HomeMy WebLinkAboutBLDP-18-006225 • MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK
UP.
_. �{
E_ CITY l -/ iL MA DATE C-4- 1S PERMIT# 62-/,P'17^90
JOBSITE ADDRESS U Le)'j pipit on-mts on-mOWNER'S NAME 04WriArA:4 -
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL It
PRINT
CLEARLY NEW:[ RENOVATION:a REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO❑
FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 B 9 10 11 '12 j 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM _
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM ---r E
DISHWASHER I • E (�,. t
DI
DRINKING FOUNTAIN q ;%!
FOOD DISPOSER I , . L P
FLOOR I AREA DRAIN •
INTERCEPTOR(INTERIOR)
KITCHEN SINK j eWWI a u �T
LAVATORY a- • v'
I ROOF DRAIN •
SHOWER STALL ' f / 4i
SERVICE/MOP SINK
1 TOILET �, I
URINAL
WASHING MACHINE CONNECTION _I '
WATER HEATER ALL TYPES
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 THETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW •
LIABILITY INSURANCE POUCY ® OTHER TYPE OF INDEMNITY 0 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 0
SIGNATURE OF OWNER OR AGENT
L1 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 compliance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Q�
PLUMBER'S NAME LICENSE#)1 ' ) . SIGNATURE
MP ® - JP❑ CORPORATION❑# PARTNERSHIP❑.# LLC❑#
COMPANY NAME 15'4"--1 P ADDRESS PO, }?op( 4-(1)
CITY STATE,VIA ZIP 0)19`7 TEL
•
FAX CELL6' erie tr57q EMAIL 00 p)tt>vt it. Co '—
LRH
ROUGH PLUMBING INSPECTION NOTES fELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
/
� THISAPPLICATIONSERVESASTHEPERMIT ❑R't4 // frL47 ❑
I / �� FEE: $ PERMIT tt
PLAN REVIEW NOTES
4
p COMMONWEALTH OF MASSACHUSETTS
DIVISION OF PROFESSIONAL LICENSURE
.BOARDOF -
SHEET METAL WORKERSi •
• ISSUES THE FOLLOWING LICENSE w.
MASTER-UNRESTRICTED
SEAN J GORANSON
N..
532 TREMONT ST ," w
TAUNTON,MA 02780-5106 [
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- - 5850 =~05/28/2020 .441898
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