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igN MASSACHUSETTS UNIFOP.N APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CTT( Tone D pais--/A624�'O.fl \ MA DATE 1 I o it B I1 q- PERMIT# i/-erir Oe0/
JOBSTTEADDRESS 3 r R.U,CIhvZti P9 4-0E .OWNERS NAME L-1). S
. OWNER ADDRESS _ TEL FAX u
TYPE OR OCCUPANCY TYPE COMMERCIALD EDUCATIONAL RESIDENTIALB .
PRINT-
CLEARLY NEW D RENOVATION:0 REPLACEMENT:LT- PLANS SUSMI I i Li): YES D NOD
•
FIXTURES 1 FLOOR-. ESM 1 2 3 1 41 515 1 7. IS 9 101 1 1 1 121 131 14
BATHTUB
CROSS CONNECTION DEVICE _ __-�p _-_I --•O-----_ - �I--- -
DEDICATED SPECIAL WASTE SYSTEM 1' I .11 Q 91 . 91 . 4I .
DEDICATED GASJOWJID SYSTEM _ ._J- 1-31 J EL !4_-, __`I.-- L -2M . --1,--1- _ _ -_
DEDICATED GREASE SYSTEM F_ __JJ_J_.._41._.J �I-_ JI.-{I..- -JI__- )A_SI I
DEDICATEGRAYWATRSYSTEM -I___...I-_.. 1.._...41_...._r).. _..iii...._3.---..1.'i '1.......-rth ri 1 E
DEDiCATEDWATER RECYCLE SYSTEM 4i 11 AlJL4 ...__ EI il'....4y`)N__-_d+ ^:I___ ._._ �I_- i __!II -..
DISHWASHER �_�.I __ It . lit rt lI . 11. I� __.) p fi 1 ei
DRINrGNGFDUNTA1N `� i#� _ _F e' Fit__ I T! hA t� P _-_
_ 1 91 9 AI ,I _.hi. @.---fl ill-"_ �-fr
FOOD OISPDSFR I 11 91 4. J I 1 `M 11; _
FLOOR 1AREA DRAIN —"F"_7--- - -. .'_r- "
�--�— . �_ 91--��---�---'"'---1' tl.-_?! -� L' – 11 ;' —
IN 1 ONCE--TOR(INTERIOR) ✓I_1 rsl_4i ?P #J h 11'_1. t9 • 11 ,f !p it •
-KITCHEN SINK e= tt_Jr S a # -_'_ lc—MI ft iF X1-3 1
LAVATORY ✓.e_ -- rr—M_ 1
ROOF DRAIN . -.1 ;t
_ # 'I 41 , # b _
4! 4 b_ f
• ---1RHO STALL • f" ( f r j_-it" 7I rj1 — t_
SERVICE!MAP SINK • ) + _4•___t_ .t' ? II 1;•4i _. a: EI /IT tl- !E fay •
Ton FT r i If IF m - 3- I'• f NA- -- -[j1�, rn ^_ a ah!
• WASHING MACHINE CONI4ECT1DN k :d i u #t _- t OC}tt`i,2i