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HomeMy WebLinkAboutBLDP-19-003436 MRP : PRAeEC : s; „ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,3 Cyr._. _ __ �4Q�U�P �J-- MA DATE a 1 PERMIT# P ? Z' 39j JOBSLITEADDRESS 47 Rep."-,y 1Ld. J OWNERS NAME C.-dew 4 Ir)aSSAt 1 P OWNER ADDRESS TEL 478 8-67- 57R 7 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIALIE( PRINT �,f CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:LY! PLANS SUBMITTED: YES 0 NOD FIXTURES 7 FLOOR-. BSM 1 12 1 3 4 5 6 7 8 9 10 11 12 13 14 • BATHTUB r CROSS CONNECTION DEVICE �,� J _I DEDICATEDDEDITED ITEGAS/OIUSANOSYSTEWASTE MM Mini MI 111.11.111111111111 ail.Mk lel, DEDICATED GREASE SYSTEM 111.,!_ 1111 W.11151.111�, DEDICATED GRAY WATER SYSTEM I - .il DEDICATED WATER RECYCLE SYSTEM ,I _a , DISHWASHER [ _ DRINKING FOUNTAIN i , _ I ; FOOD DISPOSER II _ _ _ _-_ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY '.:i._o. 'Io,.. ii r :II, .-..: .1 I it ROOF DRAIN SHOWER STALE. t 1. i'", I V L 1-' .. , SERVIC /MOP SINK/ 0 fj \ µ I_ 1 -_ - i , _ - 1 1 URINAL 1 fi u 0 2016 _ . r • WASHING - MACHINE CONNECTIO '_ �.1 i WATER HEATER ALLITYPESF-r+Kii'"=1`1 ILI. 1 1 I- ,, h _, d WATER PIPING - —' i A OTHERI _ ,.-10 _.I. , i ! sY r. i. . • INSURANCE COVERAGE: I have a current liabilityinsurance policyor its substantial a uivalent which meets the requirements of MGL Ch. YES,,�/NO 9 eq113 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LRBIUTY INSURANCE POLICY a! 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 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 appkation will be In ccrc nce uith all • ro Ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.ap PLUMBER'S NAME Kw'r 111 C, ri €- !UCENSE# I(6x0 SIGNATURE MPN1 JP❑ CORPORATION Ni#aSQ1G PARTNERSHIP❑# LLC❑# • COMPANY NAME Q n Mcej . Y;} u. "rnr, I ADDRESS /1 ( Orilr e-J PSA CITY (Al. Ye.,t-r-0\AA STATE (17A ZIP 02.67 3II TEL (6n1)7-,1- 455 j FAX 4 b-7,10tn%C CELL�OY)3W37,�EMAIL ,toil cpic M b t9 com -aS4 a n Pte- .I . • L1o4- . ._ - . . _ . • _ _ . . ... .. _. ,. ,,,,,/ t. 0,, . r. . i : . , . . . . . .. . . . . . . . . , 7,4(74_ , _. 1 . .. . . . . . . . . . . . _ . . . . . . . .? , . , ; , , . . . . . . . . . . . . . , ;. . . . . . . . , . . . . . , . . • . . . . . .. . , • . . . • . . .. . . . . _ . . . . . . . . , . . . . , . . . • . _ . , . . . . . . • . . . , . . . . . .. . , .. . . . . . . _ . . . • . . . . . , . . . ... , . . . . . . . . . . . . . . . . . , . . . .. . . . . . . . . . . . , _ . . . . . .. . . . . . . . . . _ . . .i . _. . . . . . . , . . . . , . . . . , . . .. . . . . . .. . . . . . . . . . - . : . -. _ . . , . . . . . . , . . . . . . .. . . . . _ . , . . . . , . . . . , . . • . , , . . , • . . . • , . . ., . • . . _. . . . . , . . . . . . . . . ...,_ : . . . . . • ; . . . . . . . . . . . . . . , . . • . ; .. . . . . . _ • . . . . _ . .. . . . . . . , . , . . . . . . . , . . , . , . . . . . . . . . . , . .. . . .