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BLDP-19-001322 0-1 sz), MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING/� tWORK Er CITYI I) I MA DATE r7 rirY PERMIT#//G0&/7-O)/52• r JOSSITE ADDRESS [ (oa tAtier 1,a_Y1 C„ J OWNER'S NAME'—Et, y�e�irtc- Lyorres j P OWNER ADDRESS J TELI207-a05-1OMO FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:D RENOVATION:D REPLACEMENT:0 PLANS SUBMITTED: YES 0 NOD FIXTURES 1 FLOOR-. BSM 0K 2 3 4 b Q 7 8 9 10 11 12 13 14 BATHTUB a11111ifl=;f,1111111111aaflSif11t111111ai 'a CROSS CONNECTION DEVICE int X1:MEIMN r�lAll.—'N�aM MIN a Mir NNE DEDICATED SPECIAL WASTE SYSTEM SIM MII011.1 NMI Wait11.1.11111:11111111101111111 PIM 1 a, DEDICATED GAS/OIUSAND SYSTEM fl fi,ISIME'M ��a MN:NM SS DEDICATED GREASE SYSTEM 1111111 INN atfiNMa•aarniat n,MSS•• DEDICATED GRAY WATER SYSTEM ,111.1011.111101111111011111.,f?fMNaIfP+aSSal I DEDICATED WATER RECYCLE SYSTEM a a:`l f'»OMNI INS DISHWASHER .MI lams a a 1a,a a,a is,a as DRINKING FOUNTAIN111111,1111111111111M 111.1111111 OM NINE all= FOOD DISPOSER aa,11111111 i1,11111111.1111fSSS alll�EM,ala FLOORS AREA DRAIN fif.N;aia.111111.a M$11.SSMN■MIL a aMINI[ INTERCEPTOR INTERIOR Ma a Si*1111 , 1111 1 __SIMI KITCHEN SINK MEM NEI a,anMIS M;✓ aaaaas LAVATORY PIMM illarallt Sat N Sling Si fa 'an ROOF DRAIN NM MI AMMO NS MK as aim is M IS MR a 111.111a SHOWER STALL Sala 11 illi r L _ al ala.ma,aa� nl SERVICE/MOP SINK mahas,a, ,11 aalaala!a,n: WASHING MACHINE CONNECTION a w n s m,a Asf a a as TOILET SI Mt NS URINAL 01.111,1111111.Nan is�'S,S',aMISSMI SSMism IS.S WATER HEATER ALL TYPES MIMIISMa,aa.SIMIN Int 111111,11111111,S 11111111, MIN WATERPIPI G _ nIaiafl UK 11111111a11.101 a.� OTHER r a:AMMISW Mla,a SIa 1111111111a,MINI1.11111111111 Sal:Sa.aaa .aaa MitaMeta Sliesi Sac MIL aaaIaIliahillw[rl.l ISS SIIIIIimmossami'II '.�� 111111111111111,11111 Ina wirsont NWT tali.I 111111111111111 INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[ NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E OTHER TYPE OF INDEMNITY D 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 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 an.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 so. . : ey,P t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,r�// PLUMBER'S NAME Pa tit. Q w I LICENSE#I I t Cis t tom, SIGNATURE MPS' JP D CORPORATION2114,39M3 PARTNERSHIPD#1 ILLCD#) I COMPANYNAME[6oL}h Fa-Ver Gri gcaa e. ADDRESS a5 Turn piKe. S+r CITA Wei- 4rd3ct0&kr JSTATEI MA, I ZIP 0.437 9 TEL 50 S>-521-x,700 FAX lajtql:143CELL 60tt•699-414EMAIL POWtnp 60.137 441. CD-I'Lt.. I . . . , . . . . . . . . . . . - , . . . ..- . . . r , . • . .- . . . , . - . . . , . ' _ . - .. . , . . . , •. . . _ . . . . . . . . . . . . . • .. . . . . • .. • . . _. . , , - . - •- . . . . , , . . . . , . . . . , r . . , . . . . . . . . .. • . . . . , . . . . . . . . . . . . , . . , . . . . , „ , . . . . . . . . . . . , . . . . . . . . •. : . , . . . . .. _ - . . _ , ... - . . . . _ . , • . - . . . , - - . . . . . _ . . . ... . _ . . . . . . . . , ., , . , . ... . ,, . , , . ' '2_ ' . . . . - . . . • . , . ' ' • . . . . _, . . . . • - - , . .. . . . . . . . . - .. . r - - . . . . . . . . . . r . .-. , . , . . . . . . . . . , . , - . . . • ' . . ' . . , , ." . , , .- ._ . . , . . . . , . , , .. , . " , . , , . ' . . . . . . 2 : " . . . . . . . .. , , . . . . , . . . . ' . . , . . . • . . ' • . . . . . ._ . . . .. . . - .. . . •. , . _ . . • . . . . . - . . • , . . . . . . . . , . . . . . . . , . . . . . . _ . , . , _ . 6 ' . . . . . - . . _ . . . . . . . , . . . . . . • . . . . . . .. . . . . • • . . . . . , ' ,_ .... . , . . . , . . . . . , . . . . . . . . . . . . . _. . . . , . . . , , . . , . , ' . , • ".. . . . • . , , . , . . ' ' . . r .. . _ . . , . . . . . • r . _ . . . ., .