PP-54034 � � � , tea _z -
TOWN OPDARTMpUTH 803 4
BUILDING RECEIPTS
COLLECTOR'S OFFICE
Name: r � •� - /�j. ,' �f �" Prb er /! ��,�. Dater
.,,�i �. - Owner:.. > ,!-E � ,._�`- - >
Job Location: /., ` /v/ i j i
/ �,%! White Copy-Collector's Office
Plot / / '� Lot: I j r TOWN OF DARTMOUTH yellow Copy-Customer's Receipt
�' 4 COLLECTORS OFFICE, Pink Copy-File Copy
Green Copy-.Building Department
Phone: „ %:a AUG 1.1 2008 I�
Description General Ledger#'s MA-lif. / Amount
License&Permits-Building 01000-44105
License&Permits-Building Misc. 01000-44105
-License&Permits-Electrical 01000-44106
License&Permits-Plumbing&Gas 01000-44107 /' �!/ s �;
Other Department Revenue 01000-42420
This is not a Permit or License for Building,Plumbing or Gas Received By: ✓f �11,
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
Fall River, Mass. Type of Occupancy-COMMERCIAL ❑ RESIDENTIAL E
Owners Name,,; //;q//co Owners Address //6s teeeD yea,
Building Location V irg ;y Date -- //_t 8
New. Er Renovation ❑ Replacement ❑ Plans Submitted n
111
bdhHh : IhhidI
BASEMENT
P / 1st mat2na
g
/ th 1 1( 4th FLOOR FLCOR
.
9), 5th Heat
Li6th ELME
7th MOM
8th MOOR
Installing Company Name E'ER " eta x Item% Check One: Certificate
Address Rt/ (,tPT't h) Circle ❑ Corp.
City _y-1 / State _ Zip Code 62&7k ❑ Partner
Business Telephone: /-y/_ 429- 7 /42 0 Firm/Co.
(
Name of Licensed Plumber or GasfitterINAltect
: Cheek One:
.t .I have a current liability insurance policy or its vdastantia1 equivalent. Yes coot
If you have checked yes, please indicate the type coverage by checking the apprcpriate bloc.
A liability insurance polity Er Other type of indemnity 0 Bond ❑
OM R'S INSURANCZ WAIVER: I as aware that the licensee does lot have the insurance coverage cognized by
chaprer 142 of the Mass. General laws, and that ray rig nitare en this p Trait application waives this
requiraent.
Check One:
Signature of O er•s ?gent
0 Aiu,t
.d Q ,
I hereby certify that all of the details aid information I have=twitted (cc entered) in above application are tore aid
accurate to the best of my lbevladge and that all pl,aming work aid installations perfo cad under the retlait issued for
this application will be in amp/lance with all pertinent pawistais of the Massachusetts State cgs aid thapter 142 of the
General laws_
oY
Title Type of License:
`i�� irt }Q' .
Il posrfR Signature f Licensed Plumber
City/1Uat .luaulemm License Herber 3 V` ca 7
IS-CODE-012
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