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GP-49661 TOWN OF DARTMOUTH 49661 BUILDING RECEIPTS COLLECTORg.OFFICE NameL i C�'4-1( . , Y)Ju t li i ,. . Property }ZA Date: ' 7//1 f/? 0 Owner Job Location: / • V TOWN OF DARTMOUTH 1j l,,tr j),ar j ); ,, COLLECTOR'SOFFICE �U White.Copy-Collector'sOffice Plot: / Lot: . a "" —9 2007 Yellow Copy-Customer's Receipt i/ ;60 �..- / / Pink Copy-File Copy ^ ^ 3 Green Copy-Building Department Phone: + M,,„./. ri t �s.°� �f"k Description General Ledger#'s Ref.# Amount License&Permits-Building 01000-44105 License&Permits-Building Misc. 01000-44105 License&Permits-Electrical 01000-44106 License&Permits-Plumbing&'Gas ) 01000-44107 /-/r f - = Other Department Revenue "--- 01000-42420 This is not a Permit or License for Building.Plumbing or Gas Received By: —j r�6= F'✓-^'-, a MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING �,,.e &r�i (Print or Type) \ sL, ` � - Purl aeoe4 , Mass. Date (/1 j/l 2007 Permit# 1/96 2 / 'q- (1: q(tl6 3 ,_ 4a l Building Location 2, &rcL9 fret/eV& Owner's Name 2n.) Josh,' Owner's Tel# Sl`-A0 r/ - yap/ Type of Occupency 5,',,Jj New 0 Renovation D Replacement 1 J Plan Submitted: Yes No. G 0) �'--7 co Y re co co W w W co O W I- Ce re 7 to 2 W O W co Lil aI- O} Z Z _ tea' Q Q K O ❑ ❑ Z H n ��� .\ N �a ct N O V Q 2 y W g O Q > W �t�fl� ¢Za < W -I Q re t W IT co ra Z O 2 O to r ��n K 2 O L9 2 E g ❑ O J U tY > ❑ a. O SUB-BSMT BASEMENT / 1st FLOOR 2nd FLOOR 3rd FLOOR 4th FLOOR 5th FLOOR 6th FLOOR 7th FLOOR 8th FLOOR Installing Company Name Addario's Plumbing& Heating LLC. Check one: Certificate Address 20 Cooper Street x Corporation 2720 Lynn, MA. 01905 _Partnership Business Telephone 339-440-8100 Firm/Co. Name of Licensed Plumber or Gas Fitter Steven J. Addario Jr. Insurance Coverage : I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 0 No E If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability insurance policy ❑x 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 hearby 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 Gas Code and Chapter 142 of the General Laws. / �p e By Type of License: 6/!//�(//J Title ©Plumber .. i City/Town ■Gasfitter Signature of Licensed Plumber or Gas Fitter Approved(OFFICE USE ONLY) ©Master II Journeyman License Number 13106 f. J /// z r D r z cn 0 m --1i O z co X -I X- r 0 D CI) W -Di m m Q0 Z Z j - D m -o m v -n m m C D m !� O C O C\ ) 0 m o T 3 0 7 \ A I 5 I � Cm O z CPo ill m m ► ~ 0 z N T_ CD A - I I I . A 1 O A m co N z co n 1 z 1 co