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Home My WebLink AboutP-17-3581 �.r r t MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK =e'L�1 CITY \I A,.9 mn oI-k Font MA DATE t l up q PERMIT#/, /---/7 od . 's 1 JOBSITEADDRESS 100 Wkay tcn-c OWNER'S NAME L• Hank I do--) P OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:[a PLANS SUBMITTED: YES 0 NOR, FIXTURES 1 FLOOR--0 BSM 1 23 4 5 6 7 81....r 9 10 11 12 13 14 DEDICATED SPECIAL WASTE SYSTEM ' Neumantins. aii DED D GAS/01USAND SYSTEM flan. DEDICATED r ,sral rDEDr I DRINKING FOUNTAIN , ,, a SIMM _ __ . 1M_ INTERCnfsiM EPTOR AREA INTE ) �RURRURwuauaa— FLOOR MIS NM_ MIN�!•MN MRl� INTERCEPTOR(INTERIOR I FOOD DISPOSER �„��MO� KITCHEN SINK ____ I LAVATORY ROOF DRAIN RRMRnIRIflR.1I SHOWER STALL Ste_ , _ as aI TOILETSERVICE I MOP SINK 1� TOILET1 URINAL WASHING MACHINE CONNECTION li __1 Mairits ,, WATER HEATER ALL TYPES 5 OTHER WATER PIPING �. OTHER ' �� RR _ fMn 111 MIIItami ate _amilanss im INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES a NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E OTHER TYPE OF INDEMNITY❑ 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 ■ -G ,T 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 t _ - • .to to/tb /no -dge and that all plumbing work and installations performed under the permit Issued for this application will be in .. . y, • , th all r . :rea Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME RICHARD OLSEN LICENSE# M10335 •–•/ SIGNATURE MPO JP CORPORATIONO# 2166 PARTNERSHIP 0# LLC❑# COMPANY NAME OLSEN PLUMBING&HEATING ADDRESS 357 HOKUM ROCK ROAD CITY DENNIS STATE MA ZIP 02638 TEL 508-385-5290 FAX 508-3856963 CELL EMAIL Q 1 . 1 • ; . , ti • a r • • Ley Y/eLdifi Pd0 xo -71 9-9-vt2d MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK —_la C --DO `, ";�1= CITY 1 r,r rn n 01-6 pet r+ MA DATE 1141 I PERMIT#/H/ � JOBSITE ADDRESS I 00 14 r,Y14 OWNERS NAME 1 . March II No IJ GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL at PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:gj PLANS SUBMITTED: YES al NO® APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER 111 ir I1U1UI'iUiRiII DRYERI II FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER f�j�j�;�i�il♦'1';i�i�i��li��' EUPAIRY COCKS iiiIIRiiuhRiIIi MAKEUP AIR UNIT OVEN POOL HEATER RROOM/SPACE OOF TOP UNIT EATER iIiIRiRUhIiIiI TEST ME��; , mm, �� ,m;�'. UNIT HEATER i N i ii UNVENTED ROOM HEATER _ I� �' WATER HEATER I Ii 6 OTHER II I I I II INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES Q NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ 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 Ej 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 occur. oe-rot my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be I��.--" e wi ,r rovlslon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Richard Olsen LICENSE# M10 5 SI ATURE MP 0 MGF❑ JP❑ JGF 0 LPG'0 CORPORATION Q# 2166 PARTNERSHIP❑# _ LLC❑# COMPANY NAME: Olsen Plumbing&Heating ADDRESS P.O.Box 2026,357 Hokum Rock Road CITY Dennis STATE MA ZIP 02638 TEL 508-385-5290 FAX 508-385-6963 CELL EMAIL OAT l c c ( ()ken �u rnk ry •C 0 M Leif , . isms OW5 e/-ri - Z-R/A fid2dfr 7 . , ,