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Home My WebLink AboutBLDP-19-003096 CA MASSACHUSETTS UNIFORM APPLICATION FORA PERMI TO PERFORM PLUMBING WORK CITY !AVIV Ur44 MA DATE 1 1 -i I Cf r PERMIT#8LDP./? CC3Y 6 JOBSITE ADDRESS , 2 }. ( \c 12- -- OWNER'S NAME ft r41c1 / 1 POWNER ADDRESS .94 • TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL VG' PRINT _/ CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:{) PLANS SUBMITTED: YES 0 NO❑ FIXTURES 7 FLOOR—. BSM 1 2 3 4 5 6 7 B 9 10 11 12 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 . DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK r . LAVATORY .' a 4 ROOF DRAIN 7� SHOWER STALL ', SERVICE'MOP SINK I TOILET RUi, DI URINAL - ay NGOEPARTME n- j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 7 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 TH E OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHERTYPEOF INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:I am aware thatthe licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit apQlication waives this requirement • CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT L:I 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 compile e w all erti ant provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. [/ PLUMBER'S NAME /LICENSE# 15 o�� Q SIGNATURE MP El JP❑ CORPORATION I/ PARTNERSHIP Q# LLC❑# COMPANY NAME - i , IP is A A ADDRESS tot( U i,i c tow A-V� AA , CITY 9 , Pi0,01- 1 rk*I*IASTAcI44{ , ZIP 621 6 J TEL .O :073-C'L� FAX CELL Sfiyyl C_ EMAIL U ' , - / - se ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No - THIS APPLICATION SERVES AS THE PERMIT 111 ❑ ,,/2t t '/t�C ,4j ' (/ `' FEE: $ PERMIT U PLAN REVIEW NOTES 7/1S y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY {'grmo1„' ) MA DATE II- / 1- ill PERMIT# /. r/T -00907( t JOBSITE ADDRESS ØL cart N O�S C2i L^Gt OWNER'S NAME 'i I%las LAY V1 - OWNER ADDRESS Saps TEL FAX Q TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL, PRINT f CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:L/� PLANS SUBMITTED: YES❑ NO 0 APPLIANCES 1 FLOORS-. BSM I 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER • EEIV ' L 13 • LABORATORY COCKS lI U� MAKEUP AIR UNIT J 'b\ R `I OVEN s' 'NOVy 19 alb ; POOL HEATER J ROOM I SPACE HEATER ' - reit G DE 'ARTNENT ROOF TOP UNIT , —v_ TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I 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 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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 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/1h •IIP rti e t provl ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER- ASFITTER NAME ljpENSE# /, o ) - r!u SIGNA RE MP MGF 0 JP 0 JGF❑ LPG'0 CORPORATION PARTNERS'', # LLC❑# COMPANY NAME rLu^erl.0 ? I tAliet , 114,‘, ADDRESS 7 ! o C a ( (21 an CITY Si kitty-via c, 1 STATE .Pla ZIP O,2 '( TEL 5ag.237 3.�( '7 FAX CELL S'atm C _ EMAIL . c- S /! .t , G a a 42/f ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /3 14/7/- (.LSU ✓ FEE: $ PERMIT# 7LAN REVIEW NOTES 1,7-741747 r