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GP-50393 1:-' --) / JP 17,4 ;1' /( r, US ' ) ' TOWN OF DARTMOUTH -r-f 50953 BUILDING RECEIPTS -.. 1 / COLLECTOR'S OFFICE.: i/1(--- /-7 1-7 / i/I ..‘ , ( / / 1 ' , . /1 / _, ,- f I • r ,, : ‘ci< property / / . 1/ t ( / , __, Date. i,,,, // 7 6 Name: i if i 1 j / . , /- //: /- e/- / „..--/a ,,-,'i - ct 1 , Own r: , - ,-Y 7 di 7-1-7 .7 Job Location: Lc( , ;([ is ,-Qt- 11"---° / ..„. ,/ White Copy-Collector's Office Yellow Copy-Customer's Receipt Plot: // ,,- Lot „c't , -I 7 LP ' A / ' Pink Copy-File Copy Green Copy-Building Department Phone: !own ut- DARTMOUTH t ' Irrirc Description General Ledger#'s COlitcleftS e . Amount I-License&Permits-Building 01000-44105 IL 1 8 2 •7 License&Permits-Building Misc. 01000-44105 Lizt1 1 License&Permits-Electrical 01000-44106 " "----- I ) _. License&Permits-Plumbin4Gas _ .." 01000-44107 p,.--; c ::, \ /1/4-; 6 :1,.. _ .,,, __---&-- Other Department Revenue 01000-42420 Ll Ii, This is not a Permit or License for Building,Plumbing or Gas Received By _ "} TOWN OF DARTMOUTH cn BUILDING RECEIPTS 503 • COLLECTOR'S OFFICE Name: t�; i i 1S �J_ Property / �''r . �,r:fit r S Owner: i/�_ -.. -.�.. Date � f:f. it Job Location: .--- , i _ u,f ; a <. "c'( �),, ( (.t ,% TOWN OF DARTMOUTH Plot: ! COLLECTOR'S S OFFICEwhite Copy-Collector's Office 4 Lot: - Yellow Co Customer's P s Receipt '�_ _ 'r_- ' , L: L .3,, Pink Copy-Fie Copy Phone: Green Copy-Building Department e ""stA It! we,•- - " M A J 13 I eat► rr— Description General Ledger#'s - Ref.# Amount License&Permits-Building - 01000-44105 - License&Permits-Building Misc. 01000-44105 License&Permits Electrical j -01000-441.06 License&Permits-Plumbing&Gas,' 01000-44107 Other Department Revenue "--- 01000-42420 This is not a Permit or License for Building.Plumbing or Gas Received By: % '= {f' 7 ; . MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) 'fawn of Dartmouth, P it AID/7e ur-AI ,Mass Date 9/G` 20 fJ 7 Permit# .��3*� Building Location &6 ' a0t o !C//t/G ff 'tha. / Owner's Name l'41/11,/iV t% 'ir, St.O,CLGe Type of Occupancy A. (C it llgiyC.0 New 0 Renovation tX Replacement 0 Plans Submitted: Yes 0 No 0 2 �Sn cG D m � �1 n m m �, * - -mm -1 c Z ~ O > A O O y O ly A_fi. 1 � l' GA P- m y = x m m 53 Z O o z s Ti O tri § m ti > m r0 m I' ' CO N Ft- m 93 CO O O a z L. �^ ti y m A CO A A G7 Z -� D �' y m m a m ti m m CO o N A y = (A GSUB-BSMT. / / ' BASEMENT 1ST FLOOR / 2ND FLOOR 3RD FLOOR 4TH FLOOR 34 5T11 FLOOR �1 6TH FLOOR f f\l 7TH FLOOR V 1 8TH FLOOR Installing Company Name /9.41-/2. S /°A0,4/4-m/t Check one: Certificate Address L/97 rx 4 A 7A-cc_ F'/2- r/vim yr ton/ Corporation ct 7r Business Telephone qo / - /,a c/,-a 2 Al.,gyp 0 Partnership Nar!ie of Licensed Plumber or Gas Fitter_ / 1dL- 4'C N 0 Firm/Company INSU¢;ANCE COVERAGE: I have a curren liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes f" No❑ If you have checked its,please indicate the type of coverage by checking the appropriate box. A liability Insurance policy Er Other type of indemnity 0 Bond 0 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 0 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 or gasfitting work and installations performed under the permit issued for this application will be in compliance wit�rtinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. v/// By Title Signature of Licensed Plumber / City(Town Type of License: Plumber 0 Gasfitter ITK. APPROVED (OFFICE USE ONLY) Master 0 Journeyman 0 License Number /a- 0 6 7------ - - Map 0 / Lot ol- - 72 i PJ % \ \ ( q c c k o ) G E , _ \ § ¥ ) § ro , cp 0"CS . j / # § \ 2 \ \ .. \ E. § / ° E / , — » \ k P � ( k \« k E r ti II o § ��k . 0 0 k @ ) E �. C) §UI NIP P \ #\ 2q �\ § § \ = 3 \ z ( z ‘ t11:1 ©1 \ \ § ® \N / § \ ( .k ( k i § & '. c \ % "i qas� M o = o § c mk tl / ti & , it ? \ et 7 2 £ \ \ k et _ - / F[ / J . ƒ \ 1 OD ik 2 2 ; � . % .