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Home My WebLink AboutBLDP-19-003854 MASSACHUSETTS\� nUNIFORM APPLICATION FOR A PERMIT TO PP-ERFORM PLUMBING WORK . '15A CITY`... - Akti ECC � II —1 MA DATE I Jc / . . 'PERMIT#,90/7/9-0° j. 7 JOBSITE ADDRESS 1 H 6 ,ftp n rA:51) �y I OWNER'S NAME RG y ricjoJ0 n r 1 P OWNER ADDRESS ( TELV5o,7-r 5-leg 7!Fax TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:[ PLANS SUBMITTED: YES 0 NOQ FIXTURES 1 FLOOR-. BSM . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 CROSS CONNECTION DEVICE BATHTUB NM I b Mir_MONK INS M�—;M'_;_!_ PIIIMMIIIIMIUNI DEDICATED SPECIAL WASTE SYSTEM N11111111111.11111•11.1.1111•111.11.1111,11111111flflff �n .� I DEDICATED GASIOIL/SAND SYSTEM MIR NM I DEDICATED GREASE SYSTEM 21111141M11•11I11 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM „tatI ' inis DISHWASHER _ DRINKING FOUNTAIN WIN PIM ,I simaRaMMS.I FOODDISPOSERSPES DRAIN �� II SSS—S M:,IM X11 .S'Ing FOOD �I�'11.11 S INTERCEPTOR(INTERIOR) MSPIM.111.1•11111 5 fl MSI MI S SINS M KITCHEN SINK _MOW I te' na't � LAVATORY —,—i——MISSSi—a-1S;MIMEIS MS I S 5 — ROOF DRAIN ��.i�SIMI I �. SHOWER STALL URILETE/MOP SINK 1111111111 : Y URINAL �f �/ �� WASHING MACHINE CONNECTION lellialt li p�rl1�R'i I MS IIIIIIIIIIII OWATER PIPITERHEATER ALL TYPES WAPl" 1141O: 11111111 RI a II 1 - s . Iran 1 a it mit - [ - -i, - - i- I- =I -1 • INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES j'NO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L"t OTHER TYPE OF INDEMNITY Q 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 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and Information I have submitted or entered regarding this application are the and accurate to the best of my knowledge and that ell plumbing work and Installations performed under the permit Issued for this application will be In cc e'nce with eL[ Mij 9nh bn of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7L`!/ PLUMBER'S NAME I KMAJ.r In GB 64 4 e, ,{ (UCENSE# (I sail - SIGNATURE MPI' JPQ /+ CORPORATION IyU#aSSC., PARTNERSHIPQ# n LLCQ# 1 COMPANY NAME14;(1 Mcp r;iv, P4 H, -' i r , I ADDRESS Il ` ,o Jy Pct CITY W. `ic.r.r,0,44 (STATE WA ZIP 03.67 3 1 TEL (6 0 i)-77r155{ FAX sof'r9o-BfslCELL1SOk)3tq•37�EMAIL . j�ryj (�ph)Mb t9 1:"ilJM/!hS � n� — !ApI 1) WWI /J"r BUW ENT Giivv�-� //L6 Gae -1- lr1AP /0/9Rce./ AcN. _.MASSACHUSIc i t s UNIFORM APPUCATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ ,-G . . •:_'F • cm,,Tow VARm—fI 1 l SII MA DATE Ill/flPERMIT# & af'/Q-�i'f • JOBSITE ADDRESS I I I .S Yt- drSA U�r,ji IOWNERS NAME Pell Cc.c/cjc,n; 1 • G OWNER ADDRESS f • (T I o8)7'76- 13g7• IFAx. TYPE r'r.ROCCUPANCY TYPE COMAERCIAL0 �E,rDUCATIONAL0 RESIDENTIAL dRT.Y NEW:j0 RENOVATION:0 REPLACEMENT:[0 PLANS SUBMITTED: YES 0 NOD APPUANCES1 FLOORS-" BSM 1 2 3 4 5 ( 6 7 `1 a 9 10 11 12 1 13 14 BOILER BOOS'ER 1 CONVERSION BURNER wi ., _tat sr .._ _r COOK STOVE _ T DIRECT.VENT HEATER DRYER • IQ__ FRFINYOPLA OR a=1 saws MK_.S_ SIS -_, FURNACE rtit• • GENERATOR GRILLE MIMI •S a ilkra t `i:- •�• INFRARED HEATER =n _, ,a, _ ._W: LABORATORY COCKS __p j',r,s, ,Ara ali ,$ — MAKEUP AIR UNIT r h a hn OVEN' III • t '1.•UL 1 !lb., usu ' : POOL HEATER X - _ — ROOM I SPACE HEATER ± r- ROOFTOPUNIT • .1. I , .n- mss 1 TEST Ilase UNIT HEATER f _mit: _ UNVEWFED ROOM HEATER l/[•.l )t • anania1llir WATER�EATT3t t* OTHER f "a " IBS I` "Il • INSURANCE COVERAGE ,� / I have a cur ant liabl t Insurance policy or @s substantial equivalent which meets the requirements of MGL Ch 142 YES 12 NO Q 1 I YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW UABWTY INSURANCE POLICY tr. OTHER TYPE INDEMNITY[J - BOND 0 OWNER'S INSURANCE WANER:lain 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 permiapplcation waives this requirement • CHECK ONE ONLY: OWNER Q AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby cerfdy that al d the details and information I have submitted orerdwed regard ling this appfi afion am bus and accurate to best d my Imowledga and that ati plumbing work and hstallalions performed uderthe penny Issued fortis application will be In compiarw' a provision Otte Massachusetts Slate Plumbing Codee � /and Chapter 142ws. /` of General La // PLUMBER-GASFITTERNAME I}Spv;n ceRf:,4p . ILICENSE# 1IbaQI ' SIGNATURE MP(Zf MGF© JP Q JGFQLPG'Q CORPORATION 171# d 868 C. PARTNERSHIP[ (LLC L • COMPANY NAMEIVen n'mcer;at Plum.4 Ah+ SncJADDRESS 1 I I (1- tJ1.cr1 P4A • . CITY 111. Y/,Pmen;4I1 • STATE I I)141 ZIP OA 67.5 TF1 r • Ar:.lid F • IARI 0? 9n1q • BUILgt ��/-�/'P1)Iq¢0 -1 • ' L.R. .�/� By lli�.______1_1J Li - .. . . , . 7.4 , , , 7 -.7 • - - • . . . . . . . . . . . . . . , ' . • . . . . • . - , . . • • , .r. • , . . . • , . . - . . . . , . . . . . . .• , • . . , . , , .. . * . . , . . . , . . . . . , . . . . . . . . . , . . , . . . . • . , . . , . , . , . . , . . . ' , . . . . , . . • , , . . , - . - - ,. . . . • . , • . . _ . ' . . . , . . . :1 • ' • . , . . • , . , . • . . • . . . . . • . ,• . . . . . . . . . . . • , • . . . ' . . . . ' . . . , . . . . . . , . - • , . . " . , . . . , . . , ... -, • . . . . - " - . • . . . . . . • . ' . . . , • , . . . . , . ' . • . . . . . . . , . i . _ . . . . . . . _ . . . . ' • • . ' . , . . , . . , . . , .. . . , . . . . . • . , . , • , . , . . , . . . . . , • , . ' . . I . . . z a , . . — tt . • . , , . . . _ . . • .. . t . , . .