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Home My WebLink AboutBLDP-19-000883 • S • MASSACHUSETTS� �( UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING �rWORK p�j CITY 500-V^ IArmmvUUflt /� MA DATE $l/r/�/7 PE(R�MIT#�P' `ited0 b3 JOBSITE ADDRESS 3). I / f A , vG OWNER'S NAME )(We- topic's (/S OWNER ADDRESS SG TI4 TEL ,SOS-766-GC%lYFAX __� TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL❑� PRINT CLEARLY NEW:❑ RENOVATION: 0 REPLACEMENT:I, � PLANS SUBMI I I EU: YES ❑ NO It FIXTURES I FLOOR—. ESM 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE • DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM • DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK j LAVATORY • SE DRAIN ......e.'�' I SHOWER STALL SERVICE ICE 1 MOP SINK 1 TOILET I I URINAL I IWASHING MACHINE CONNECTION WATER HEATER ALL TYPES ( - 0, , WATER PIPING OTHER iI INSURANCE COVERAGE: �/ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES fL/ NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHERTYPEOF INDEMNITY 0 BOND 0 OWNERS INSURANCE WAVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachuse ene ws and thtt my s' re on this permit application waives this requirement fi �O!/ CHECK ONE ONLY: OWNER GENT 0 SIG ATURE F OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are tnie and accurate to the best of my Imowledge and that all plumbing work and installations performed under the permit Issued for this application w61 be in compile nt 'sip e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 5CoM%Q- ( LICENSE#19L16351,0 SIGNATURE MP JP❑ S CORPORATION❑# PARTNERSHIP 0# LLC[�#$?-x993976 COMPANY NAME r fir ?101h late 1 �j A� A ADDRESS Po &x 2Z2 CITY /1a/w/I/G fi ✓ STATE/MA ZIP 6626`l 6 �7 / TEL P5 -4Y/-3 793 FAX CELL 50I,Y.14" EMAIL SF,PIlhafi frim tee/P1/L.cam LC /I go— BOUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 (IRA 1 n� /_ FEE: $ PERMITS ` �d�/�� n FLAN REVIEW NOTES (/1\ M1 '/�(/ r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 7ap�_ C ` , CITY SOcSkA Nart/I to MA DATE 771 `120/f PERMIT# /f24P-/9-oco1 JOBSITE ADDRESS 21 ?it i-ct A - OWNER'S NAME ?Arc 10/405 GOWNER ADDRESS Scare- Ta *22o7o 2Y FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL Li------ PRINT CLEARLY NEW:0 RENOVATION: 0 REPLACEMENT:Ly PLANS SUBMITTED: YES 0 NO Eg---- APPLIANCES 1 FLOORS-. 88W 1 2 3 4 5 6 7 3 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - - COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE - ' GENERATOR - GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN -- - POOL HEATER a �. i U _- i I ROOM I SPACE HEATER 1 - ROOF TOP UNIT J TEST _. ._ .... . . . .. ._ _ .- - -- . .---- -- — UNIT HEATER INVENTED ROOM HEATER -i (( I_ at (1_ d)) - WATER HEATER 1 �i / t OTHER INSURANCE COVERAGE ,�/ I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MOL Ch.142 YES L7 N0 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSU CE am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Massachus ene and that my signature on this permit application waives this requirement CHECK ONE ONLY: OWNER L'7 AGENT 0 1 SI ATURE OF OWNER OR AGENT vL 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!inc.,:..- and that all plumbing work and installations performed under the permit Issued for this application will be in corny wi a,•ertinent pi' . of the 4) Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /f' PLUMBER-GASFITTER NAME rJ CO A - tict LICENSE#P(f(,3s-y if l SIGNATURE MP Lrd MGF❑ JP 0 JJGF❑ LPG!0 CORPORATION❑11 PARTNNERSHIIP 0# LLC 0# SR COMPANY NAME /tel /(R P 1U vv,',Aq ADDRESS to v0� Y 2d a. CITY ificinNWG�r reL ✓ STATE/PA ZIP 026 91( TELf67 2Yr).27s A,, FAX CELL ,5 4414 EMAIL SIR it OA 50c-accYGi��f 411. CIdf"' tri rf Lib_ JIOUGH GAS INSPECTION NOTES '/ THIS PAGE FOR INSPECTOR USE ONLY SINAL INSPECTION NOTES - Yes No THIS APPLICATION SERVES AS THE PERMIT 0rar-44.4❑ VI V • FEE: $ PERMIT II Of( kR44 FLAN REVIEW NOTES