PP-59083 ,, °� N4,9 TOWN OF DARTMOUTH
E4 7 4
BUILDINt RECEIPTS
PHONE: 508-910.1820 FAX: 508-910-1838
`t18
Name: Property Date: f
Owner: i /,/ .` 7(' ,
Job Location: i i j 1 White Copy-Collector's Office
Os f { , ,z r. f,,F,, Y Yellow Copy-Customer's Receipt
i Pink Copy-File Copy
Map: Lot: Green Copy-Building Department
Phone: ���Q � 1 , ` ' ,
Description General Ledger#'s Ref. # OF�C- Amount
License & Permits - Building 01000-44105 4 e� � ,
License & Permits -Building Misc. 01000-44105 ti'° ek
License & Permits -Elec_trical 01000-44106
License &Permits/- Plumbing & Gas 01000-44107 ff., 61 '.r
License & Permit's,-..Trench,,. afety 01000-44129
Other Department Revenue 01000-42420
THIS IS NOT A PERMIT OR LICENSE FOR BUILDING, PLUMBING OR GAS
Received By ., ' o- , u.
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type) 'rown of Dartmouth �J
, Mass Date // 20 /0 Permit# 6��11 C
Building (�
Location 3 I< <>Muiv l)Z>Cr J%;�7C leo Owner's Name :S_ -7500-' _„S T -Z=-Z.-L7-
Type of Occupancy rk-.$
New I -, Renovation ❑ Replacement 0 Plans Submitted: Yes❑ No ❑
FIXTURES .
xi co o
n n --1
7 --1-1 - m O c 0 = O —I co r 0 _ZT. D › O R 2
,` t x 2 y --1-1 m cL 13 D Z O O (4 Z m r j O r--' "I
`v� w` r Z O C N Cl)O C) m m Cl) 0 xl Z „ 0 - a g 9
Q' O CD 4 x m --, ? 2 '- O ��77 c
�.f 'c m Crn Cn P- %1 CA D 0 D to ( 2 co Cn C 2 2 2 x C
(n Z co Z Z Z 2 �7 Tl
` ,.ice re:- CD CO C! Z CD D n
. s-910 Z CD Z
SUB-BSMT.
P BASEMENT '
1ST FLOOR
2ND FLOOR
3....... 3RD FLOOR
4TH FLOOR
(S 5TH FLOOR
6TH FLOOR
i„.....--3
j lk g 7TH FLOOR
8TH FLOOR
' )
Installing Company Name J! ) Vj3 C)L : :;DIR. Z Check one: Certificate
Address I, _JC2S H Cotes (p cy?K'_S u.--.
ElCorporation
<)c, 1 6/ i7 r . /1•j f
Business Telephone == h ! 5 O ) S I / z ❑ Partnership
Name of Licensed Plumber C 13 C L- C`j'4-/-0
0 Firm/Company,
INSURANCE COVERAGE:
I have a current Jiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes - No ❑
If you have checked ry ,please indicate the type of 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❑ Agent❑I
Signature of Owner or 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 rovisions-of the Massachusetts State Plumbing Code and
Chapter 142 of the General Laws. r
By
Signature of Licensed Plumber
Title
City/Town Type of License: Master El--- Journeyman 1❑
APPROVED (OFFICE USE ONLY) License Number ///_ )
't
Map 7 q Lot Ve ' -_
P ❑ * ❑ E CD n ° n
`5( P 2 B° o '• o
O CD
� q9
tz
pz, OWN OFt- -.'
CD
�_1 tJi a . V ���.SnFI tlm�/
r
❑ m n
❑ 0 0 � o y b
° ° ° O o �.
�o O
ti ❑ ❑ ,::,,
' ❑ ► r OInl cz c,� L
z7 TJ z7 b A 2
y d d d*
*
° cz
A �:
1 d P,Cd d o X=,' 0ob
CD 1 b b
cc om" w
co
A) tlitb,
1hP