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HomeMy WebLinkAboutBLDP-19-001828 ,A f; ., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -:Ving-_: ;CITY I .5 ` W MLIL4hMAG ? MA DATE 19 tt /o i PERMIT# F/51-0 W JOBSITE ADDRESS 1 1-1 4/ kY /LLGI,./ -Sr OWNER'S NAME o � (2 nWMfD SIVi;e 1 .Z P OWNER ADDRESS 1 SA-Air; 1 To 2.7-O t5-S isAXI I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL Q RESIDENTIALa PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT PLANS SUBMITTED: YES 0 NO0 • FIXTURES 1 I FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB .111in „ ni CROSS CONNECTION DEVICE leallliatilliiiMOISSISSINIIIIITSISIIIIIIIS loll.IS DEDICATED SPECIAL WASTE SYSTEM mot SAS aS15 5s DEDICATED GAS/OIL/SAND SYSTEM S. S5� �'aaSSS IMIIIMS DEDICATED GREASE SYSTEM "m ams 5mi5 5sus a DEDICATED GRAY WATER SYSTEM 1111.11111111111•1111•ISSIIIIIIITSISSIMMIIIII,Willifise SUS DEDICATED WATER RECYCLE SYSTEM WM 5 S5 IIIIIIISSSSSIIIIIItiSSNMI la DISHWASHER 1 5NMMeNM SIN T-- NNE illiMaillatilli MK MK DRINKING FOUNTAIN al�;S 5_ I' inimirSITSSMill.S FOOD DISPOSER ' ioeitusii'r�US FLOOR I AREA DRAIN 5 551E0aItWS .SIsoll 5 INTERCEPTOR INTERIOR 11111111f11INIsJItSTiji1 MIIISWIKS5= KITCHEN SINK I �_ _*WMil MF iMilliniiiielims is LAVATORY i PM allinini MS NW illilindinillilliallinitila'' ROOF DRAIN 1 55 IIIIINIIIIM SE SM.SI1l1_SI i=1 SHOWER STALL PM ilmtS S'I IIIIIIII SES,1I,M IIIIIII SERVICE/MOP SINK 5SFS S Mk____ 11�SiminF + ” S----= TOILET I Is NM NS IS SI MIKMSISISrWLIOI ATI"I i1 U URINAL 1 Me Mit 5w 55lS'555asSANS WASHING MACHINE CONNECTION .111 S__PMaS5 5 U_S_SW WATER HEATER ALL TYPES aA_�___ssa.s lSWWIn g WATER PIPING 1 SI'Si IMIIIIr :S -' feW_ OTHER • VOW f.S ani' '_ # ____Ian WJ NM NM MI al NS SS Mk IS NS Saa MA , INS SOS imiSSmiNISINESSIalmiliff Sr wit -- - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i . LIABILITY INSURANCE POUCY 0 OTHER TYPE OF INDEMNITY 0 BOND Q 1 • 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: 0•ER AGENT Q SIGNATURE OF OWNER OR AGENT ?T� my knowledge I hereby certify that all of the details and information I have submitted or entered regarding this applicado• -re true a • - .t • . ,• my sion know) and that all plurlbing work and installations performed under the permit Issued for this application will •- in comp •_ isair.0 of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / _,M PLUMBER'S NAME ANDREW LEIGHTON 1 LICENSE# 16130-M t ' ' - GNATURE MP +Q JP0 CORPORATION,#13734C IPARTNERSHIP©#1 (LLCaI I COMPANY NAME HALL OIL COMPANY INC. ADDRESS 435 RT 134 CITY SOUTH DENNIS STATE Q ZIP 02660 TEL 508-398-3831 1 FAX 508-394-3068 CELL— EMAIL • 1111 - - • - ��\`, _ i • • ' 3. • • • Z7 / -f 12