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Home My WebLink AboutP-19-676 map : lithe 0, MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK t_wp _ctV: CITYC Y4Qmv u7 - IMA DATE rct—M-1PERMIT#PjnlRGh0174 ! OWNERS LI Jnn�?JOBSITEADDRESS 1 9 IIP r.mor + / VP i P OWNERADDRESS TEL 413 374-1679 'FAX j TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL 0 RESIDENTIAL Of PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT: PLANS SUBMITTED: YES Q NOQ FUMES 1 FLOOR-. I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 • BATHTUB1 -_1 i i I it CROSS CONNECTION DEVICE }sir- _ 1 7 SIM DEDICATED SPECIAL WASTE SYSTEM ll DEDICATED GASt01USAND SYSTEM nl ma t mins DEDICATED GREASE SYSTEM aa _� DEDICATED GRAY WATER SYSTEM '!fflf 'fl DEDICATE)WATER RECYCLE SYSTEM I DRIN DISPOSER tinlaalmMlilata DRINKING FOUNTAIN ea _ FLOOR/AREA DRAIN • INTERCEPTOR(INTERIOR) NMI MIN �_ IIIII NM�KITCHNSINK �ILiniiRiflk SERVICEI MOP SINK 5 _ i TOILET al URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES IM UE i,� II WATER PIPING MND, OTHER _.. 11111111t MIMIeill i .--MIMI PIMr---`--i— i '—111S PIM__il _ _ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[13/NO \ l IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LABILITY INSURANCE POLICY U OTHER TYPE OF INDEMNITY 0 BOND 0 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 0 AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information 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 In o^,Name etch ail p% � lon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. l PLUMBER'S NAME KP.Ahr �GBnd� I UCENSE# II6a0 I - SIGNATURE MP RI —JP© CORPORATION t#aSF 'C 'PARTNERSHIP Oft LLC®#I COMPANY NAME k&),',1 M`d7IJP. P:4 m —The, 1 ADDRESS I n (iochtsd PdI i CITY W. :AC,-n,o i4A STATE WI ZIP 02477 3 TEL (6 oc)j?s'-45S th FAX 404'79 0.tS1c1 CELLL0930.37, EMAIL I ' k(Y1 r.plumb t9 co m rm 41y n PA I I • IAUG 0: 2918 ' • ., 1 ' - .1 - 'S.//9/..•1 #? "7 . V7� 4 /riAP pa e./ _MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM GAS FITTING WORK • 0=-:7-7717-1 _ 0-' CUTY,TawC n aT WPM() lrrY IMA DATE j/ I I JPERMfr# A.44"R-WO talc JOBSITEADDRESS I I F VP4•Mnn4 hue lowNER'sNAME I LCIUre. Oleo nn P . >j <T OWNER ADDRESS ' • Ta(413 3711- I b7CFAx- TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL9 EDUCATIONAL RESIDPNTALDi CLEARLY Y NEW:0 RENOVATION:Q REPLACEMENT:ElPLANS SUBMITTED: YES Q NOIf] APPLIANCES I. FLOORS** BSM 1 2 3 4 5 6 7 • 8 9 10 11 12 13 14 BOILER - BOOSTER WS It ? MOW .. CONVERSION BURNER SillalialilaWariStiniii*MO...111iiiittilallift COOK STOVE • . =CM Mir SflnS ,Ina °' nillallaninnarailli DRYER Sanagetiata• IS tat FIREPLACE FRYOLATOR jar _pm --Nos aiiiir ` ._um- GRILLE WM. 1Sas ! . , . «.. MOS ' INFRARED HEATER 1 err iso �n . 1a LABORATORY COCKS =pors __ prima.` zein-�� MAKEUP AIR UNIT c « . aasi . MAKE ovEN- N_ _ ass ' :d It ',1L'LLil, _ POOL HEATER - e n_n_Ian • •�Il�id si _ m on ROOM!SPACE HEATER IM)�I.7_;1•�i1�l� �i �•.�,• AM ROOF TOP UNIT - IIJUIIRIIW*JIiiiJII TEST UNIT HEATER UNVEWFED ROOM HEATER )l f S n__fle as ere. ' • - -WATER EATER--- - - NMIItalliaallitlffiglirn . antatittil --- ININIE1 i ill INSURANCE COVERAGE I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES OZNO IF YOU CHECC YES,PLEASE INDICATE THE TYPE OFBY CHECIaNG THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY a . BOND 9 OWNER'S INSURANCE WAIVER:I ant aware that the license does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit hppli ation waives this requirement • CHECK ONE ONLY: OWNER I] AGENT Q SIGNATURE OF OWNER OR AGENT I hereby certify that all d the details and bJum,a&a,I have submllfod or entered regarding this application am true and emirate to hat d my Imowledge and that all plumbing work and Insiagedions performed under the pant blued fonds application wil be In comptiarce s e provision of the ch Massausetts State Plumbing Code and[fir 142 of the General Laws. PLUMBER-GASFfi'TER NAME I ketr;., m cve r:tie. !LICENSE :• 1169 Q " - l SIGNATURE MP(21 MGF© JP ID JGF Q` LPGI9 CORPORATION af# 8 6k 8G PARTNERSHIP P LLC 19t COMPANY NAME( )fl mcgrrpt rr Plum 4 ri ed 5ncIADDRrstsJ I1 �esel.. 4 Peg I • an' ( l.U. Ynemen.--Fti • I STATE rim Z1Pl OAG-73 f Ta.r(560 =rig 4556. rit I g • FA4soli79I 0-57:5JCELLI (EMAIL - I I I • I I M'J!b II? ad I I Ei,JIL .... i -I. - .. - r • r ` ..