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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT 1`0 DO PLUMBING
(Print or Type)
Mass . Date— -f�-- 19 8 7
City, Town Permit
Building 1� Owner 's
AT: Location 3 � ��I t (� 1�P I u� Name �CC06evld �'I O_9 9/0 //,/) o
_ ----------— --r—,
Type of Occupancy: zfsticlehlty
New ❑ Renovation Replacement ❑
Plans �/
FIXTURES Submitted: Yes L No ❑
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SUB—.BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
7THFLOOR
8TH FLOOR
(Print or Type) Richardls
Installing Company Name Plg.& Mg. Inc. Check One: Certif.icatp
❑J Corp.
Address 79 Union Street ,Rear ❑ Partnership
Easthampton,Ma 01027 ❑ Firm/Company
Business Telephone 413-527-0291 Name of Licensed Plumber
RICHARD A BOULANGER — --------------__--
hereby certify that all of the delails and information 1 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 pro-
visions of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws.
By
Title S ' nature of censed P1 mber
Type of Plumbing License
City/Town: PST -7867 [
APPROVED (OFFICE USE ONLY) License Number FLI Master ❑ Journeyman
$
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up
7
Date ......................................................................19............
R''chard Bou'Longcr
Plumber jj
chard' P?
...................................u.......................
Leo-,,,ardl Maw,iolno
L�
Owner ....................................................................................
36, Bea ttl-e Dr!.ve.
Address ...............................................................................
P,en o'vc t'.o, n
.....................................................................................................