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Home My WebLink AboutBLDP-19-000635 Tame: PAReet : g, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK L. w ; CITY rev, Gt./M'I Pori I MA.DATE PERMIT# rwA/9-oOO&4r JOBSITE ADDRESS 0_4._ S 90.4—T7/ I OWNERS NAME r4 r`Q tempeiy' I ' P .OWNER ADDRESS I TEL 77 j/-330 3933IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 ' EDUCATIONAL Q RESIDENTIAL® PRINT CLEARLY NEW:Q RENOVATION;Q REPLACEMENT:® PLANS SUBMITTED: YES®' NO® "FIXTURES 7 FLOOR-• BSM 1 2 ' 3 4 5 6 7 .8- 9 10 11 12 13 14 5 BATHTUB CROSS CONNECTION DEVICE s n = DEDICATED SPECIAL WASTE SYSTEM aalaiJul DEDICATED GAS/OIUSAND SYSTEMalgaSanPS Tin DEDICATED GREASE SYSTEM iu .S_aaa ar anta EDAr - � 1 DEDICATWATER RECYCLE SYSTEM I Je _MUM.mil ll... DISHWASHER i n s110 DRINKING FOUNTAIN 1 I � IS t FOOD DISPOSER �,��S� . iWilMI FLOOR/AREA DRAIN i iIL. NM INTERCEPTOR(INTERIOR) I :rW 5 KITCHENSINK . air611x1S MIMS LAVATORY ! liS allition SHO111./1111.1M MI WERSTALL S MOP SINK 1 S a� I_• MI ROOF DRAIN � I' — TOILET I Malt s'sSI MI URINAL A ". IS, , S MS WASHING MACHINE CONNECTION Ma SOSi_ .. . NMI. __. . .,_iIt—tS-5 WATER PIPINGWATER RALL TYPES �• r l OTHER IM Mi Inil"�1 . ._._ . . I -1 i 1 , E COVERAGE: f— _, INSURANCE I have a current Jiabllity Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 NitsQ (go,D, V E.: IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW I - (,��j---��/] LIABILITY INSURANCE POLICY D . OTHER TYPE OFINDEMNITY❑ BOND i L-�'1/2018 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chaptel;142 of thtLPat -r vi,- r Massachusetts General Laws,and that my signature on this permit application waives this requirement. I •v • T • • CHECK ONE ONLY: OWNER Q AGENT Q SIGNATURE OF OWNER OR AGENT - I hereby certify that all of the details and Infomration I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be N compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. • PLUMBER'S NAME IMiLe Iti`'�'cit`rt.r•Q ILJCENSE# If7Ti� SIGNATURE -4- MPD JP Ca. CORPORATION Q# - IPARTNERSHIPQ# ILLCQ# ' COMPANY NAME 1" 1 ( c, N 1 t -P P N # !ADDRESS I / cAAilsr f f..Ctj&- 1-04---Q I CITY S o ` a f`Jv\.0 Vfrt./ E STATE I (MAI--I LP O 2 4 6a `/ I TEL 7 7 y W IO 9/r.„-Z. I FAX CELLI I EMAIL 5 1 ns et• .M chi",rQ,r-e-: S ✓\--4-r t • C n rv-, I LWIL5(-) d2K • ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 P1/)9.6_ /JL6 02--( FEE: S PERMIT# /—// ✓ / t, PLAN REVIEW NOTES /` 2`� v ✓/1a • Cr* fit•,r Sett 452.4` .