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HomeMy WebLinkAboutBLDP-19-001405 /nflP : PRAeEc : MUi 0p MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK 1 curt -- _-y ntrov-r14 —F` MA DATE PERMIT# �lLn -11 00/�/os JOBSITE ADDRESS 16 �ro9Utn•'S etv,7J ( OWNER'S Eleanore,. MP.nrJnMA., I P OWNER ADDRESS I 408)T'I-ISF�? IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL 0 RESIDENTIAL Ly PRINT CLEARLY NEW:Q RENOVATION:Q • REPLACEMENT:0 PLANS SUBMITTED: YES 0 NOQ FIXTURES 1 FLOOR. BSM 11 2 34 5 6 7 8 9 10 11 12 13 14 BATHTUB .'�r ( ; r T I( CROSS CONNECTION DEVICE I - r DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOIUSAND SYSTEM y I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM 1I - i- - M DEDICATED WATER RECYCLE SYSTEM li, � _ DISHWASHER 1 _ DRINKING FOUNTAIN ��n �� FOOD DISPOSER FLOOR/AREA DRAIN Mean I ' INTERCEPTOR(INTERIOR) KITCHESINK ' LAVATORY STALL SERVISHOCE IMOP SINK ' - -- iiw . ROOF DRAIN TOILET �i lira I Mil tli--11--- IM !� URINAL WASHING MACHINE CONNECTION j; -� t ! i; .. .. WATER HEATER ALL TYPES { I jr WATER PIPING • I - - R -- _'Yut41i.II OTHER I _ r r ' -`� F INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.14L YES aeN0 Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABIUTY INSURANCE POLICY E OTHER TYPE OF INDEMNITY D BOND Q OWNER'S INSURANCE WAVER: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 Q AGENT Q ' 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 all plumbing work and Installations performed under the permit Issued for this application will be In c„s'encu with ell ye ' Ion of the Massachusetts State Plumbing Code and Chapterap1424of the General Laws. (/ PLUMBERS NAME 160r /nGer;CAP !LICENSE# II(,6L0 SIGNATURE MP Da JP CORPORATION p;J#a C-1PARTNERSHIPQ# LL n C©# • COMPANY NAME VW^ 4 %.D&:io,, r U. -Mr, (ADDRESS n r 'odrr J PPt A CITY W. kfrrnnov4A ISTATE MI ZIP 026,1'3I I TEL (6o1)- 7F• 4556 I FAX 4ot:71 u-u 61 CELL boe)30-37.4 EMAIL . for c.,p pip m b 0 C;o nl ras4 ✓ o eA 1 • ui I-. isu\A jou F Ur G/hf� `GIQ?l6 �� fillip pa c &/ _MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • jr CITY,Taws n of VA ' ' o 0 " • 1 MA DATEEffifirri PERMIT# l 0/x/9 OD' V - JOBaTEADDRESSIIJr 0ra-1110 3 ghrti, IOWNER'S NAME JFJPnnrrrl"ti Menr)c,nr, t • G OWNER ADDRESS f • j TEIrc o D T 7 I- I SI9 FAX 111111111111/1 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:VI PLANS SUBMIITBX. YES 0 NOD APPLIANCES 7 FLOORS-. Baa 1 2 4 3 4 5 6 7 • 6 1 9 19 11 412 4_13 14 BOILER - BOOSTER _ ._ _ CONVERSION BURNERr COOK STOVE • = It i...- .. DIRECT.VENT HEATER allig DRYER 1:111=111inla FIREPLACESilt NEW la Mt NNW WS FRYOLATOR Jar 1 mu i al _i r nilowiliijute FURNACE _ ,__ • GENERATOR GRILLE - ■ AN. _-: • ... ei INFRARED HEATER _.-If { LABORATORY t _ . MAKEUP AIRUNNITKS rr~- Ul t1�' sb 1r }LL1 in �^ikr . 1 OVEN' � SreS. • "LAI ,.,.,,.__ POOL HEATER • MS flS C ! il.'/ . ,,i1SU dittr ._.. ROOM/SPACE HEATER , ROOF TOP UNIT • aasa ._�' TEST i e 'Alta t UNIT HEATER UNVEN•FED ROOM HEATER • - 1, W A EnE i N E to r.>_�>_ INSURANCE COVERAGE I have a current liability Insurance policy or as substantial equivalent which meets the requirements of MGL Ch.142 YES elf NO I F YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY C HECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY fi./ OTHER TYPE INDEMNITY Q - BOND OWNER'S INSURANCE WAIVERZ: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© AGENT 0 SIGNATURE OF OWNER OR AGENT • I hereby candy that all it the details aid hdopmetion I have submitted or entered regarding this application are true and accurate to best of my knowledge and that all pushing work end Installations performed wider the permit Issued fortis application win be In eompfence pm4m d the kiassachr State PhanChapterbi g Code end Chapter 14d 2 the General Laws. PLUMBER-GASFTTTER NAME I k;,. m C, r:tie. I UCENSE • 11690 --f` - • SIGNATURE - MP a MGF© JP 0 JGF 0 LPGI© CORPORATION tit la 80f CG(PARTNERSHIPDj lac D4 1 COMPANY NAMEIYeon'rnc-Er;JtPlum 4Lecct -/tc1ADDRESS j II (Int_,..el- Pal- I • CITY I.U. 4,r,v,nrl4k • STATE hill ZIP O2.673 JTEL (5680 -77g 455 i • FAkt!okY1no-67tslam) (EMAIL - 1 4 , /././.. 11:,<-10)811AL", , kie, ):- ,--- v!Th.: 7,8(1 ,012y- , . . , a . • • .. - _ ... - . . . r • 9 • a