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Home My WebLink AboutBLDP-19-001027 • • �"1 cA p • IPcA r c e I � • MASSACHUSETTS UNIFORM APPLICATION FO A PERMIT TO PERFORM PLUMBING WORK . 9="y=ep lil— ° CITY ��//�/ MA DATE I �K ,�i PERMIT 110/9-19 JOBSITE ADDRESS eDD blbS 1 �k OWNERS NAME P . OWNER ADDRESS • TEL • FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIALK . PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:I 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/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN . ' • FOOD DISPOSER - FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK • LAVATORY • ROOF DRAIN SHOWER STALL • • S ER VICE IMOP SINK TOILET URINAL • WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I WATER PIPING . • OTHER • • 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 THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABIUTY INSURANCE POLICY 4, OTHER TYPE OF 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 ❑ AGENT ❑• • SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding Si,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 complia ith all Perti •rovision •f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. j /,":40. PLUMBER'S NAME .Cart 5. R i ec e l l LICENSE# $:(y(e • sint TURE MPIE1, JP 0 CORPORATION❑# PARTNERSHIP 0# LLC❑# COMPANY NAME Carl F. R;ectetl t Son ADDRESS 7757 Mein Stree"} CITY ' OSterv; lte STATE MA ZIP 0aCo5S TEL 50S-- 1-Ira`s- Co3C,,9 FAX CELL EMAIL • • 4—R. � • • 1 ck p ' Par c e MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK l CITY "I d e,INWT r• MA DATE dkil 1.41)? PERMIT# &42/7-17-1917/01-• 7 JOBSITEADDRESS! JO Ochs is IOWNER'S NAME --- J1JJ J GOWNER ADDRESS TEL (FAX • TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:Di RENOVATION:Li REPLACEMENT:: PLANS SUBMITTED: YES NO❑ APPLIANCES 7 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 • BOILER COOK STOVE DRYER FIREPLACE LI k di k— FRYOLATOR fSna'lflfiflfi SSS FURNACEI ..,. rata . ._ -^I dl .. . .. —.. GENERAT•. .,.... GRILLE INFRARED HEATER LABORATORY COCKS •. . . . UNIT 11111l POOL _ EATER ROOMH SPACE HEATER ROOF TOP UNIT flf' flflfi _ - 11111MaillIMIIIIIIII TEST UNIT HEATER NUMMUUMU . UNVENTED ROOM HEATER WATER HEATER OTHER r t • INSURANCE COVERAGE - I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES INO Ej I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a OTHER TYPE INDEMNITY ❑ BOND DI 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 ® 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 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 complia - ith all Pe•'•- t provi e Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - _ - PLUMBER-GASFITTER NAME C, c,r I 5 . R;e d e 11 LICENSE# d"Zycj S ATURE MP MGF© JP Q JGF© LPGI© CORPORATION Q# PARTNERSHIP©# LLC©# COMPANY NAME: Carl R. R;edell r Son ADDRESS 778 Mein Street CITY Oster-ville STATE MA ,2IP oa& 55 TEL 5OB- Hd$ - Co3Co5 FAX CELL EMAIL ; (12e1A +2 en -21) tre/v --wring„)