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LA
aCITY OF NORTHAMPTON
APPLICATION FOR PERMIT TO DO PLUMBING
No. 19
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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SUB-BASEMENT
BASEMENT
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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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20TH FLOOR
NAME AND ADDRESS OF BUILDING 1� NA/ME CERTIFICATE NO.
re 7eLA-cl-(�QQ CORPORATION
PARTNERSHIP
C'Cf L Q lr�, C ,�'rr r3, ��• 1 FIRM OR COMPANY
NEW OR RENOVATION
NAME OF MASTER OR JOURNEYMAN PLUMBER
NAME OF OWNER t�y 6 ✓/�+c'�S G4 cr (71
ADDRESS OF OWNER ADDRESS %' 3 �- �' ��-'I'zd S S�
PLANS SUBMITTED? YES TELEPHONE NUMBERS:
NO ✓ BUSINESS J y
ESTIMATED COST OF JOB RESIDENCE S / J 7 C/
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.
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Signature of License lumber
_ L 2T
Designation and License Number of Plumber
001,
35s '
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r-2 /17 1113 7 -ZE I,"
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2710 1985
Date ...................�LZ4d.................................19..
Robert Conz
I
Plumber ............R...................................................................
&i.R. Cohz Inc,
Owner ..............V ...............
Address e...;4..................................
...................................................................................................