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HomeMy WebLinkAboutBLDP-19-000675 Mf1P : MAeEt : + "IS, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK V, ` CITY C.— N 2(Y)6 (TTW1 MA DATE PERMIT#nI OP-5-0c0 6V JOBSITE ADDRESS H O Oran n �VP , I OWNER'S NAME O9i k 1 din t) IaS 1 P OWNER ADDRESS ( Taken3)99 i-934`1' FAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL D RESIDENTIAL' PRINT CLEARLY NEW:0 RENOVATION:D REPLACEMENT: PLANS SUBMITTED: YES❑ NOD FIXTURES 7 FLOOR-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 11 l CROSS CONNECTION DEVICE THTUB r- r liar �I1. f DEDICATED SPECIAL WASTE SYSTEM �� '�'�' M DEDICATED GREASE SYSTEMI1:11 DEDICATED GASIOIVSAND SYSTEM S DEDICATED WDEDICATED ATER REY CYCLE SYSTEM 1 _1111111.IS SIM IM 5 �, r SYSTEM MI MS Ma DRINKING FOUNTAIN � I �� �� DISHWASHER i _-_ : n�' _�sonn; �! FOOD DISPOSER p FLOOR I AREA DRAIN I INTERCEPTOR(INTERIOR) � an ,is�, i l fl am Sinsiss;au SSS S S IPS IR LAVATORY PIM ISPa MIMR aiMOM MI S——S MI 111=11 ROOF DRAIN INK 1 IM 'l� SHOWER STALL �ina ,1 In '�atan SERVICE IMOP SINK MEMn a a! TOILET URINAL 111111111SIiNOI SIR MN 111.1111 al IS ISr,MSS EMI MI MI NM WASHING MACHINE CONNECTION 111.111111111;11.11ii011111iiiiiiiN 1111111Munislim Mum,IIIIIIIiiii SAM WATER HEATER ALL TYPES NS UK 11111111111111111111111'J [1M1 'MNf' '5 OM 111111111111111 WATER PIPING antes' � �� nia�itilS OTHER of n: .., _ - , I i MIRI _ :1 u INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[13/NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ar. 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 ' 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/tthhhee best of my knowledge and that ell plumbing work and installations performed under the permit issued for this application wc, nca ill be In wt'ha ll n of the Massachusetts State Plumbing Code end Chapterap142 of the General Laws. PLUMBER'S NAME j6u:r• in c,3 A o (LICENSE# I IG9O SIGNATURE MP de JP CORPORATION deg Q:K4C JPARTNERSHIPD# n` LLCQ## i COMPANY NAME ," Al CB,;d p. P:+ ).1., =il r'. 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J . • .-. . _ • •. . cio 9-zi , ... fl)4,° PM?C ell. +' 1 _MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK •LE-- r+ITx!lows of /il2M n UT rr3 MA DATE I ERMIT P k. 04341 IIS/ V 67s II • JOBSITEADDRESSI I (Odin" /nn �ue loWNER'sNAME I rnCQ r' - f 4i�cJ,rjrc OWNERADDRESS J • (TEli412 9Q) •9349 fFAXJ i PRINT OCCUPANCY OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONALQ RESIDENTIAL cna>:t.Y NE t] RENOYAT1OItD REFIACEMENT:Q PUNSSUBMpTED; YESQ NOQ APPLIANCES 7 FLOORS 9W 1 2 ) 3 4 5 8 7 • a 9 10 11 12 13 14 BOILER _ 1 � BOOSTER _MI M i CONVERSION BURNER a .tala aaa_ illtaTai COOK STOVE • 1101k DIRECT.VENT HEATER DRYER FIREPLACE _. - ._ _-._ a' _—_ :r te ___ FURNACE 1� • GENERATOR - GRILLE INFRARED HEATER LABORATORY COCKS1111.114‘ r 441 — MAKEUP AIR UNIT r.A4114 „ ."-r ..wYC.. C . y,1Lii s-4 l r. 7 POOL HEATER ROOM I SPACE HEATER ROOFTOP UNIT • •• u �,- TEST _ UNIT HEATER ! _ •_ ' flmg ' UNVENTED ROOM HEATER _ _ inann __ ___. stans -WATER. 1-' _ ___ atsewinimmagnarmianiajlairaistn - . . - . i i INSURANCE COVERAGE �,� I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES U NO 0 IIFYOU r IED YES,PLEASE INDICATE THE TYPE OF BY clic IG THE APPROPRIATE BOX saow tiABILIT.Y&JSIRMJCZP000Y lei OTHER TYPE INDEMNITY jJ BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Charter 142 of the Massachrsetts General Laws,and that my signature on this permit application waives this requirement • - CHECK ONE ONLY:. OWNER Q AGENT Q. SIGNATURE OF OWNER OR AGENT I hereby may that all of are details and Irdmnetlm I have submitted or entered regarding this apwuattgai are five and aaauam to best d try bhowledge and that all plumbing hat and installations portioned under the permit Issued t to this application ail be b canpOa[o a pmdsign tithe Massa:hist Stats Pinding tads ad t tec 142 d the General Ian'HINMERCASF 7ERNAME`ICeu;n IncreCela tLICEIJSE II( )O -_ a - - AR MP Q1 MGF Q JP 0 JGF Q`` LPGI Q CORPORATION d# a a. • a- PARTNERSHIIPQ41 (LLC LD& YNAM cOMPANE amlY1c-srrg0 (Jlusi4lied SnrJADDRESS! I1 (i- tJ,cdat-4 1 � k_ t • l ._ r 1 r CITY I I.U. 1/,,,,> nt.--tti • I STATE] 7JP( OD673 (Tlit a {1-775 4554 I ! • FA srrn7ae-6785IcmI IE IMI - - I I .l IP n n 7111t i( I • _ E3UY3D '� ''��`` '' _ 7 NT If . .� _ /� -