17B-017 (4) 4
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
V
Mass. Date >;� 19
z1
City, Town Permit r`(
Building owner's
PAT: Location 4cj t�r�c{caE" k'�c_cc� Name
V"Jct- C"ICk-"Cdr'Type of occupancy:
.P New ® Renovation 13 Replacement ❑
Plans ❑
FIXTURES Submitted: Yes ❑ No
Z W
Z 9
F- W „�� N O z _ > W
N Y J N } , t h 0 O Q Q
n W F W 0 P v a W t h LL Z 1&1— ); F-
v Z Q m W y W >- < F. W Z C <IL 0 W Z < d Q O ..
O z Q < W Q '� < W q f! J = O O J k
w = c i 3 3 0 Z =1 3 Y d o ►- z z < W IL x m x IL
< f < < 0 N W O y ~ Z O O W Z Z W F' O V Z
< < O < J ,� < Q ¢ a < O < F
o
SUB—BSMT.
4 BASEMENT
1ST FLOOR 1
2ND FLOOR
� g 3RD FLOOR
4TH FLOOR
L 6TH FLOOR
STH FLOOR
7TH FLOOR
STHFLOOR
(Print or Type)
Installing Company NameMal Cichy Plumbing Check one:. Certificate
an ea g Corp.
Address 90 Conway Street n ❑
❑ Partnership
South Deerfield, MA 01373
] Firm/Company
Business Telephone(413) 665-4030_ Name of Licensed Plumber
4 Malcolm Cichy
1 hateby certify that all of Use details and Information I have subusilled for entered)In above application are Irne and accurate to the bell of my
knowledge and that all plumbing work and Insiallations performed under Perrnll Issued for this application will be In eompUance with all perllnenl pro-
vWons of The Massachusetts Stale Plumbing Code and Chaplet 142 of the General Laws.
{
By
Title _ Signature of Licensed Plumber
City/Town: 7907ype of Plumbing License
APPROVED IOFFfCE USE ONLY)
License Number ® Master ❑ Journeyman '
MAL CICHY
PLUMBING & HEATING, INC.
P.O. Box 94 90 Conway Street
SOUTH DEERFIELD, MASSACHUSETTS 01373 DATE ... _May ._2, ..19.$'9...................................................... _.........................
TO (413) 665-4030 Reg. #7907 Sue✓Ecr.,_Remodeling. - _Bathroom,,,,
City of Northampton .... t........-.......`?o_t......a,va. ,1,a,1 ,1_ .............................
....
Frank Sienkiewicz - Plumbing Inspector
Northampton, MA 01060 ....----....-,.---
P......................................._............................_................................................... ...... ....................... .................
................1111 . .... .. . ..... ............ ...._........ ....................................................................................
Dear Mr. Sienkiewicz:
................................................................................................................_...................,.............._........... ..... ..... .. ...... .......... . ....... .. _..__...........__............................................... ..................... ..
> Per our telephone conversation .on May 1, 1989 , Dresden Blue 1. 6
..................................................................................................... ...................................................................................................................._........................................................................................................................................................................,.
toilets are not available as of May 1, 1989 . We will be using a
..............
standard tank for the job located at Bridge Road, Northampton.
.....................-1-1.......................................................................................11.11.... . .......... ........... ...... .11.1...1. ..11.11.
Thank you for your cooperation on this matter.
............................................ . . .. ....... .. ............ . ...... .............. ............... ................................... . ....................................... .................. .. ........... . .............. ...............
................ ............................................. . .
........................................__.......... ..... . ......... .1.11.1. .... ..... . ....../.. ... .............. _
V
........................................................................................................................................................................... .....��1: .........._...,... .......:..,...,. .... ..,................. ..................
. ..,.......................... ....................................__.
...............................................................................................................
.................................................................................................................................. S/GNE :�
❑ PLEASE REPL Y V NO REPLY NECESSARY
k ,; ......../ .................................
Date ....
..............
Plumber ... .....................................
Owner ....................................
Address 4..e
. .................................
..................................... ..............
.... .........................................