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PP-41440 - TOWBUILDINGN OF- DA RECEIRTPTS MOUTH - COLLECTOR'S OFCE ,' f A J.Z. +? Name: t� `-'j /} ` J.Z. �-'--j 4/2, property 7 '�. '�2-4..ce`.a. e,... Date �r /;�, 4, ) Job Location: r � f' ` 1^/' / / /l .s'� IOWN OF DARTMOUTH '-; , `tom- Oil Fm0R'S OFf10E - White Copy-Collector's Office • t Plot: �.• Lot: / ellow Copy-Customer's Receipt t.a i� '; e[fl � '� I v1. ans ink Copy-FileCopy /� TAE� JGi" reen Copy-Building Department Phone: �l ■ ! Y ,��� . . MAi13 Description General Ledger#'s Ref.# Amount License&Permits-Building 01000-44105 License&Permits-Building Misc. 01000-44105 License&Permits-Electrical 01000-44106 1 i License&Permits-Pkimbing&-aas 01000-44107 7,,r ` , Other Department Revenue 01000-42420 ,rr) This is not a Permit or License for Building,Plumbing or Gas Received By: Ii j i MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) Town of Dartmouth ,Mass Date 7141-0 20 0.5— Permit# Building Location /ec & 7 Q E13 ( // Owner's Name fin/cT(-HA Ock tfS /A! Type of Occupancy New W Renovation ❑ Replacement❑ Plans Submitted: Yes I71_ - No 0 FIXTURES * _ D � ; w O N O Zr O H N r G1 % D D O CD) 2 g� 1 e` ' O ti 8 ? 23 Zr O n II z 0, ti Z -n o c _Ti T DV T. ?jYYY, i' r ••fr co 2 rn m D A ,, D o D .N (mil z ,, N Z z 2 2 -43 % ' -1 y (n < 0 Z • N - L7 N ni T ./ JV CO CD in Z N D_ N •kti . .fl/ Z 2 SUB-BSMT. - ' BASEMENT ' 1ST FLOOR I 2ND FLOOR 3RD FLOOR 3 (7 4TH FLOOR 5TH FLOOR '/ 6TH FLOOR /'�I 7TH FLOOR / G//V 8TH FLOOR Installing Company Name Oa O)_LAG 2 Z Check one: Certificate Address 6 \.-Jam Q3)4 wet LI1'2c [C.S i L ❑ Corporation CO . 4j 2T ,,ot 771 G>_2I1 Business Telephone . 77 O± cjf1! / 3, El Partnership Name of Licensed Plumber 1 3 (5 Z Li- If2 Z ❑ Firm/Company INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ❑ No❑ If you have checked ems,please indicate the type of coverage by checking the appropriate box. A liability Insurance policy 0---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❑ 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 the permit issued for this application will be in compliance with all p e provisi the achusetts State Plumbing Code and Chapter 142 of the General Laws. By at L'' /¢/-4^ Si nature of Licensed Plumber ' Title City/Town Type of License: Master EL_ Journeyman ❑ APPROVED (OFFICE USE ONLY) License Number///JJ Map o 0 Lot cM- 2 % • 2 * _ >00 e) ) \ ) / III .. / \ § \ / - \ \ _ � / fr'0 .. $ % ■ % CO. � � E / o o / tt / ti 0 0 0 ] E / $ O M % M 2. 2 § a k 0 / 0 ƒ / / \ \ \ \ \ J zte \ \ tt \ \ \ x 7 % ! ! # f k - � 2 > t 2 o R a { _ , # , 2 O / kq t0 LH(cC \ ? 0 - CA Q NSri \ aA _ \ g y y E 7 / -© w . ©\ \ /\ c - - 2 ; �g