PP-457 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
r2._-____--iv
-A, TOWN OF DARTMOUTH Date A/g,y ,2�. 19 9�'
e_ '7 Permit # 9�/
C � �
Building, .„,..- Owner ' s
AT: Location / 29 .5',). 44/ .4
u, 4,19— Namee'!,v.4-e /4 C /j/p,/c-2lia., 4.--."/
PiA'4! lu_i /�,/ '0U /4 19• _, Type of Occupancy: r,`,1S
New II Renovation /- �t y 1y G�9pF�
0 Replacement 0
Plans
FIXTURES Submitted: Yes ❑ No
- - - -
•
Z COl)
0 . Z
I- V) in-i-1
rA O Z 41(
Z W w •
Z
uJ Y N >. 0 a N = 0 CC CC Z
a h
4 CC
°�A I
N xILI N I. 0 W N Y Q N Z a Z yC U
co tx >,. a F-' Co ZCC a 2 a a 0 ...
U Z 0 O- A cc E < W G Q Vf t, x Q OC tL
a N N OG J 19cea
I- V > 1--' O Z to Z f0/f I- Z 0 OO 0 _ X W II-- O C.) X
a _ a a s _ _ a a 0 a -I _f: a s CC � CO a 0 a 1- -
3 be -I m CO a t7 J 3 M I- CO U. 0 0 a <l; 3 CC m , O 0
\ \ \
BASEMENT
1 1ST FLOOR \ \ \ \
2ND FLOOR U \ V
3RD FLOOR
4TH FLOOR
5TH FLOOR _ � - ,.�,
6TH FLOOR
An7TH FLOOR _
8TH FLOOR
.
(Print or Type)
_ _ _ Ins.talling. Company Name / i aC,44 6.3 ,?/ Check One: _Certificate_
fr
❑ Corp.
Address /69 s- Div 12,9.c�ex _JZD, _ 0 Partnership
0 Firm/Company
Business Telephone 9 3' 6 6 .3 Name of Licensed Plumber
/We dip. 6.174 G 4 ( ✓-...4../
I hereby certify that all of the detail 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 Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts.State Plumbing Code and Chapter 142 of the General Laws.
I hav nformed the ow or his at II do no ave lia • y durance including completed operations coverage.
t.---"'
.--; �"�E; =eLL� y-L�, ---> cam'
signature of Owner/Agen I have a current liability insurance policy to include completed operations coverage.❑
" 1
By eiI:� �
Title /�� ,/ ,�,,.. ,� 4, >✓ ignature- of Licensed Plumber
City/Town: // Type of Plu bin _ License
APPROVED (OFFICE USE ONLY) License Number ►% Master : i. ourneyman
/---- ce
....._, /
w
t=1
H
e)
X
tzi
En
, _ _
____ _____ ____—__________ _
-
,
il• "II
tl tzi
It CI
*-...
‘ Ilk el
(44))
\ Z
r
\I • :f_.. • ,_ I
tli 1-3 E.°
IN, .8 iti
N N,
i Z H
li. X tb,, 0 H MI
N
tt
'Li 0 '21 \ tv • to.
z 0 w z a
ciN ' . 53
Lkt;ijitcl MI
t-41-1 *11
6:1:1H L.
0 CI
U
h. ti
1-i
z r
k.'
0 H Z \ Z 0 \O
t .
oti
C.1
....
le .o
0 t13 Z = \s 7:1 H
I-3 \
Z
0
()I
\\S,
,..,
\.....
''':
c''.\,'
)--.• S:1) M
77 )-.• (D ):. -(Z3 CO (D
• (A X) • =
s
sl, ..
\.. _ H
m .
1\
i'.
t\ '
\ H
tl r.,N
IX%
A 1,
{...
,-.