE USE ONLY) KEW t ` Fee: $ r'J PERMIT NO. G ate Building Owner's AT: Location ��y �%1Tt'f= POAD Name �nwv-4 WF_ST �SorliN t/�PMOt�h� , Type of Occupancy w✓Ci�i cwJ�fiZ- New ❑ Renovation ❑ Replacement EY Plans Submitted Yes ❑ No ❑ I (PRINTORTYPE) Check One: Installing Company Name (d�.73 ifAwm B'Corp. C9367-7— Address 356 ❑ Partnership [ GST %2tira . /l'149 oa6*23 ❑ Firm/Company t Business Telephone m -d Name of Licensed Plumber or Gasfitter,�4�Qjl1,Cl INSURANCE COVERAGE: Check One ... I have a current liability insuranceolicy or its substantial equivalent. Yes I� El If you have checked yes, please i ica�te thyiype Qf coverage by checking the appropriate box. A liability insurance policy L!Y J 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. Check One: Owner ❑" Agent Signature of Owner or Owner's Agent c I hereby certify that all of the details and Information I have submitted ignaty9 of Licensed (or entered) in above application are true and accurate to the best of Plu er or Gasfitter 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 License Number Chapter 142 of the General Laws. TYPE LICENSE: ❑ Plumber ❑ Gasfitter aster []journeyman U LLtCi '. N U Z cc W CC N cc N ¢ O M N 2 a J Yn W OF m Z n Cc E5 cc u W ►W- w W a y a¢ a WXLu W Z U W = N W Q cc _ a LU Q W Q F y m Z LL Z W S 2 '� FE Cr l= 0 0 O N S O S 3 V a O a LL: O cal .a.! cccc > G 1W SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR I (PRINTORTYPE) Check One: Installing Company Name (d�.73 ifAwm B'Corp. C9367-7— Address 356 ❑ Partnership [ GST %2tira . /l'149 oa6*23 ❑ Firm/Company t Business Telephone m -d Name of Licensed Plumber or Gasfitter,�4�Qjl1,Cl INSURANCE COVERAGE: Check One ... I have a current liability insuranceolicy or its substantial equivalent. Yes I� El If you have checked yes, please i ica�te thyiype Qf coverage by checking the appropriate box. A liability insurance policy L!Y J 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. Check One: Owner ❑" Agent Signature of Owner or Owner's Agent c I hereby certify that all of the details and Information I have submitted ignaty9 of Licensed (or entered) in above application are true and accurate to the best of Plu er or Gasfitter 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 License Number Chapter 142 of the General Laws. TYPE LICENSE: ❑ Plumber ❑ Gasfitter aster []journeyman 6117/2015 Document Category Map -Block Number Street Number Street Name SlipGen- Portal Home Town of Yarmouth Template [Building Dept] Slipsheet Identifier [sg28081] Building Permits 089.18 0034 HATCH RD Department Building Parcel ID 12288 Backfile Batch Scan Document? Additional Naming Info Index Operator Date - Time No Operator, Yarmscan 2015-06-17 - 11:56 httpJnasertchel2/SlipcerV 1/1