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29-080 (2) s s r v A O a� y x ns a r v r z v z w ! " OQ p = M 9 @• O 0 9 Opp 2 x 0 O m K O C O N m y 7p C p 1" w _ 'r p A f�0 � d O � C � w = G r O c 44 0 to O O = d v o 30, n O Oo a y to z a00 0 .. y Z 41 ' n � r A MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) NORTHAMPTON Mass. Date //- cZ3 19 87 City, Town Permit # Building Owner's AT: Location-4(5- ��, , a22 �-z Name ��.Z ..� Type of Occupancy:_ dwelling New ❑ Renovation ❑ Replacement ❑ Plans Submitted Yes ❑ No ❑ H N W N e) N tJ Z cc 0 cc 0 F- Lr O W W W 0 V 01 W O J 2 W < m rA M' < W O O ' W W W W d N W t V W N W < W H p W W W H J r < 3: lY a 0 W W H r' a Z ` W h Z F. W W O > W F. W W ? = 6 N m Z O Z 9 O N I x = O O Z W 0 ; O J 0 W Y O a t— O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 6TH FLOOR GTH FLOOR TTH FLOOR STH FLOOR (Print or Type) Check One: .Certificate Installing Company Name Hodges Plumbing I and Heating ] Corp. 672 , Address 12'3 Hawley Street "p0.Aor, ///(p _ [:] Partnership�„� Northampton, MA 01060 ❑Firm/Company Business Telephone 586-1150 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 the Massachusetts State Gas Code and Chapter 142 of the General 1Lws. TYPE LICENSE: By Plumber Gasfitter Signature of Licensed Title Master Plumber or Gasfitter r' City/Town: Journeyman � License Number APPROVED (OFFICE USE ONLY) r'iaf' I W/h Date 8 Dec 1987 Plan No. 37 9 ktichard LHodges Gas Fitter Holly Martineau Owner Street 45 Acrebrook Drive Building Old—New.