__ • _ , ; . . , P7/IP p/97?ce / ' ge.. _MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS Fi1lNNG WORK CITY,Tom \/4 k'm o uTu I MA DATE1 PERMIT$g/4/99-CV 99% • JOBSrTEADDRESS! 47 RPvier-I /• Ofl . IO ERS �StE UP. Alia 55n •� . OVYNERADDRESS (TF1rg79 Rc7-57G.'71FAX TYPE OR OCCUPANCYTYPE COMMERCIALQ EDUCATIONAL ID RESIDENTIALW" a ARLY NEW:Q RENOVATION:Q REPLACEMENT:Er PLANSSUBMITTED:YESQ NOD APPLIANCES 7 FLOORS-t BSM 1 2 3 4 5 6 7 • 8 9 10 ' 11 12 13 14 BOILER 'W �- NE BOOSTER aillitiRa ainteJf ■i 1 CON ION BURNER lilt' . ( RECOO�SVENT HEATER OVE S e I ildralar DRYER Pia _ swISs ' FIREPLACE I FRYOLATbR sl > — FURNACE I. • GENERATOR E GRILLE INFRARED HEATER __ .j_ 4 LABORATORY COCKS MI live 5'•r r Mitt onfl•/". k MAKEUP AIR UNIT tat NO ,In OVEN' yoh )1S06 . rim _r POOL HEATER rs f` s 1 f r • , ROOM!SPACEHEATER i.-" _,_ y ROOF TOP Ufa - s r : "'II TEST T t 6•i r UNIT HEATER � '.� _ 1111101111111UNVE7�FFED ROOM H i II t 1 INSURANCE COVERAGE I have a current Jiability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES NO Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF CO E BY CHECKING TIE APPROPRIATE BOX BELOW LIABRI N INSURANCE POLICY OTHER TYPE INDEMNITY[I • BOND Q OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Masadust s General Laws,and that my signature on this permit hppUcation waives this requirement - • CHECK ONE ONLY: OWNER Q AGENT Q SIGNATURE OF OWNER OR AGENT 1 hereby certify that at of the details and Information I have submitted or entered regardng this applkanon are true and emirate to best of my knowledge and that an plumbing work and hste0anors performed under the permit Issued tat is application wil be In compliance ti s 0 provisim of the Massachusetts State Phsnhing Code and Chapter 142 et the General Laws. PLUMBER-GASFITKER NAME gem e n m CB r:Pie 1 LICENSE - 11(�T' 0 '•• SIGNATURE MP a MGF0 JP Q JGF Q` LPGI Q CORPORATION ill# .98(, c C PARTNERSHIP© I LLC ammo COMPANY NAME.i{(e„�n•m�Srrcte Plum+)zc=f '1c,4ADDRESS; II rineilecd Pc+ 'A 1 CITY W. Y,rmnt.-fi, • STATE giga)ZIPI Oa673 ITaU, \ 778- 4554 i f • FAXe.sa)790-67851 caLl6ok 3t',4-37a4EEMNLI f m c.p l u m b 6 c o m cAS 1 s 0 est ! S . . . .. . , . . . . ' . • . . . - . • , . . , . . , . . . _ • . . , . . . . . , • .,.. _ . . . . • . . , ' ' , • , . ' . . . . , , . _ _ . . . . . . . . . - . . . , . . . . . . . , . , . • . . . . • . . . . . . . . . . . - . . ' . . . , . . . . . , . . , . . , . . .. . . . . . . . , . . . . . . . . .: . . . . . . . . . . . . . , . ' • . , . . • . . . • . . . . . . • , , . . . . . , . ' %' • i , . . , . . , . . . e . . . . .. . , - . . . . ' . • • . .. . . . .. . . . . , . . . . ' . . , . , . , . • .. . , . . .. ... . . . . . .. . . . . 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