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HomeMy WebLinkAboutBLDP-18-006376 0064 • MAP: PAR c6'C : ` 59 sw., ,tom MASSAC USETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ^w'_ CITY " MA .DATE r ( PERMIT# a /4O' /jLC4d4 • •.,t 5 birdman • 0 a JOBSITE ADDRESS3 •La.linnelaill OWNER'S NAME lag Ir a AM O ' ' ' P ,OWNER ADDRESS I Ta 7EC'/- 367 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 9 RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:IP REPLACEMENT:© PLANS SUBMITTED: YES® NOD FIXTURES T FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB , rnl�tDEDICATED SPECIAL WASTE SYSTEM .-- e DEDICATEDDEDICATED GREASE SYSTEM _,„111111 Ir, „1.1.1.1.1MIffill.. ..1.1.j1111.1.4 - l'ailliMIIIIPM.111.111101 alailaSITINIrajiMISI S #iiiiiillawaikallintlim W DRINKING FOUNTAIN RDEDICATED GRAY WATER SYSTEM NN FOOD DISPOSER [ ;L t wtIMITMISW llI_ FLOOR 1 D IN ENNI-WillISSILISSIJIMI OM MAIM[MI KITCHEN R(I�NTERIOR) aiWJ'NriCa lei�L��SS •5 fl LAVATORY :a:_a_as. ___S_SIIII�, DRAINROOF SHOWER —ted lmoti owrisiJ lalrclenall ,'ia to ISIM SERVICE I MOP SINK MEI 1.0' 1Si d5u 1aliaaari la`:l ,'I _ is I� TOILET =wa'a�rISL n asn■tllM��t�l�i— URINAL 11111111.1111.111.1.11.1111111.1,00.111.1=MiltilliStaillor WASHING MACHINE • ipaWnA111i_i1a11�1/,�1! IAtAt s![ninimJ�714t7 ILaw�1i111R1�■I![! VVATER HEATER WATER • ►, �_ • oTHEItatIS ass110011 a- amilml I,ll iiii saanwasoranousitarmrsitinsing wai LI! h t� insis mwl a,111�[i 1,lm I . 1 II • INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES[g NO 9 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY© , OTHER TYPE OF INDEMNITY 9 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 0 AGENT 9 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 penult 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. . v( (� PLUMBER'S NAME Nf(.K&PL k(J5 n4f ILICENSE# 19ii II e\). (1- - MPD Jp icP- CORPORATIONO# . IPARTNERSHIPO# LLCO# -• COMPANY NAM ( b r �• Q ^1'J t-4 ADDRESS V je 1 CITY Sp (0-MQ "l f STATE Wm P flEWAT- TEL 7It% ( C') 9! L4 FAX CELL 1 EMAIL _ .1 s , • is 1 I 4 ., La.4 ` . 44 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No / THIS APPLICATION SERVES AS THE PERMIT 0 0 • • /Pt ��� /� ' FEE$ PERMIT# 4II'4 /)2- 01-e_ "^ # 64 /71 PLAN REVIEW NOTES LP fr ?1/ rlg 7 a • • • 4.) • �. ' u