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Home My WebLink AboutBLDP-19-004000 MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK rF_ CIN4tnlo vtuJ' MA DATE, l 17 / 19 PERMIT# M-Xf l�OU (ocw JOB SI DDRESS'bO `— .ACet ICL o So llOWNERS NAME iJn & 9n✓f . q✓) OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUC TIONAL ❑ RESIDENTIAL E/ PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO 0 FIXTURES 7 FLOOR—r BSII 1 2 3 4 5 6 7 6 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM • DEDICATED WATER RECYCLE SYSTEM DISHWASHER • DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY • ROOF DRAIN SHOWER STALL I t{ r• SERVICE/MOP SINK 0 Cif i I TOILET ! i I URINAL I + N (I 7 4n 1 I , WASHING MACHINE CONNECTION I i • ( WATER HEATER ALL TYPES11� = I J WATER PIPING -- I OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESNO ❑ IF YOU CHECKED YES,PLEASE INDICATE THETYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY ❑ OTHER TYPE OF INDEMNITY 0 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 apQlication waives this requirement CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT L:I 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 al plumbing work and installations performed under the permit issued for this application will be In co pliance wi all P rtinent provision of the Massachusetts State Plumbing Code and Chap 142 of the General Laws. Odrc.0 PLUMBER'S NAME 1'<eWL✓tC_41 $ LICENSE#/f-3&49, SIGNATURt MP Ef7 JR 0 I CORPORATION 0# PARTNERSHIP❑.# LLC 0# COMPANY NAME ,/4/'I�cS 7 JL t ADDRESS 3' ��L DA-1C 121 CITY 4cPeaS/t4 ` STATE rn A ZIP TEL &B S--ec1 o FAX CELL' ' '6 EV 6ya7 EMAI A P r e-r do gi 41,9 . ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 / _4.Lrj //eea /yam FEE: $ PERMIT# �// //"Q /�� PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 43' CITY G.{Jr>,/NJI( MA DATE 1 I7 l l PERMIT# IiLMV7-00703 JOBS DDRESS Ra OWNER'S N.AM11 ' OM Ai12QKL GOWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL LI/ PRINT / CLEARLY NEW:❑ RENOVATION: 0 REPLACEMENT:[� PLANS SUBMITTED: YES 0 NO 0 APPLIANCES 2 FLOORS SSM 1 2 3 4 5 6 r 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER - — COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE - FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER. LABORATORY COCKS •_ MAKEUP AIR UNIT I 9 (' w: 7 t r j._ , J OVEN —— I 7 POOL HEATER • ROOM/SPACE HEATER .AN Q( I f y . ROOF TOP UNIT - TEST E y -.- UNIT HEATER li, '___ f INVENTED ROOM HEATER WATER HEATER I OTHER INSURANCE COVERAGE � I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Li N0 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 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 pennit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT ❑ SIGNATURE OF OWNER OR AGENT id. 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 3- and that all plumbing work and installations performed underthe permit Issued for this application will be In compliance with alertin t provision of the ,4} Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (� ��-`n 9 y�nS PLUME -GASFITTERNAME LICENSE# //-3 ` Y�1 SIGNATURE • MP L.19 MGF 0 JP ❑ JGF❑ LPGI 0CORPORATION❑# PARTNERSHIP 0# LLC 0# COMPANY NAME SR(L( cit( �1 ADDRESS 31 E-z CAC lei, CITY C[� O l STATEMA'' ZIP OCX I TEL 5cige-ia'o-6Vap FAX CELLS08'680`479, EMAJ / a . it . i, P 2 ''r 1 • 1#14/1 ( OVA Oh P( 1.1-