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PP-49662 TOWN OF DARTMOUTH BUILDING RECEIPTS ' CQLLECTOR'S OFFICE Name: I 1. r I' r, ` 41r'iea- -- ` v7 29 Property f Owner; L Date: Job Location': ') TOWN OF DARTMOUTH — r. J —11 (�u!/� J, 77 - �;< r..�. `--// COLLECTOR'S OFFICE Plot: - - f^7 Lot: ! White Copy-Collector's Receipt c —7 JUL -9 ZOO, Yellow Copyc p d - Copy Customer's Pink Copy-Flle Copy Phone: - - M A J 13 Green Copy-Building Department Description tra Ref.# Amount 01000-44105 License&Permits-Building Misc. 01000-44105 IZMIMMICan 01000-44106 ica ' ` ' 01000-44107 lannallarla Other Department Revenue .,_— 01000-42420 11t's is not n a Permit or License for Buildin Plumbtn or Gas �F f � Received By: f � 4t1f>/�_{`-r,�y�'. • MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ,,`5 er.�r (Print or Type) ya t .8iC, ' r N M /��34'�. �ylTN®fir ass. Date 2007 Permit# Q!, Building Location 2/ G4tPf iivOt O/1. Owner's Name %7Ads-FPUCT Owner's Tel# 56 fr' - we/'003 y Type of Occupency , :",cr // New 0 Renovation 0 Replacement Er Plan Submitted: Yes D No El z F J COO Z ~ Ill W Y UIll -J CO Z a D r .{v 0 Z 111 it co re W W > o W vi z alien en (7 g a.a & O K 4 U p 7 Q W Q W K Z w O J I� W 2 Q = >i = O Z S , Y 1 O m Q E Q W 0 Y W �� r Q F Q Q 2 N N aOa Q Z O O u1 Z Z W F- O U 2 .v Y J ttl , i7 0 J 2 r rp ,11 (7 7 O Q Z m O 0SUB-BSMT BASEMENT 1 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 ❑x No If you have checked yes, please indicate the type coverage by checking the appropriate box. • A liability insurance policy 0 Other type of indemnity 0 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 0 Agent El 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. By Type of License: Title ©Plumber . „....0"a;1‘111 City/Town ■Gasfitter Signature of Licensed Plumber or Gas Fitter Approved(OFFICE USE ONLY) ©Master •Journeyman License Number 13106 • 03 Z O it I C.) w 0 z U) w E CD 0 cc I n o re A (l 1- Z U m iii z W a z 0 O0 OILI j IL I- * I- ILco a O H g ¢ I Z O El � a10 OLL I v z ' 1O a N o m G -I C O U O m N. 4) ; J 0( w m a a O -� a F 0 w r LL Q a M L_ I Z.. 1 dl_ I -__ - - 1 . 1 w 2 U F w Y co 1 1 co Z 0 N U w a co z_ J Q Z LT.