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HomeMy WebLinkAboutBLDP-19-002263 A7flP : • • ' e , IL, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK trawam2e, °tit, CITY 4 / 0 1 -. MA DATE1111M I Io PERMIT# /0/- -/i- 17-4'6' JOBSITEADDRESS A OM MI OWNER'S NAME f2Arl mcrrit.ley ( P OWNER ADDRESS ( TELt08-)367-13,17 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL ® RESIDENTIAL Ed PRINT CLEARLY NEW:© RENOVATION:0 REPLACEMENT:IX PLANS SUBMITTED: YES❑ NOD FIXTURES' FLOOR BSM . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _f:-_ flfl a NM MIN MIS S IM CROSS CONNECTION DEVICE WITS 11..W MRN MKS K DEDICATED SPECIAL WASTE SYSTEM ,, I da a a SSW NM IIIIIIS DEDICATED GAS/OIUSAND SYSTEM 11111.1111.MI SIMIlmaiimin intirramitia__s SANE DEDICATED GREASE SYSTEM S S 'il S S W I S 55 ice; DEDICATED GRAY WATER SYSTEM PAlaiInt 5 "Ms salami PIM.-S(f i u tasia.liasimiessamarsorriationamissismiT DISHWASHER INI111.111 In MR ia 0111aaMit P 1,011111 Nola DRINKING FOUNTAIN -0Wijiii—W m.5 W SS S St stiS a FOOD DISPOSER IMMIIICINII,Mit'MI MRS,is mass int us_ is FLOOR/AREA DRAIN Mai Illii IaaNMS 5 45MS5,MI INTERCEPTOR INTERIOR lililliONISINICINSINCIIIIIIIIIMMIMINILS.,S, i1iiiiii. KITCHEN SINK Sang imam a!PM=WWI Ma MI NM MN mu wain LAVATORY inicf i ■Iri [5I5:5, '_ IS ROOF DRAIN MINIS MI MK Mi.atoutimit a m,W M„_NS ai SHOWER STALL M'Nil NM'„n,i aIS, Wane a SIM i Mica Plialim SERVICE/MOP SINK _ ins'S SAsMtS,Sslam imille TOILET amIS_.umiSs: Ewa_M a URI • _ at _ lige Ma lai IS CR WO NLCONN C •• - I.i ' NS aal ,f IMICINISSI EMU • ilutzsinaal ra in sir Ns Ilia sit MS in aim satiriiiimi at anlitt WATERT P, G 1 74tIG>sI i _;S1 S id le_ S MKS OTHER a � ��_ I __ _ SiS S!S S STS iiiiinsa S,S1 Intalli NW MI INIS IS MI SS um BUILDING DE PAN HA F NI SSW - la MI lia 11111111S ISSPIS�I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 12/NO ID IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L'7:t - OTHER TYPE OF INDEMNITY© BOND Q 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 requiremenL CHECK ONE ONLY: OWNER 0 AGENT • SIGNATURE OF OWNER OR AGENT I hereby certify that as 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 c„xwmce mei all ro Ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. QQ e) !LICENSE# IIbo2o I SIGNATURE PLUMBER'S�,,,( NAME I�P�:r f� GJJ rise)01 MPIKI JP© CORPORATION#a%X C. IPARTNERsHIPC# LLC # I COMPANY NAME[Ilzi O%ftc4 - -i Rl. Tnr• ADDRESS Il £ Pced _1 CITY IA). YGrn+ov4A (STATE MI ZIP 02.6jJ7'3 l TEL (60 )-7-7i. 4554 ( FAX 4oi"el a.ufrr.'CELL15093L4.37ox4t EMAIL I toll Ci pl o m b 19 co m.xls4 :, n ea 1 • • • Gift CIG47//(0, a Vo-- .. _ . . • : . . . . . . . . yzai--Ar . . . , • . • . , . . . . . . • . . . . . . . , . . . . . . . , . . . . , . .. , . . . . . . . , . . 