PP-29751 TOWN OF DARTMOUTH 297:171
t 7 .,3 BUILDING RECEIPTS
a ' j COLLECTOR'S OFFICE
Name . %_ ^ Propertyg Date:' r 1
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Job Location g- COLIEC OR p rrR
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a 0�White Copy-Collector's Office
Plot j - Lot tff Yellow Copy-Customer's Receipt -
! J U L 1 5 2003 Pink Copy-File Copy
Green Copy-Building Department
Phone: - ad%
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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 il)", 11 i k _,, ; )
Other Department Revenue 01000-42420
This is not a Permit or License for Building,Plumbing or Gas - - Received By: L
TOWN OF DARTMOUTH 29 7E
1
BUILDING RECEIPT'-
COLLECTOR'S OFFICE
Name - - Property Date • .f. —7%
t a t l ti'dPwner: I t..=�Y l _. /.-{ v / r/ / �' •�
Job Location: i
l !'!' 7,4ic • vt-.� �- %LC- - �.% Ti PF(Ut U i?i""
LG.ttci OR ` �d_0 fir-r.-,/White Copy-Collectors Office
Plot: Lot:, 17 j / Yellow Copy-Customers Receipt
I Pink Copy-File Copy
i �ff•• y7, 2� Green Copy-Building Department
Phone `l `�'c�'
Description General Ledger#'s rcP1 Rigallrf.#0 2 Amount
License&Permits-Building 01000-44105
License&Permits Building Misc.. . 01000-44105
License&Permits-Electrical 01000-44106
License&Permits-Plumbing&Gas 01000-44107 s k 2 l
Other Department Revenue 01000-42420
This is not a Permit or License for Building.Plumbing or Gas Received By:
r.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Printrnt or
Type)
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-__�t- Building Location.L�V0`I" ) D�d �i' �1Y2,1� Rd. Owner's Name pVrl.�, '-l/�rJL-�i.�
/ Type of Occupancy , IAJ° �� I1CjV
New f}Y Renovation ❑ Replacement 0 Plans Submitted: Yes 0 Now❑
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FIXTURES
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SUB—BSMT.
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1ST FLOOR 1 7
2 ND FLOOR
3RD FLOOR
4TH FLOOR
.
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
Installing Company Name Philip Stanley Check one: Certificate
Address 10 Green St 0 Corporation
Marion, MA 02738 0 Partnership
Business Telephone 508 748 9575 0 Firm/Co.
Name of Licensed Plumber Philip Stanley
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 yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ES] 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 0
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have subm' :— elated)In above application are true and accurate to the best of my
knowledge and that all plumbing work and installations pad. ed undo ']]]•: mit issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Plumbing C••e and •
2 • . . {gws.
Signature of Licensed Plumber
Title
• Type of Ucense: Master® Journeyman❑
City/Town 9710 APPROVED(OFFICE USE ONLY) License Number /
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