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HomeMy WebLinkAboutP-19-936 MflP : PIM eEC : -CS MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -.t CRYO /AumiN L.1� MA DATE PERMIT# _/ # I;-000'ie4, JOBSITEADDRESS ,�, f{ mnnr:n5 Ln L . 1 OWNER'S/ NAM/E Pa ,` AN; /� r I P OWNER ADDRESS I TEL 6/7 90 14?S FAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL 0 RESIDENTIAL Er. PRINT CLEARLY NEW:0 RENOVATION:C] REPLACEMENT:Ele PLANS SUBMITTED: YES 0 NOD • FIXTURES 1 FLOOR-. 8511 . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I _moi r I r _ CROSSDEDICATEDCOSPECIONAL DEVICE ( fS n Mn�I IN DEDITED GAS/OIUSAND SYSTWASTE STEM EM S'ilS. ;I5 i5_,a';__',i_;�w a a a _ r IMIll DEDICATED GREASE SYSTEM � s �', I!li l�1' ;� DEDICATED GRAY WATER SYSTEMA na�'I _Leas DEDICATED WATER RECYCLE SYSTEM I I � � I i DISHWASHER- I 2 -. n nn'n DRINKING FOUNTAIN �� V � i l i ��MN'PM S 5 FOODDISPOSER� J----- _ _, ---- - __� ��II FLOOR/AREA DRAIN rr% .- II i f _ r . • INTERCEPTOR(INTERIOR ,,, •o KITCHEN SIN .• . I c_ 'R. .. .: LAVATORY i ,,( o ROOF DRAIN""I ‘`.4 iI SHOWERSTALL:I m m 1111: I , a I,„ l w, i ,r_. SERVICE/MOP SINK I , . _ TOILET _ URINAL .o - : WASHING MACHINE CONNECTION I, „ I - i . - WATER HEATER ALL TYPES i WAT OTHER PIPING . . ;a i S W ( OTHER � � ��� IN MIR NM 11111111111•11 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES dNO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY 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 ell plumbing work and installations performed under the permit issued for this application will be In c„elionce Min allEerjlg ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _ _ (aft/ P, PLUMBER'S NAME K,l)Vit` In GBrj ILICENSE# 1/&an - SIGNATURE MPE' JP CORPORATION!Zit a%( "G 'PARTNERSHIP©# n ,LLC®# COMPANY NAME1.14),'n M&d r p4 )J. 1n r', I ADDRESS I I I �iod va eJ Pct! I J CITY W. Yr...r n„ ,4A. STATE MI ZIP OP.67 3 TEL (5 0€)))-7- 7-78'-14554 FAX 4of'79u-toilCELlt09314374EMAIL • Env (,PfUmb 0 Con2rlxS4 rnP,,J • GRID yips - _ _ . . - , • I . ;. �. ; /Ap ,oARce / '^''' ‘S. _MASSACHUSI_k I s UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =:kms:` crlY,rod wn of YA OW/'^ MA DATE S3 I c,. I �r i PERigr# A4DP- 7-tvcq JOBSITEADORERS I orr 61 n_nnInr3 L.n $OWNER'S NAME I Pot/i 4r•c.vr 1 • G OWNER ADDRESS ) (TEli 617 qog- )ej. fru) 1 TYPE PRDVTDR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL El RESIDENTIAL(, Cr BLY NEW:0 RENOVATION:Cf REPLACEMENT:ri PLANS SUBMI II EU: YES[j NO APPLIANCES 7 FLOORS-, BSM 1 2 3 4 5 6 7 • 6 9 I 19 11 12 13 14 BOILER - IIIKAIKAISiiinillikali . • BOOSTER _ _. -- Sf CONVERSION BURNER COOK STOVE • -la_ _ a _I. DRECT.VENT HEATER MKS.�- 'i S DRYER —; ii i - FIREPLACE FRYOLATORr -4 I-CN.... t . Ira S Ina ' FURNACE I / -- - li'Ti,i t - • GENERATOR I: tars IIIIIIVAIIIIIIIIIIIIr GRILLE '' • ' w nS PW'i7--i" . : ... i • INFRARED HEATER /d.0•', m. i;Tfi 'i ili LABORATORY COCKS t '. 5—a, [n u! LLQ;WI'r fii•.4l 4.1r1 it••'a 1t MAKEUP AIR UNIT 1,. . r i ,— {8.a.i'IL' LT a',twA'"I•' !I 318a!171i2d:' I OVEIV• - `/- In n E_;_.ora,ir'i`i1+aiirr3_.Q'a`� it212E7,an-._ POOL HEATER ' I •-• IWf 1l•rtfii'°`�•i - ROOM I SPACE HEATER----._ Go 11M.1111111111 SE i� Jly; Tt ROOF TOP UNIT • ;" "n` immf:, TEST IM UNR HEATER Itti UNVE TED ROOM HEATER __ _ __ I • - -WATER. I3' --- - - --- TIORIn.iL,' i _ _ pa`s. OI o: —`iiiiSifilit . all.m'i i mama awls=mil INSURANCE COVERAGE I have a current liability Insurance policy or fts substantial equivalent which giets the requirements of MGL Ch 142 YES 16NO Q I F YOU CHECKED YES,PLEASE INDICATE THE TYPE OF CD E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Q • BOND C OWNER'S INSURANCE WAIVETh I am aware that the licensee does not have the insurance coverage rte by Chapter 142 of the Massachusetts General Laws,and that my signature on this permitbppkcation waives this requirement • CHECK ONE ONLY: OWNER T] AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby catty that a at the details and Information I have submitted or entered regarding this application me true and accurate to best S my knowledge and that all plumbing wait and hstaaalaac perfumed unclean.petmt Issued far this application well be In axnpfanae a ptovWm of the Massachusetts Stabs Plumbing Code and Chapter 142 of the General Laws PLUMBER-GASFI1lER NAME 1 kt,;n m CB r:tie 1 LICENSE MET()lis(9 ---- - SIGNA'NRE IP21MGF© JP JGFQ LPGIQ CORPORATION fait e$68G PARTNERSHIP D71 ILLCa I •COMPANY NAME .mnde Rlom411ac t (� inc1ADDRFSSI JI neloce4 Imp A 1 4(thcg • crTY in. Yrtet„„r<-+6, • STATE ran ZIP p$6.73 TFL (sok)-rib- 4 564 I • FAXtt!toti)7eto-67261 Call (EMAIL - q • y _ I -_ -' .. - - - - .. -_ W r 1 • • . , - d .- - - - - ' , i . . .. . . ., - r. 1