HomeMy WebLinkAboutBLDP-18-006346 4_1s a-1 5-/c/ie If ea''t -i t vt 29 Yy i SD ry <Np**
g , MASSACHUSETTS UNIFORM APPLICATION APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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rr �yrw(iy(, ( MA DATE 0///r.)PERMIT# hi.i2l19-00(o24'$
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JOBSITEADDR I�!,��Q)p„fyg� OWNER'S NAME e. Y`4. sa-ne--
P OWNER ADDRESS I TEL[StI 37Y 4YSr FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 9
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:9 PLANS SUBMITTED: YES❑ N00
FIXTURES 7 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB - t ( II 1; I 1 f L _i
CROSS CONNECTION DEVICE .r
DEDICATED SPECIAL WASTE SYSTEM
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DEDICATED GAS/OILJSAND SYSTEM I 11 I a , -ir
DEDICATED GREASE SYSTEM 7 6 r
DEDICATED GRAY WATER SYSTEM i V 'p .- i a i 1,.
DEDICATED WATER RECYCLE SYSTEM i J ( ii _ i ,r
DISHWASHER ! I�
DRINKING FOUNTAIN - I _
FOOD DISPOSER '' T II
FLOOR I AREA DRAINI
INTERCEPTOR(INTERIOR) , ( 1 r
KITCHEN SINK
LAVATORY ,1- ,} II
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ROOF DRAIN �;
SHOWER STALL 4 P.-{ it • N r
SERVICE/MOP SINK ,, r
11 i, I � I ,
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TOILET `1
URINAL FI
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WASHING MACHINE CONNECTION 'I- r'�-�" •
WATER HEATER ALL TYPES t M� Tri j
WATER PIPING r 1 1 , ( I
11 I _ IIii, _
OTHER r
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 9 No ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW -
LIABILITY INSURANCE POLICY 9 OTHER TYPE OF INDEMNITY ❑ BOND 9
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 ON • OWNER ❑ AGENT ❑
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and Infomiation I have submitted or entered regarding this application are e and accur. -16-1;bes of my knowledge
and-that all plumbing work and Installations perfomied under the permit issued for this application will be in 'radiance eat• ovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
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PLUMBER'S NAME Paul Owen LICENSE# 11061 SI c A URE
MP0 JP CORPORATION O# 3943C PARTNERSHIP❑# LLC 0#
COMPANY NAME Bath Systems Of Mass(Bath Fitter) ADDRESS 25 Turnpike St
CITY W.Bridgewater STATE Ma ZIP 02379 1 TEL 508 521 2700
FAX 508-588-4303 CELL EMAIL powen@bathfitter.com
if if 60
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY fTNAL INSPECTION NOTES ,
Yes No
THIS APPI CATION SERVES AS THE PERMI( 0 0 ..
FEE: S PERMIT II
. - PLAN REVIEW NOTES - . . ..