HomeMy WebLinkAboutP-13-036 •
tom, MASSACHUSETTSTTUNIFORM
1APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK' •
_1 ;' CITY SC/nit/744�h Tar/ •MAA DATE ///f 12 ' P�EyRMIT# Pf 3'O
JOBSITEADDRESS /51 SC 4106/14 (di OWNER'S NAME(tC C0-1 ZG S-r--CC,
P OWNER ADDRESS Seek t•
TEL 53/4O7-35p yell FAX •
'TYPE OR OCCUPANCY TYPE COMMERCIAL 0 • EDUCATIONAL 0 RESIDENTLA1cD -- .
PRINT •
CLEARLY NEW:❑ RENOVATION;0 REPLACEMENT:C! PLANS SUBMITTED: YES❑ NO❑
FIXTURES 1 : FLOORS BSM 1 • 2 3 4• 5 8 7 8 9 . 10 11 12 13 14 -
BATHTUB .
.
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM l7 g
1k 1 O U E
D
7--/-2-12-
DEDICATED GASIOIL/SAND SYSTEM
DEDICATED GREASE SYSTEM Jill 7 7Q
DEDICATED GRAY WATER SYSTEM . 3
DEDICATED WATER RECYCLE SYSTEM . 02 /.�' 4 ‘
gwl
DISHWASHER • . 13y
DRINKING FOUNTAIN 1�r.� f�e —
FOOD DISPOSER w. _
FLOOR/AREA DRAIN • •
INTERCEPTOR(INTERIOR) �� y
KITCHEN SINK - / %/Z[J. 4' ev-t uc'et
LAVATORY
ROOF DRAIN -
SHOWER STALL
SERVICE/MOP SINK. -
.TOILET -
URINAL . .
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES - •
WATER PIPING . • . . • •
OTHER • • •
• INSURANCE COVERAGE:
• I have a current liability Insuriice policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES 13(CIO 0
•
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
• LIABILITY INSURANCE POUCY M OTHER TYPE OF INDEMNITY 0 BOND 0 •
OWNER'S INSURANCE WANER:1 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 w rpU floe with all Pe . . ,. •:on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �II� `►_
PLUMBER'S NAME paniel Huntress //LICENSE#10977,; ye i•TURE •
MP� JP❑ • 10977 CORPORATIONL�742549 PARTNERSHIP❑# ,LLC❑#
COMPANY NAMENurotocoofma d/b/aRRto-
ootPr ADDRESS 175 Maple Street
CITY Stoughton STATE MA ZIP 02072 TEL7R1-297-7049
• FAX 701-341-8817 CELL781 -603-5412 • EMAILdan.huntress@rrsc.com