PP-38406 TOWN OF DARTMOUTH
La BUIIcDING RECEIPTS ?v f t - -t
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Property _ Date:. 5 % r
Name: `.. 0 w �`} C / )!
;'I Owner " '
Job Location:J , . - J . i_ .1 ;.%. f
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/ L.., zy ;-f) i r J ie e AI L'" 17 / WIC op�y-Collector's Office
\ r; lit.,,/- 11ow Copy-Customer's Receipt
Plot: -i% - Lot: . 6P ��4. py-File Copy
cottttle� Green opy-Building Department
Phone: - )ij, f i .� r
Description General Ledger#'s R f.�%t Amount
License&Permits-Building 01000-44105
License&Permits Building Misc. 01000-44105 ' `
License&Permits-Electriicat.,
01000-44106 �'
License&Permits-Plumbing&9as 01000-44107 i;-,z` ( .; r €f'i 0/ n
Other Department Revenue�' 01000-42420
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•' `<not a Permit or License for Building.Plumbing or Gas Received By: /'
MASSACHUSE'TTS UNIFORM APPLICATION FOR PERMIT TO DO FLUInu
DARTMOUTH, MASS. Type of Occupancy-Commercial ❑ Residential a
Owners Name Ci., ,�-€4.6( , Owners Address /O S 7r/6
Building Location 5‘c -R Date �� O�/
New ❑ Renovation ❑ Replacement Plans Submitted ❑
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SUB-BSMT. _
BASEMENT / I
1st FLOOR
2nd FLOOR
. 3rd FLOOR
/ 4th FLOOR -
1 & 5th FLOOR -
3 6th FLOOR _
7th FLOOR
glia 8th FLOOR t
Installing Company Name 0 4i7 "'1' /S I
01-4--)6072 Check One: Certificate
Address r jr/t44A-A- g.__Q_ a Corp. /2/a-
City &)O-r State (1/l 0 ( Zip Code 6 7 7 Jo ❑ Partner
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Business Telephone: (a 1 6 Z-'/i " ) ❑! / Firm/Co. _
y Name of Licensed Plumber or Gasfitter 1/C jC«"XL
INS[RtANCE COVERAGE: Check One:
I have a current liability insurance policy or its substantial equivalent. Yes No 0
If you have checked yes, please indicate the type coverage by checking the app nate box.
A liability insurance policy Other type of indemnity Bond
OWNER'S INSURANCE WAIVER:I am aware that the license 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.
.. Cheek One:
Owner ❑ Agent ❑
Signature of 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 the 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.
B y Type of License:
Title MASTER Signature of Licensed7OPlum
City/Town JOURNEYMAN License --'`.'mbar ' "
Plat Lot_
Dartmouth Building Department
\ 'D 400 Slocum Road
P.O. Box 79399 508-999-0720
/1 Dartmouth, MA 02747 FAX 508-999-0738
APPLICATION FOR PERMIT TO DO PLUMBING
Fee Number 3,F yG
Name & Type of Building:
Location of Building: /a 59 I-1y u /44 P (4 ),
Win: c:it E r 47/J/c/ nr,/ fr41-- I/ License #: 9 {-Pits
❑ Service/Temp Service ❑ok ❑failed* Date Insp.
* comments
❑ Rough ❑ok ❑failed* Date Insp.
* comments
Final ok Cl failed* Date 1- / T 0 S Insp.
* comments
Y
Remarks:
///y/] (!J PERMIT GRANTED
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lnSreetentflaelltnes: c=� /9h'-&-,n- Date: 3-7?