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2011 Jul 27 - Plumbing Permit - Mop Sink
I - �� �7— z l ��� f �' ��a� � �l� � � �� �, . � MAS3ACHUSETTS UNIFORM APPLI�ATION FOR A PERMIT TO DO PLUMBiNG � CITYITOWN: ar --. �� --�____,,,� APPUCATION DATE: 2? /I -------_� JOB ADDRESS: ��� �f��icv� AtJC � PLqNS SUBMtTTED: YES� N0� POCCUPANCY TYPE; COMMERCIAL�RESIOENTIAL� IVE1N� ALTERATION� REPLACEMENT� REMOVAUDEMOLITtON D _ r PLUMBING: PIPING—FIXT[TRE3-FIXED APPLIANCEg_AppURTENANCE3 Z ENiER tOTAL AMOUNI FOR FJ1CH SELECTION MTED TO FNE IYUMEpKg ALTERNATNE TECHNOLOGY DlS�F,R SINK: SERVICE ASPIRATOR ORINKUK;FOUNTAIN STERIUZER DRAII�k AREl1 FLOOR � EJECTOR STOttAGE TANK BACKWATER VAIVE EMBALN�NG AUTOPSY ��� �F�� ����M F000 CHEST MISTING SYSTEM VACUUM DRAINAGE SYSTEM BAR SINK GIASS WIISHER WATER CtOSET ��B �IR� ICE R WATElt HEATE[�ALL TYPES BIDET INTE EpTOR:ALL INTERIOR WA��P�p�� CROSS CONNECTION DEVICE KRCHpr SiNK r OTHER NOT LISTED 'i DEDICATED: AC�WASTE SySTEIW LqUNpRY CONNECTION DEDICATED: GAS/�USANp Syy"fElYl LAYATORY DE�CATED: GREASE SYSTEM pIPE REUNING.WaRK ONLY DEDICA7E0:RECLAl11�0 WATER ROOF ORAIN DEMTAL FIXTURE 1 E IPIIAENT SINK: t-2 3 BAY PREP. �ISHWASMER SINK:CUIWC FLUSH RIM pLUMBING IN3T I.i F'R F'( M.('AMDSNv twrc�niu�,..r.�.. CHECK ONE ONLY NAME: c C`o , i�i� ADORESS:-� S fv+rbr'�q� �f2.�.� D�o►pa�lan Business/� C(TY. �rtws�r �"] �-----_____.._ ....�---------- STATE:� Z�:� c�Z6�.�'J � ❑ iP Busi�ss TEL• 2' FAX:� EMAIL•��,,.�.,�Pi ,..�.q.�—;,,� � 8�s►� NAME OF UCENSED PLUMBEi� • ❑�����t� IN3URAYCE SOVERs F i have a current BabNilv Ir��pol a.i������m������Ch 142 YES NO It you have checked yffi,plesss te 1he typs d coverage by checkin9 tf�e aPProP�iaa box below D A liability i�urancs polky Ofher typs ot inclemniq� g�� owNEas ursuRaMCE w��a�aw,►.aacm.i�a�se.�,ne��e�„�,r�br���u au��ac�,s�a ce��w,, and Eh�e my signaar�on ads pem�c app�ptlon�thy requiron�ent, cHECK o�o�r Sf�lfB Of OWfIBI 0�OW11�3 A 8/1t O�R� AGENT owNEas r�n�: Sz � �---.__...___..._.._..__�.._. .--__ ❑ 14� A�� �wrt SZ �t'LJ �TEL: . FAX: ��1 herebY cert�that aN ot th�delaib and irdamafbn 1 haw subm�tted(a enteredj re�d�'i9�P��aPak�lon ts trw and accurad to °��►�0�`���t�aW P��+9�and installatloro pe�fomied undv th�Pe�mit issued wiM b�tn compl�witl� p�th�e�Provisions of th��Unitonn State Ph�mbin9 Coder,and Chaptet 142 d tl»Ge�ai Laws. U� (OFFICE USE ONLl� Ty_pE OF LIC'A�at• Pen�# ` �� �P ��s � � � � � Sfgnatnre of Liceased Ptnm6ee F� �� tc rue Yumber. �-.. `�" , � �,��, L 2 7 20 � BUILDING DEPT. BY -- _ --- .