17A-124 (2) BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE /
NO. U ��
APPLICATION FOR PERMIT TO DO PLUMBING
NAME&TYPE OF BUILDING
LOCATION OF BUILDING
J
PLUMBER
PERMIT GRANTED
DATE 1g
PLUMBING INSPECTOR
4;;t- MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO ULUMBING
(Print or Type) �
Mass . Date 19
City, Town Permit # `�
a Building Owner's
AT:: Location 3 70y� Name /;'_
Type of Occupancy: ezz IC40✓eC
New ❑ Renovation Replacement ❑
Plans
FIXTURES Submitted: Yes ❑ No ❑
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SUB-BSMT.
BASEMENT
1ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
8TH FLOOR
7TH FLOOR
8TH FLOOR
(Print or Type) Boulanger' s Plumbing
Installing Company Name & Heating, Inc. Check One: Certificate
® Corp. 387-C
Address 373 Main Street , P.0 Box 89 ❑ partnership
Easthampton, MA 01027 ❑ Firm/Company
527-3240
Business Telephone 536-8845 Name of Licensed Plumber
David C. Teece
1 hereby certify that all of the details amt information I have submitted(or enleredl in shove application are true and accurate to the best of iuy
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 State Plumbing Code and Chapter 142 of the Gencral Laws.
By &,4 �
Title_ _ Signature of Licensed Plumber
City/Town: M 760 e of Plumbing License
Q ❑
ADD n� License Number Master ❑ Journeyman
0a7
..........191Z
. ...
Date ...... ................................
Plumber .......A!&..............
Owner .... ......
Address ..................
......................................................................................................