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HomeMy WebLinkAboutP-19-2067 M420_ egi4Ce • MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PLRFORDI PLUMBING WORK - ':=e p . clrrl bt'+ 7fl w c t'm ( MA DATE) /a/rPP (PERM& #gili /9-o*6 7 : JOBSt ADDRESS) 5-79L9 ils4t,t//1 n% 1 OWNERS NAME) /i-fisevite--)2'f 69•cc 4 OWNER ER ADDRESS Smzir I Tlik ilr--799-a.%tt (FAX] -- i • TYPE OR OCCUPANCYTYPE COMMERCIAL • EDUCATIONAL© RESIDENTIAL) RINT CPLEARLY' NEM.0 - RENOVATION:Er REPLACEM9rnD • :fIANSSUBMIRED:YES© NOy FIXTURES 7 FLOOR-+• - 8813 1 j 2 3 4 1 5 1 6 1 -7 8 9 10 11 12 13 i4 BATHTUB - • MlifialinIMMII f •-- ' • i -- i _. 3 CROSS CONNECTION DEVICE lS_ fl IS S1 fl5 M DEDICATED SPECIAL WASTESYSTEM alsamiliampraini 9 Si DEDICATED GAS/OIUSAND SYSTEM �a:I Kms+ _ I aaaa nu wtSlisi1 i•Fi t1E lines DEDICATED GREASE SYSTEM MIT .- IMia,S nillig tI aS Dc'DICATEDGRAY4YATERSYSTErv1IIMIIp�19111. 5g f _ I.1111SLS a N 9s3 lM.TOMIr . DEDICATED WATER RECYC SYSTEM DISHWASHER - SaaiI5I�SSS, S' DRINKING FOUNTAIN 11.., __II_ il I'd 'I IL ___g I- " _. _-__.# i FOOD DISPOSER • I- g i AMILMIF. 0 INNIaltall.iMMIlle FLOOR/AREA ORM a a. rileMMII i tMi55 INTERCEPTOR INTERIOR , _ ' -illirn _. Y - y KITCHEN SINK —1 - ����is_91�nl�g�l�il�a111���__ �r�'al LAVATORY _ fate SL1 iSpe fi 1f ' lla_I 'fl ROOF DRAIN - nilliti.traTail - - --_ .M1S-S T SHOWER STALLrileftteAll gr iii _La L �I _ 1_. SERVICE!MOP SINK IgTIIINIantillikaa_IzI +' TOILET URINAL Mt It I 1 �-- - --al l:= • !c i WASHING MACHINE CONNECTION USTj 11f JII0La6adaSa gam' WATER HEATER ALLTYPES flSSS,SSi resit ina WATER PIPING • St.ffillEMIRSIE [ 1 atilli _ . I OTHER _.J I- a -- i . Pi -i i . r ' " Si INSURANCEhichme is O@fl5 201E ihav@a cur+entliabililvjftsvtancapolicy bt'itssubsta3tlia{equiva[enliwhlc6maa�c�mq��ofMCLgL1�, ,.� (MU CHJECICEpiTS,PLEASEINDICATETHETYPE OF COVERAGE Of CHECKWGTHE APPP.OPRIATE 13 BELOW - BUII_DIN GDEPART ENT • IJABILRYINSURANCE POLII,Yr OiiHERTYPEOFINDaz=jJ - BOND 0 - -- • OWNER'S IAJSURJWCE l&AUJEJt lam aware that the licensee does not have fliaronsmbecoverage required byChapterl4lofthe Massachusetts General taw.%and that mysigmihas on this panni application waivesthisrequirement. - • - Cl•IECICONEONLY: OWVER 0 Ka 0 SIGNATURE OF OWNER OR AGENT - I hereby certify Matelot the details and bdormaUer I havesubmtled orenread repealing this applicant'eetrue and amaatetothe best otnwlamw)adga and that all plumbing work and lnstaliafonspedormedunder the pasta ksuedfur thsapp)icaJanvaliba�. •• ,arms all Per nentpmv�swacUbe Masaaohuseas Rata Plumbing Cede and Chapala-142 oftha General Laws - nii '-1i..��.. . - PLUMBER'S NAME Jh G-1/¢.fv7- E -OpiiO 1X IU �.CENSEg - G ,,'TUBE - - ' IvIPEr OPD CORPORATIONM4Sc(djrY1_PARrNentiPED) (ua - . • - • comPANYNAME)a• G�9v€rk,¢lle.49j;*tADDRESS)WiNir-A7V £T✓Atfir ;1' w I j� CITY /2.--7,01/4,207-7" tSTASEc1rIi`I, Z1P) oay9 ' ! MAsv�.3Fflyva 1 ' -Q7 FAX r Fes,:, CELL,IS�$,f a°7� 1 MI rr�- A• c racer vn,..n flit - • t-/` Iti PW:&favy'WhwtewmmYmmabenbm�mmvmYmY mutlesmSortebwJmimYmrla�mwablva®mm¢omtdcsWmm;stir mrmaw mw!AxaFtdk r. .... ,/� 11"th frt9md id'eteyuvmumuerptiata la Rhear rivtatd untvdmdmmm ammr.rnwrtsFummhlWrmtmmrmp esem taha=4=tet mdq Ore therpa nakaurtmmuerovi4s8nemadWtemie ttup tmd¢o aT emthmumesrmmFa+IIvhstspateWvAOumFeemtmlint5bcbtomtlrern¢res 7 thrps®stoiedd�a¢sasemddimz:smetp®ImtS .t gimes ff yfr So4Weveammshs3'— _ - a. dhra®ddbySsknaecs C w f/ )-(0