5 , . • , . • . . . . . , • . . . , . . . . . . . . . , . . . . . . . . . . . . . . . .. . . . . • . , . . _ . . , :, . . . ... . ._ . . . . , . . . . . . , . , . . . .. . . . . . . . . . . . . . . . _ . . . . . , . . .. „ . . .. , . . .. . , .. . . . , . . . . . . _ . . „ : • . . _ . . . , . . „ .. . . .. , . , . . . . . . . , • , • • . . _ . . . .. . . . . . , .. . . ... . . . . . , : . . . . . • . . ... _ . . . . . • .. • ._ , _ . . . . _ . . , _. . , , . . , . . , . . . .., .. . . . . . , . . . . . . . . . , . . _ . . „ . .. . . . , . , , . . . . . , . .. , . . . . . . . . . . . . , : . _.. . „ . . . . • . . . , . . . . . _ . , . , . . . . . . .. . . . . . . . , . . . . . .. . .. 5 . . .. _. : x -- /nA.o ,oAR c e./ _,.MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .' art LTowt�of Y4 Q m n(� — MA DATE " I n PERMIT# hop-/9-atua6, G - JOBSITE ADDRESS I 40 fP_55Pf1Rr'n . IOWNER'SNAMEI K0A #1 Lcai,lek/ I • EE OWNERADORESS 1 0 3 7- 3 FAX, tTY , PRIN rT OCCUPANCY TYPE COMMEREIALD EDUCATIONAL 0 RESIDENTIALW' a.RARTX NEW:D RENOVATION:D REPLACEMENT:al/ PLANS SUBMITTED: YES NOD APPLIANCES 7 FLOORS-• BSM 1 2 3 4 S 6 7 ' 8 9 19 11 1 12 I 13 14 BOOSItR a P11,111111.11.1111.11 t ,, a . _� # BOILER •� 1�i CONVERSION BURNER 1� ' COOKSTOVE J DIRECT.VENT HEATER Or DRYER FIREPLACE 1�1 � - Sallialle M a FRYOIATDR �`Tt� �- - 111111.1111fl' FURNACE • GENERATOR GRILLEcis x - - INFRARED HEATER _ . . n i. . �. LABORATORY COCKS ��71�1�iW��`�Lu��a�L .u�..I!!I „(]yf _�. MAEKkEUP AIR UNIT r •—" Inlet , '" m POOL HEATER =' ' n •' ROOM I SPACE HEATER ROOF TOP UNIT - ' • TEST ..__ -. . a , UNI�4�lE�T�t. � I C� - 4 ' __ U M HEATER" t . 's miss • NM -0 EATER fa J 1RI!RRRIRRRE!!- __,__________, • INSURANCE COVERAGE I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142 YES bQ NO IF YOU CHECKDITS,I EASE INDICATE THE TYPE OF COgGE BYCHECKWGTHE APPROPRIATE BOX BELOW UABILUTYINSURANCE POLICY OTHER TYPE INDEMNITY[1 - BOND D OWNER'S INSURANCE WAVER: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 9 AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all d the details and Information I have submitted or entered regarding this app bon are hue and accurate to best my Imowiedge and that all plumbing work and Installefiors performed underthe permit Issued bible application wl be In arnpianee -a'. ._ pd wvsian of Ora Massachusetts Stats Plumbing ride and dacha 1422orthe General Lava. e/ . PLUMBER-GASFITTER NAME I it :n m cB r:rip I LICENSE +- 11690 -- '-'-S/SIGNATURE MP I71`MGFD JP D JGFD LPGI D CORPORATION '# e9 •(,, G PARTNERSHIP D 4 'LLC D# COMPANY NAME"I(gnrn'm8rtrf2 (JluM.+flea �1cJADDRESS I II (}n4,4.1 PTA I Curr Ul 7erennnn-ft, • STATE) E,I1/74.1 IP 62673 TEL I (5.00) 77?- 4564, I - FAX ot)Tao-Gwt6JCalicoR36437o�41t EMAILI kmcplutn 6C_r9mcttc4 , fl2 I( • I,- . • •