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PP-33854 TOWN OF CARTMOUTH -s A BUILDING RECEIPTS ham A COLLECTOR'S OFFICE I� , + s i Name r r f - i 17 a F!,! s"I. �- j Property ',- I iF.. .r 's, Date i J/ c-'�' f. Job Location: ... f j f 'r 'V ; White Copy-Collector's Office Plot: Si; Lot: 7 �'• - `? : Yellow Copy-Customer's Receipt r . - Pink Copy-File Copy Green Copy Building Department Phone: Description General Ledger#'s Ref # Amount r License&Permits-Building 01000-44105 License&Permits-Building Misc. 01000-44105 .; i �v i € 1 License&Permits-Electrical. 01000-44106 I' fA4:: License&Permits-Plurxibing&Gas 01000-44107 1 • • -`" -1":' --- '-.� j Other Department Reveen6e _.-_ - 01000-42420 It j Thisis not a Permit or License for Building.Plumbing or Gas Received By: f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING DARTMOUTH, MASS. Type of Occupancy-Commercial ❑ Residential AL Owners Name Owners Address /V SL T Building Location / T 50 iv/90/4 e ex_ Date . (V-.0 9 New ❑ Renovation ©"."---- Replacement ❑ Plans Submitted ❑ •,M z VD C4oz Z > W �R * Z Z to a w x F Z o z z z CLI /. O 1 III E~ W H U x 4 ►� .- x ¢ W in a C7 �' 3 >C UU w p W Q a ¢ w Z A Q a z A a4 A .9 w -� W x H A S a x E., ¢ W x e.�. Q E.U., > E-0 O A Q E-4 Z p p z W ¢ O U x 3 a� a m v) A A a 3 x H cn w C A ¢ 3 a pa o SUB-BSMT. BASEMENT 1st FLOOR 2nd FLOOR I ;1. i , I ;-- '1:.= (‘) 3rd FLOOR f E,1 4th FLOOR 5th FLOOR !-� 6th FLOOR . r �, 7th FLOOR .. 4 / 8th FLOOR Installing'4' ---<1.-----7' (/ C 1:\i : — -0 Company Name °l�rt )�,t. N9 1".tit3 C.0 if S p y S Check One: Certificate 4 � SO � ' Address �/J ❑ Corp. City 9C IT State '1'f l) Zip Code 0 e)-29<) ❑ Partner Business Telephone: 3 0 6 3 G 3.1011 irm/ ' Co. Name of Licensed Plumber or Gasfitter (9)O .- al d/2-/�°�-l/ 0 INSURANCE COVERAGE: Chec ne: I have a current liability insurance policy or its substantial equivalent. Yes No❑ if you have checked yes,please indicate the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity 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'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 pertinent provisions of assachusetts State Pl g ode and Chapter 142 of the General Laws. B y Type of License: A,----- �-IGiA� Sign re of Licen umber Ci Title ;TER City/Town 0 JOURNEYMAN License Number /0 474 2,6 _ _ 7 7 c/o-- 2.6 - Plat 7Lo ,05 of ro A F )11\ j / N•OF• 3 i /O ,. rt, t ,c,? 3 � i-- i � � l '_./..• !'a-' I BDfD:7.1 a Al, S CO aA O o 111 o o � w ›Zi \ CD ito b 11' O N WI O O 0 O H ° ° ° Ai i O eZ' tlin ca. - .,„ il a• 0 . IT./ Z""' tri OM dCD CD cu N. u lftik4,"*...... b 0 `o � o rnco . � 1 �i b o O ti ti k --......) y ,� l� N