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=917 YP CITY LlGt_/.:2„24JL�i _ I MA DATE L4-I12J PERMIT#/94 P-'B-DO int
JOBSITE ADDRESS L... il depa, /L�._ . _ OWNER'SNAMELZCar” q_.. ,
OWNER ADDRESS L • ��l7 t j TEL[(p/7 6O —OjAX I
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TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIALr«i
PRINT
CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NOD
FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM " i
DEDICATED GASlOIVSANDSYSTEM 4 � 11 I' 11 1, ''
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
I i
DEDICATED WATER RECYCLE SYSTEM I .
DISHWASHER
-
DRINKING FOUNTAIN 8 1 7
FOOD DISPOSER
FLOOR I AREA DRAIN
INTERCEPTOR(INTERIOR)
KITCHEN SINK
LAVATORY a
i
ROOF DRAIN
- �
SHOWER STALL - R E_C Essi i'.. ?
SERVICE I MOP SINK {
TOILET
URINALt a — tPR I ? 2018 1
WASHING MACHINE CONNECTION • d
WATER HEATER ALL TYPES
WATER PIPING _
OTHER r
INSURANCE COVERAGE:
I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[] NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
UABIUTY INSURANCE POUCY Lr l OTHER TYPE OF INDEMNITY Ci 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 El 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 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 be in compliance all Pe ' nt provision o
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Eric T.Kinch LICENSE# 16257 SIGNATURE
MP ED, JP CORPORATION]#4030-PL-C PARTNERSHIPJ# LLCDt
COMPANY NAME Eric T.Kinch Plumbing&Heating Inc ADDRESS 14 Hanover St#10
CITY Hanover STATE Ma ZIP 02339 TEL 781-829-6666
FAX 781-829-6667 CELL 781-351-1190 EMAIL kinchpiumbing@gmaii.com ,
2mcu- 14-1S(.4.4cr �, c.4I`
JACO
=34 pot{ 6 OGS