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46—ACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Northampton P , Mass. Date �-- /t�Q 19
° City, Town Permit # ��'l
Building' Owner's
AT: Location ,� 'Q/�p Name
Type o f
Occupancy: dwelling
LyNew ❑ Renovation [] Replacementlil
Plans Submitted Yes ❑ No ❑
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sue—BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
GTH FLOOR
0TH FLOOR
7TH FLOOR
0TH FLOOR
(Print or Type) Check One: Certificate
Installing Company Name Hodges Plumbing
and Heating corp. 672
Address_ 123 Hawley Street [] Partnership
_ Northampton, MA ❑Firm/Company_
Business Telephone ,q'k&-//S'Q_. Name of Licensed Plumber or Gasfitter
$ Richard W. Hodges
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 this Messachwetu State Gas Code and Chapter 112 of the General Lws.
TYPE LICENSE;00j
By Plumber
as
Title Master e Plumber or Licensed
or Gasfitterr
City/Town: Journeyman 7743
License Number
APPROVED (OFFICE USE ONLY) P jMT,S