+e • • • • ' • s - .174. � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `I_)' CITY �4ir'NIDJniV B r-T- - I MA DATE I1 7- I T{1 PERMIT#/kMP-19-05067j JOBSITEADDRESS T6 t FA:4ps'T IOWNER'SNAME! �" /v P/1Ofi1 r A ) -_I GOWNERADDRESS i �-�- �� Tal-1(,j - 7-'N{l•1-IFAX1 J PRINT TYPE EO OCCUPANCY TYPE COMMERCIAL;-( EDUCATIONAL_J lRESIDENTIALJ CLEARLY NEW:, j RENOVATION:7...3 REPLACEMENT:,_..1 PLANS SUBMITTED: YES ILI NOD APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BOILER _J_J I ' _l_J• . I-J-_I-J_. i-J-J BOOSTER J-J-______I;_I I_J'-u-1-1_j -J 4 j-J CONVERSION BURNER _1__I_1 I•_Ji_I__I:_ j _J __1,_J_J COOK STOVE '_I__1,_J I_J-J,_J-J-J_.I TJ -1 DIRECT VENT HEATER .J_i l-�;_ _J_]_1_1 _ _:___J J _� :_1 1__1 DRYER• ' _ILLI-J-)J-J_I:J_Jtilt-I_Li__IJ� FIREPLACE JFRYOLATOR -J-J j:11.= ' L.._I -J �J_I __1 -J-J-J-J FURNACE ._I J..: _ I Lj_Li. 1_J_I_J_1 =--I 1._I-J IGENERATOR !I I_I_t^,1_I_I-J-J-1-J-J.J- I_� GRILLE I .-t.==1-.1-_J _- I_J____r_1_I_I _J_J_!J INFRARED HEATER . _1 flii I'"_1 , ! I--L1_, 1.:14:__I 1:;,1.=� =J i'_J_Li COCKS MAKEUP AIR UNIT r Lr ' " "LLILLI_I-J-J J' ____i_____I_lit-J-J-J-J at __.I'J__-J_1 • i_-_J _ i-i ___i ..:L! _I--I_ I alb OVEN _I-J I I_I__J_.1_I_J_J'___J ._J_-_I_I. POOL HEATER -J_J-J'-J.1_11 J-J.-J_I_J- 1 -J ROOM I SPACE HEATER _" I_I__J _I 1 I ,L_I I I I____1�I ' ' I ROOF TOP UNIT _-_•_I 'I" _J_ ! ____J__J_LLD LD I_-J 1 L__1_J_J TEST 1 1_I. ! !_J--J_i I_j _I__I UNIT HEATER I__J_1 ' I_i ' I=1-__J _-1.-_1 ' I_-i j_1_.! UNVENTED ROOM HEATER • _J__LI Li __I_1 ___:.!J._.....i I J_;....1_____J 1_I WATER HEATER. ..-------.--._ / i f J^I_J 7::_.1 iI_--J^J._I_i-J_1_1__J_l OTHER l ,.r:_ ,.._ _______.---- - I -i_I ... I_ I I I_ J_J__J-_1'J I ' . _ .R _. . .., i.. . I-t-1 -J _I -1 _I _J-J . _1'-I -J-1 fig _... • -I_J-1 1 ` • _• I 1-J I i .. "`I I I_I INSURANCE COVERAGE E1 have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES rsO D I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY r OTHER TYPE INDEMNITY Ti BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Ti AGENT ;_I SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application am true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME: 1/1,l(G C �•4 1 UCENSE# 1 SIGNATURE MPE MGFJ JP;D JGF j LPG] CORPORATION' #` r--- ..� _( �Z OP �PARTNERSHIP.;.1#----�LLC:,I#i I COMPANY NAME: NI P-(DO - VIII_ r T7- IADDRESSI • tufa 4-711?- P r_o _ CITY *;011-1 .. ... I STATE ZIP•--0116�' EL' • FAX CELL: EMAIL' c± ' 0 •. II LP Si ' .t, 9s' 4 I •Lf JI'� ^+ r' S ' e= t 1 • ff.?.I. arIB \ ( SU(:DINGU::... ivy NT I Lion) CR8 ROUGH GAS INSPECTIO NOTES THIS PACE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yea No reT474717 THIS APPLICATION SERVES AS THE PERMIT ❑ 1:1 FEE: $ PERMIT it 0 (-47dPLAN REVIEW NOTES •811 /11 • .. t . •