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HomeMy WebLinkAboutBLDP-19-003435 Mile : PRAeEG : MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK __l1=' cITYr �Ao f1 P -�I f ,MA DATE Iof PERMIT#� ' Pn -ct / /r JOBSITEADDRESS n/P4 (_arson We r� ! OWNER'S NAME (/11;r. 01.m' P OWNER ADDRESS TEI([500adO-77F9IFS TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL 0 RESIDENTIAL Er PRINT CLEARLY NEW:Q RENOVATION:0 REPLACEMENT:i2fe PLANS SUBMITTED: YES 0 NOD FIXTURES 7 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB — ' i a CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ _ _Mar DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM r DEDICATED GRAY WATER SYSTEM IIIIISMINSIMMII MIMES� - - _ DEDICATED WATER RECYCLE SYSTEM I DISASHER DRINK NG FOUNTAIN Sala MSS=IIMIIIIMIIIMPS FOOD DISPOSER1.11=11111. MUM_ _Ill`. FLOOR/AREA DRAIN R INTERCEPTOR(INTERIOR) KITCHEN SINK .- - . LAVATORY _. ._F Sk ROOF DRAIN r" jt- 1 V L- r SHOWER STALL' . - {,L) _,. L- "rI Y t t SERVICE/MOP SINK � 1'� rr I � ,, _ TOILET l 1 fir V O 2��, URINAL 1 ) T_- Orr- c� . - 7 WASHING MACHINE CONNEG ON' "`l _ - ,j w��„o.�, - ._ . ,, 1 AKr�� - WATER HEATEI{ALLTYPES.—�-- =` '/0 ' - WATER PIPING ". .. ti OTHER ( _ / I �i. 1 a INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 2/NO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY[if OTHER TYPE OF INDEMNITY Q BOND Q 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 Q ' 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 rtimetbrr7s with all i Ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME �v-,1), r ffl 0./30A o f LICENSE# I(bao -- SIGNATURE MP RI JP CORPORATION#aR6 C 'PARTNERSHIPQ# j LLCQ# • COMPANY NAME && McBride, Pd U. (u . !ADDRESS 11 liocJr- J- Pod" 1 CITY W. yo„,- Y 0•,,,4 . STATE MI ZIP OP.t,-7'3 TEL (505)-rid'- 455%- J FAX sof"9 o.t5n€CELL01)3c4.37 EMAIL E'm C.pi ii m b 0 CO fr cDtsJ :. n ti , • D L/ i s • '7?CPi ..r _MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FRTING WORK ..- CITY,T� avm of \/1 U O rn vat J I MA DATE SP]SI},a PERMff# P/1 -N-0739W • (� JOBSITEADDRESSI }I K4"enr5Gn (pew 1 OWNERS NAME I Lee. (;h;relv;n G OWNER ADDRESS ) • (TE(550)G4O•7739 reit MINIMIt TYPE R OCCUPANCY TYPE COMMERCIALI•0 EDUCATIONAL RESIDENTIALIya' PRINT ,.,/ CLEARLY NEW:0 RENOVATION:9 REPLACEMENT:I,IG PLANS SUBMI iiw: YES NOD APPLIANCES 7 FLOORS-+ 139A 1 2 3 4 5 6 7 • 8 9 10 " 11 12 13 14 BOILERMISINIESEtaalliMaaaltaaa Mtn BOOSTER Ma flfa aa'tianni� . CONVERSION BURNER __ __1t"in_ s COOK STOVE aim lima a=aItaa Secs a IlltaasealINIMissitaaaaaalissigaaaaana DRYER T allINI WI_5 f PliMailliiarilliliaa FIREPLACE PEI I--aina— Tri_ FRYOUtTDR Wan_Miliv ;i_-5.fl _milL :S=.i FURNACE is1l 1�;i ,lf�'riUUI ii Ln • GENERATOR ansuraaranaa Salaaaar GRILLE 111 't, ii, f1 E-nlv77-7 ... r11.• INFRARED HEATER ltia ii'iian.Piga a Winailllilir LABORATORY COCKS WM:a Mitanlillir 1{11(,kiaT:a4gA'J a914L'TLla MAKEUP AIR UNIT iAwls 1:=1 a1 ,lit—tIallt • 'At i 11L tiliar Allit OWN .i-'•, 111110.1;naLEai� ' kal'=It Lij i -T IIIy:_=n 3 POOL HEATER al IIIIISSINFIMIIMIN Ilm a +LW)k.kLL'MSIa I ala t l.dl1 [Rtci-Ala ROOM!SPACEHELTER'��ii • MRaaI_ia;nni :t7ra..�1aai•-- ROOF I• UNIT—:'' _.iAmi=p.i _iawaii r:8i a 3airacmora iMisaCitaaall.10.1na=/ilk' moi= UNVENTED ROOM HEATER i P;K " illalitillNISINI.,1: aS s S SS an.a_Ina r • - -WATER . P:1, - ---' Is0![�>itiMir Jim aanSZTaii1asta ausc1 a a afillgaa...flan.'_moi ani fl WL lJ=;a11111taaIfl INSURANCE COVERAGE I have a cur ant liabifty instance policy or 3s substantial equivalent which meets the requirements of MGL Ch.142 YES OND IF YOU CHECKED YES,PLEASE INDICATETHE TYPE OF COVERAGE�_,,{ BY CHECKING THE APPROPRIATE BOX BELOW LIABUTYINSURANCE POUCYU[.l OTHER TYPE INDEMNITY O. • BOND Q 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❑ AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that al at the details and Infommtion I have sutantlfed or etched regarding this application ars tme and arcuate to pixie best d my knowledge and that at plumbing watt and hstallators pertmned underlie permit issued for this apptcadlon wA be In canpliance - alba provision e Massachusetts stats Plumbing Cade and 22 d 14the General Laws. - Jia/ - PI.l1MBER-GASFTITER NAME`IeV r n 1Y1 cQ r:,4P. (LICENSE • 'Iwo - ='- - - SIGNATURE MP a MGF© JP[I JGF❑ LPGI Q CORPORATION aft a •(,• G PARTNERSHIP 041 (at a COMPANYNAMEEKa,,n'm rrce plum*i4 err} hcIADDRESSI II rinJJ,,cel po4 A P CRY I.U. �/,.re„nr...4ti • sTATE rum WI Og E.73 tT11 (5a8)-rig- 4 554 I - Witicoff7cio-578510ELthok 36437d¢1EMAILI Wry)G f)I U ni b 6 cr3 m css4 , 1)ei I 14 ' •--7- _ . Z