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THE COMMONWEALTH OF MASSACHUSETTS
--- *-X, --------OF----1` 0- x.- kt4-yq-P - --------------
APPLICATION FOR PERMIT TO DO PLUMBING
No. 19 —S3—
WORK MUST BE PERFORMED IN COMPLIANCE WITH ALL PROVISIONS OF THE MASSACHUSETTS STATE
PLUMBING CODE AND CHAPTER 142 OF THE GENERAL LAWS.
FIXTURES
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Q Q Q = v� ✓� Q Q O Q J J Q 0! o! O! Q !-
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SUB-BASEMENT
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
5TH FLOOR
6TH FLOOR
7TH FLOOR
8TH FLOOR
9TH FLOOR
10TH FLOOR
11TH FLOOR
12TH FLOOR
13TH FLOOR
14TH FLOOR
15TH FLOOR
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17TH FLOOR
18TH FLOOR
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20TH FLOOR F17 ,
NAME AND ADDRESS OF BUILDING NAME CERTIFICATE NO.
61 P+t.Sr( N} Ct iztjle. CORPORATION
—
jRUMG{- - MA . @F. PARTNERSHIP
FIRM OR COMPANY
NEW OR RENOVATION t(e-Li
/� e NAME OF MASTER OR JOURNEYMAN PLUMBER
NAME OF OWNER �/jt�ltN
f �'° �UItt7 l T� � fls
ADDRESS OF OWNER HORtAtf— A A e 010 � ADDRESS ILL AR k�r ��r 1 � r 11 ��1 � 'FT• 1�4 0�U
PLANS SUBMITTED? YES TELEPHONE NUMBERS:�1
NO BUSINESS' y
ESTIMATED COST OF JOB
RESIDENCEl7j r � + "
1 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 SEP T. 1973