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PP-85019 0 TOWN OF DARTMOUTH - BUILDING DEPARTMENT RECEIPT 3 51 i`3 PHONE: 508-910-1820 FAX: 508-910-1838 -- , € r tr Name:/Lb i (l \ /0 l:r Property Owner: v 4 ... _.,.Date __ Job Location: /! / fir' j ta/1 4, (, G _._ Map: 2/ Lot: Description General Ledger#'s Ref. # Amount Building&Building Misc. 01000-44105 �c ppH7-44,90 ] leetrrc l 01000-44106 4) pelts I Plumbing & Gas 01000-44107 ,11 .� Trench fety 01000-44129 r 6 @ a Other Department Revenue 01000-42420 iowiv c© ti�G White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received �.... ./(.23 THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR Q' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • 4 JC ®�� � CITY � I MA DATE i �GC_...J PERMIT# 5�1 JOBSITE ADDRESS / fi._-�` dV� ,! jl6D �I OWNER'S NAMEI v� __ P OWNER ADDRESS L_ — i •�` _— TELL ___ _...____ IFAX 1Y _� _ 1 TYPE OR OCCUPANCY TYPE COMMERCIAL.i EDUCATIONAL n RESIDENTIAL PRINT �,� CLEARLY NEW:L RENOVATION:LI REPLACEMENT:L I PLANS SUBMITTED: YES I 1 NO CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 1-71— Jr_— Milli —111111---1F-11111111MMIIIIIMIIIIMI DEDICATED GAS/OIL/SAND SYSTEM r-_-_ ri ----i 111111-1i Wr A ilium imiiiiiMinili Tr-I DEDICATED GRAY WATER SYSTEM r----- E ', �+ � I 1 ]! jDEDICATED 1- - � � ~i � II ;� s FOOD DISPOSER 1— " — FLOOR/AREA DRAIN M;_`~_- - iiiaLM--- INTERCEPTOR(INTERIOR) Allnig__ Mall1111M1. 1-----mil LAVATORY 1r ' MIIIIIIIII ROOF DRAIN EIIIII SERVICE/ •• 11—ITN _Air— Ma WASHING MACHINE CONNECTION iftI_ � ( - 1111111.1 WATER HEATER ALL TYPES 11 (. �:. . . al • I I I r i , � iM!i ,,,,__ �r �:r.��__ _s i_____11 l_. :..:,:1i , 11.__. 1F-:ii! _. r If 1 —; — ._-r_----- . _ -- _ ._ _, r-a t_ICr_ in J._ _ - -- __ -!I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES i— VO lij IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY BOND fl OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER [I AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are -e and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will bx'e in"'pH,. ce with all Pertinent provi i f the Massachusetts State Plu bing Code and Chapter 142 of the General Laws. " PLUMBER'S NAME re,f9' `'- I LICENSE#L � SIGNATURE MP[PE. CORPORATION L#[ PARTNERSHIP) 11#4 ILLC0]#[ T J COMPANY NAMEr _ ]ADDRESS r './C.T✓ fe- fir- ��. -- i CITY fif` i/G I STATE 2 r-iZIP O1/7 TEL L 3 FAX CELLI� V EMAIL w_—__�_—_ _.__e _ r'. 114 •Lt....1 CA ''. / „ W 0 \,...,;., U \ rz' -;.(--, ......... .......... 0 0 :In% --- z >- 0 1--• ci) w 0 W w W., co ce 0-1 co 0 ri;111 \ 44 • 0 Z \ 1:61 0 04 P- W < • = o 7.3 a. a. < (Ft CO di = U.I I— U- CO c•T4 E ‘ o z z o 1 P ---4 u w .3 a., cn AO 4 J ------ . . = C.7 \Nrs' 0 g4