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THE COMMONWEALTH OF MASSACHUSETTS
/v-- �'--�/ _�7 `" ? /h- ---------
APPLICATION FOR PERMIT TO DO PLUMBING
No. y'(��/ ,JUN 3 0 1983 19
WORK MUST BE PERFORMED IN COMPLIANCE WITH ALL PROVISIONS OF THE MASSACHUSETTS STATE
PLUMBING CODE AND CHAPTER 142 OF THE GENERAL LAWS.
FIXTURES
_z
Z N
n } 0 Z ~ w
w N J Q U Q �n Z a'
N Y N J N F- Z Z) Z J
w v7 H w F = 4 ,� u- Z a x
U w Y CY a a
U m = K >- Q v� (7 -
Z �n w x F- w z p Q Z d w
w 0 � x Q p Q J N CY � J z O
w 3 Q Y
w = Q 2 3 3 O z = Y p- O � Q w w
F- U > F- 0 2 a Z Z O N w I- a:Q Q Q = N ✓� Q Q O Q F-
3 Y J m N p p J 3 S F- u- 0 p 0 Q O
SUBBASEMENT
BASEMENT 11
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FL(&R
9TH FL R
10TH FLOOR
11TH FLOOR
12TH F
13TH FL 42 R
14TH FLOOR
15TH FLOOR
16TH FLOOR
17TH FLOOR
18TH FLOOR
19TH FLOOR
20TH FLOOR
NAME AND ADDRESS OF BUILDING NAME CERTIFICATE NO.
CORPORATION_
PARTNERSHIP
FIRM OR COMPANY
NEW OR RENOVATION
NAME OF MASTER OR RNEY AN PLUMBER
NAME OF OWNER
ADDRESS OF OWNEI ADDRESS CC
PLANS SUBMITTED? YE TELEPHONE NUMB RS:
NO BUSINESS
ESTIMATED COST OF JOB RESIDENCE
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 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.
Signature of Licensed Plumber
Designation and License Number of Plumber
FORM 1240 HOBBS & WARREN, INC., REVISED SEPT. 1973