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HomeMy WebLinkAboutP-18-5303 t died CAL(( At . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _1j c CITYI VtV dj pal" 4 IMA DATE rd 7/f! 1 PERMIT# pp—/S-dO3 ll JOBSITE ADDRESS I 7/Y C. hc- v Z 57764/91 OWNER'S NAMEI,4/G4 z o_ve t/ I 21 P OWNER ADDRESS I/'7LLiIe4S &/e6e ryd/Ilps(JfTELI IFAX /- TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES Q NO FIXTURES 7 FLOOR-) BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB M � ��il�� i� i ��lnnii CROSS CONNECTION DEVICE �( l DEDICATED DEDICATED SPECIAL WASTE SYSTEM llellellI111111II1111101111111.111111111 DEDICATED GREASIE SYSTEMUSAND STEMis f DEDICATED GRAY WATER SYSTEM �� � 1�� � a1 DEDICATED WATER RECYCLE SYSTEM r s '11 DISHWASHER r �� DRINKING FOUNTAIN � � I��i�i �� ,Mi ��an FLOOR/AREA DRAIN r � j nl � imaiminalimilimilailitaillimilmilanitilielinit INTERCEPTOR INTERIOR S I KITCHEN SINK MIS (�S�I��i�M ��, SSINIMMOMEnatationilmolisailitilit ROOF DRAIN e I li I�I� RSHOWERFSTALL ssssII r � SERVICE/MOP SINK TOILET ���'�M �,� � URINAL I � u�I ���lemilmmilmil WASHING MACHINE CONNECTION antiat ISS(55r5 TI(ISr f-i ll sib WATER HEATER ALL TYPES inut imilimilatmiNSIMISINISOMISINIII OTHERSSfa:MqfIII■It —Jmill�f llgln'i� aniellimirellialmitimmtlestistintimit —flanI 5 fli'ISSS SS r �r : sire m rIIIIIIIIIIIIIIi t INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MG , .r a FA' 111 s D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELO LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY© BOND 0 MAR 2 6 2018 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage requir:d be Massachusetts General Laws,and that my signature on this permit application waives this requirement. BU s I , i TME T i ...cam' S'' / SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER [ 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 all Pertinent provision of the Massachusetts State Plumbing Code and5ppter 142 of the General Laws. 47 PLUMBER'S NAME G 'YOWL! LICENSE#( 8.. SIGNATURE MP ] JP© CORPORATION #I _IIPARTNERSHIP®# - COMPANY NAMEItQ.4(/-yam/,G ! 7,2/#414 ADDRESS 141 YG4t a ��iVG I Il��� CITY t f STATEP*1 ZIP I("do)"J7 Y II TEL +!7t3 FAX I ._. _ S0 - •[7 .- .� __ .I CELL I 9 EMAIL �� ROUGH PLUMBING INSPECTION NOTES FELONY FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes. No THIS APPLICATION SERVES AS THE PERMIj 0 0 fte G8"/ FEE: $ PERMIT �/ FLAN REVIEW NOTES J J/ //c' AFIPAir Pyr