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29-322 (2) = z . � r z � ■ V n � 0 z ■ ■ � � n / q c k k ƒ . aQ ƒ ■ § > § _ m \ a& � q 7 ■ ® ƒ / 2 / m C § \ m 3c S ■ o o CT ■ c a 0 § In o 30 09 c c z x $ .t x 7 ƒ § §rQ § / $ 2 _k 0 K3 m o o ® ; r z �m 0 ■ � � @ G) � m z . m _4 . 0 � 3 , . � MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) +�0i l f Nat-i� KP4-oh Mass. Date Tg n� 4 19 S� City, Town Permit # a Building Owner ' s AT: Location '3 t R c trt b rook a r_ Name -± rect �✓t!CkLO Ve Type of Occupancy: New ❑ Renovation Replacement ❑ Plans FIXTURES Submitted: Yes ErNo ❑ z z rn a to to Y F W J co N O = z W W W �G J CO } V Q N O O Cr = _ N z z 0) O z z Z a Z N Q W (A 3 X V N m W N x > Q F- N = O Q a 4 O n. z O O Q W z '� Q W D Q N z OC J N N J p W O W S 4 = 3 0 a Y 3 O W W Q Y Y W > O y n O z O O W O V Q. Q = C Q < O J W O J F- o SUB—BSMT. BASEMENT 1ST FLOOR J I 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR BTHFLOOR (Print or Type) Richaxd s Installing Company Name Plg.& Mg. Inc. Check One: Certificate ® Corp. Address 79 Union Street ,Rear ❑ Partnership Easthampton'Ma 01027 [] Firm/Company Business Telephone 413-527-0291 Name of Licensed Plumber RICHARD A BOULANGER --- 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' ed for this application will be in compliance with all pertinent pro- visions of the Massachusetts State Plumbing Code and Chapter 142 of the General ws. B'y - 'itle _ S' gnature of icensed Pl ber Type of Plumbing License City/Town: APPROVED (OFFICE USE ONLY License Number ❑ Master ❑ Journeyman I w/c $12.00 1 lav q 7 June 188 Date ..................................................................... ............ Richard Boulanger Plumber ..�ict�ad••.y...�lt�atbng..................... Fred Becko Owner ..................................................................................._ 381 AcrebrooM Driva e Address ................................................................................ REnovation .......................................................................................................