HomeMy WebLinkAboutP-14-225 .=� IVU& b/ l.FSUJt I I J UNItUK1V1 AY Yul.H I Hat nil's.N r"nIY„• ,v, L•., •-•••.••• ••••••-••••-• ••..••••
/903 PERMir# gq '��• t CITY kin ggeda//LIDNIMA DATE�r -�- �"OPSITEADDRESS /c9/b/' $lnn an/eg A OWNERS NAME �I.1Y(p 't er-
P OWNER ADDRESS c5 4411 0 TESOp7ys%066 FAX.ad r.7l5vi974
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TYPE OR OCCUPANCYTYPE
PRINT COMMERCIAL EDUCATIONAL 0 RESIDENTIAL1LV
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1 u / EARLY NEW:0 RENOVATION:(]A' P,EPLACEMENr:0 PLANS SUBMITTED: YES 0 NO 0
FIXTURES 7 FLOOR— BSlAr 11 I 2 3 4 I 5 I 6 I 7 I 9 I 9 10 I 11 I 12 13 L'.1_4
BATHTUB I I I I I I
1/5 CROSS CONNECTION DEVICE I I I I I I I
DEDICATED SPECIAL WASTE SYS I I I I I II
DEDICATED GAS/DILISAND SYS I I I I 1
Q\ DEDICATEDGREASESYS I I I
DEDICATD GRAY WATER SYS I I I 1
DEDICATED WATER RECYCLE SYS I I I
DRINKING FOUNTAIN I I I I
DISHWASHER F 1 1 I f I
FOOD DISPOSER I ! 1
FLOOR/AREA DRAIN I 1 I I I I I
INTERCEPTOR(INTERIOR) I I I I I I
KITCHEN SINK I k I I
i I I I I
LAVATORY.:.-
ROOF DRAIN-- I I I 11 I
SHOWER STALL I I
SERVICE!MOP SINK • -
I 1
TOILET I I I 1
URINAL I I I I I
WASHING MACHINE CONNECTION I
WATEHEATERALL TYPES • I I 1
WATER PIPING I I 1
OTHER I 1
I I I 1 1 I I 1 k
• INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which•meets the requirements of MGL Ch.142. Yes WNo 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILriY INSURANCE POLICY (v OTHER TYPE OF INDEMNITY 0 BOND ❑
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of
Massachusetts General Laws,and that my signature on this permit application waives this requirement
CHECK ONE BOX ONLY: OWNER 0 AGENT ❑
Signature of Owner or Owner's Agent
I hereby certify that all of the details and Information I I`ave submitted(or entered)regarding this application are true and accurate tc
best of my Knowledge and that all plumbing work an.. installations performed under the permit Issued for this application will t
compliance with all Pertinent provision of the Massachusetts State Plumbing Code and C -• 142 of the General Laws.
PLUMBER NAME `A 145 O 10 b re W/• SIGNATURE /
UC#...L1(2._21-MP❑ JP❑ CORPORATION ❑# PARI ' HIP ❑# LLC ❑#
COMPANY NAMS,I)re ld SR(LtW11 MMC p� ADDRESS: b F ess I Z. AL
cITYs'T7cetQc:bet STATE) M� ZIP Cbf� ) Ball: cc�rcLos piw4oi► Cape0/Alaa.cork-
TEL, U c 347 57lI`J caLfdI.36d' Nod FAX
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OCT 032013 ii 'y
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B 111LDING Dvt'"NT Lflh7
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ROUGH GAS INSPECTION NOTESP&4 THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES C�'L/�l/f/io/y0, Yes No f 0 'L- "-Co at tali--
THIS APPLICATION SERVES AS THE PERMIT 0 ❑
FEE: $ PERMIT i
PLAN REVIEW NOTES
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