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Home My WebLink AboutBLDP-19-001486 MPP : 1'4ACEG : y .a MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK C,� li, • __r_ cin f.—. -- - y�1 PMmJl _p— I MANnDATE 9 � , PERMIT It/340�19"ali7 81P JOBSITE ADDRESS I Q (j."Ili J gnrk ,2J J OWNER'S NAME r',I c 1 K �i s P OWNER ADDRESS I TELI774 994-3A0tAX TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIALg' PRINT CLEARLY NEW:© RENOVATION:❑ REPLACEMENT:1d PLANS SUBMITTED: YES❑ NOD • FIXTURES'1 FLOOR-. I BSM I 2 3 4 1 5 6 7 8 9 10 11 12 13 14 . THTUB f CROSSONNECTION DEVICE Yr _ r . { I rI DEDICATED SPECIAL WASTE SYSTEM lairtla DEDICATED GAS/ONSAND SYSTEM DEDICATED GRAYSE SYSTSMDEDICATED GRAY WATER SYST(aADEDICATED WATER RECYCLE SYSTEM ,, rtl r I ___ i as. DISHWASHER OialtliMar DRINKING FOUNTAIN WN -1 FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) „.., ., I, , , ,,- it I - _ - ,. , LAVATORY b KITCHEN SINK i ROOF DRAIN ---1 _ ,( .- .4.,, I .. SHOWER STALL -_tn4 _ I,_ . _- I-=_' SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION �i w -� I r._ MK WATER HEATER ALL TYPES ■)f WATER PIPING -115 MEI rill, . — OTHER I _i -_ 1 , +c d _; • i 1 I : I, a _, i INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 2/NO ID • IF YOU CHECKED YES PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Uri • OTHER TYPE OF INDEMNITY 0 BOND ID OWNER'S INSURANCE WAIVER:tam 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 hire 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=rcennnce archa6 hn of the Massachusetts State Plumbing Code and Chapter 142 of the General taws. " PLUMBERS NAME j6Q:r Moan?)O I LICENSE# t(G9O 1 SIGNATURE mpg JP© CORPORATION Iy,J#aStiC, 'PARTNERSHIP 0# LLQ# /� C • COMPANYNAMEI i ;n MicOCJP.P4 Th tt trcJ,. +ADDRESS ii ( .o 4 Pcl 1 CITY ITV. Y�arn.ov4A STATEjrall ZIP 02.673 TELT (5ofC 14/. EID I FAX 4c4 lno-6`141 CELL LSO)3t4.3V4I EMAIL I em r..pip m b 0 'Com n ots4 s ' 11 . SEP 12 mid BUtL ��• NT BY AtLP , 1 i>i h�- d2 y _ - 7.7(/:/)//1 • • • • • • • . • • • . • • • • • • • • 4 .. .- -. - .. .. - - 1 SAP /0Al'c e,/ • `.' _MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • CITY,Taw f YYAW M$ 57-74---1 MA DATE 9 Ip i: PERMrr# WA'>'Q-al/ea& 1 ��nn ff)' ] ' JOBSfTEADDRFRSI Iq /. IIrr�o eroaL PAOWNER'SNAMEIM&c# P: Lig • G OWNERADDRESS ( - (TE11774 494-3(o71FAXimmilia PRIIgtbR OCCUPANCY TYPE COMMERCIAL0 EDUCA11ONAL0 RESIDENTIAL g• CLEARLY NEW:0 RENOVAlloN:0 REPLACEMENT:ID PLANS SUBMITTED: YESO NO© APPLIANCES 7 FLOORS-. BSM 1 2 3 4 5 e 7 • 8 9 I 10 11 12 13 14 BOILER - - �. BOOSTER I W ,: CONVERSION BURNER a __ � Wll `llIlli`11111111.11 MEOWS COOK STOVE M; i DIRECT-VENT HEATER DRYER FIREPLACE FRYOLATOR 11111r_ -_ FURNACE - -- • GENERATOR .-: GRILLE _ Ng• rr, - - INFRARED HEATER 1 LABORATORY COCKS ., MAKEUPAIRUNIT use - rvo OVEN )Th. uI=.cornar ROOM HEATER S ROOM/SPACE H61TER i - » Y„ • r• . �. ROOF TOP UNIT • _ TEST UNF HEATER ` UNVENT•ED ROOM HEATER -WATER EATER----- - - --- (I/ ) W:Wmu _WE r I lwi ' _ - --:---- amfl INSURANCE COVERAGE I have a warrent TrahTdy insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES LINO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OFBY CHECIUNG THE APPROPRIATE BOX BELOW UABRlfYINSURANCE POUCY OTHER TYPE INDEMNITY ID. . 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❑ AGENT 0 SIGNATURE OF OWNER OR AGENT • I hereby certify that al tithe details and kdommalm I have submitted or entered regarding this appPmton are true and accurate to best of my knowledge and that all plumbing work and installations perfonned underthe permit issued for this application wR be In compla u providm of the Massadmuset s Stats Plumbing Code and Chapter 142 affix General taws PLUMBER-GASFi1TER NAME {gyp V:n IYI C r:�P. I LICENSE - ma Q -'- - - SIGNATURE MI'a MGF© JP❑ JGF 0 LPGI 0 CORPORATION Ef# a 8 6k G PARTNERSHIP 04 (Lc a COMPANY NAMEJk¢,m-In rlc11 a Rom-+p.L} Si1c,(ADDRESS( II (ineJ-n.SrJ P I • CITY W. Yneirvm .Ain • STATE MEP I Q'a67rr f e Y e�',et`Qr'iS- t6r L • FAY46ot7'l0-57%5(CELLI Ft EMALE . 0 I , SEP 12 2018 4-kit BUILtAI NTD BY \ ��I : .