The URL can be used to link to this page

Home My WebLink AboutBLDP-19-001373 r,J~�• MASSACHUSETTS UNIFORM, / APPLICATION FORA P RMIT TO PERFORM PLUMBING WORK • CITY (f./`'(Gr/viD(l /J MA DATE = PERMIT#/f.D 2-51-6 /97,9 JOBSITE ADDRESS y7 u. b-PJ /c tic7 �- c � OWNER'S NAME br[2 C//1 42cQzde OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXTURES 7 FLOOR-, BSM 1 2 3 4 5 6 7 8 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 Pt E C 9 IV i LAVATORY ROOF DRAIN SHOWER STALL SERVICE I MOP SINK I TOILET %UILD NG DEPARTMENT URINAL Y —-- i WASHING MACHINE CONNECTION WATER HEATER ALL TYPES II WATER PIPING I OTHER l � 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES± NO 0 IF YOU CHECKED YES, PLEASE INDICATE THETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY y, OTHERTYPEOF 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 0 AGENT 0 1- SIGNATURE OF OWNER OR AGENT 1-1-1 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 imowledge and that all plumbing work and installations performed under the permit issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# - SIGNATUR MP ❑ JP DL CORPORATION❑# PARTNERSHIP 0# LLC❑# Pr OP - COMPANY NAME Pik C/J r1 SP -P4-1+ ADDRESS / Afal yf Ll�c-- L_ CITY 5Q 7Q r M out-el STATEA, ZIP a t 7 TEL ?7y$/D 5/zz FAX CELL EMAIL i-K i 0Ø- M1! LJ Dr ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ pb FEE: $ PERMIT# G��l Volt( PLAN REVIEW NOTES ' • • • i. IZ:k MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK tail---a.s` CITY (Jt <7-A71/1-7-(37.1 - MA DATE; .s (PERMIT#*PP'17 /473 JOBSITEADDRESS•' L z LI,� �-r a�,_I� IOWNER'S NAME E.0-7-- 40 t..J77 GOWNER ADDRESS i 1TEL tFAX' I TYPE OR OCCUPANCY TYPE COMMERCIAL;,.] EDUCATIONAL ,_J RESIDENTIAL PRINT CLEARLY NEW::11 RENOVATION:L REPLACEMENT:0 PLANS SUBMITTED: YESIJ NOS( APPLIANCES T FLOORS-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER ___J LJ'I11—J—JJ_J—J JJ'_-1—J_J BOOSTER _J I.I._i TI_I'_—J_I___I___I— _I I_J CONVERSION BURNER I—J•I_I___J I'I L_LJ I_J__I•___1; I_J COOK STOVE __I____J I____J_ t I LULL(—J—J'--_J_J I —J I DIRECT VENT HEATER _i_I I—J;_l_J _1-_ -J___I______I_J:__J_J L I DRYER• I_1—I-_--I_I__J_'_J..__LI-_-_1•_1.:__I_I•I_J FIREPLACE _J J ..- t I�J'-1 1 __ -1_i____I II____1" I_J JFRYOLATOR .=IC I I _f.T1___11_1.-_____I'I .—I_I I__III FURNACE _I'LJ I I_J' J_{'_i ,TI_I i _ t _J I r1 I GENERATOR J-J_I—J —1 J_J I J___I I_I—J'_ GRILLE I_J.—!_1 —I I_,_J'I._I_1_1 _1•_J -.1_J INFRARED HEATER . I — • _ I _I_I' _ _R , _ I'..—_J I LABORATORY COCKS _I_IL]I I III' I itMAKEUP AIR UNIT _I_.__._J'_I __I'J__-J I --... 1-_1r ._ J OVEN _I-J___J I I_I`I 1_ 1._iJJ I1 I I i POOL HEATER _1 U .•._J—J _-.I____[.___S I— f l`�7M N I_U1_J ROOM I SPACE HEATER _1 I__ _I I f I I ,-__J _I_I I I ROOF TOP UNIT -_-_•-I-.J_-J_..J _I J_..I I k7TT 4..._.4,rr.. t;,,,, . - 1 I TEST _I__J—J J I=4_4,1.___I i._j_ —I_ _j 'I! UNIT HEATER YI-J'1 ! - i I__J_-J_-J _i I I UNVENTED ROOM HEATER _-J__I_I _-i _.,I_J —I_i I I_J _i ___J WATERHEALR. . ._-_-.-_.____ _A-I-_Ll� 1 I I___I-J_J-I._J_I_I I pJH€B 1 .r ...._...., ._—. _I I�I._I I i_I_J _I___1_.1 I I—.__J-J . • I I`I_I _,_J J I_—I I I _.J-J'--I I.-J 1 i" -1_i-JJ 1 —I'_._I'I_—I_J_lJ-1'_1 • 1 -- I_I_I _II—J_I_I_I'I I_1_J_ ~_I INSURANCE COVERAGE C I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES lig NO D I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY : OTHER TYPE INDEMNITY 'jj 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 ,,j AGENT • 1- SIGNATURE fSIGNATURE 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME fLi- j I. .A 2 LICENSE it/ S NAS- X MP: j MGF:J JP'®-4F LPGI. 4 CORPORATION La# 5/67 PARTNERSHIP I# LLC:=f#k �( COMPANY NAME C t f--4.F I ADDRESS l iLCA7 _ CITY O . arINA r.., J ISTATE• ft;: -I-ZIP p?.4; 73-ITEL314{ $l69,c.c= FAX . _-._..__...(CELL! .._...- - (EMAIL // ^ • 5*-t ^T O- •M e $ r, c 9-42 Efre--1-/ S O• 1 U?•1/ GIC-Ii(17I q O ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 n(49 ✓ � FEE: $ PERMIT# i ,LC//f/ KLAN REVIEW NOTES 1 c/1 pn r GG /C 06 79.C/24 17-7.01-9-C-Q/)- d