HomeMy WebLinkAboutBLDP-15-002432 MASSACHUSETTtS UNWUKM AYY4CA I IUN rum A Y CKMI I I U rnnr .n.w r..u.w.au.v .. ...a
1 CRY'S'1l/9/'Mo ccf4 I. MiL DATE /O/a 7//y I PERMIT X/24/Q-)n9041 az
Joest ADDRESS 7 `f MA-rt4cfl er Act. I ov'MERS t•IAME[ $ fMcne y -2-i9ccN/O
POWNER ADDRESS:la!$ MrdvJon,� rye �i I TcysoLteligrni
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 ketEDucTMLl.) RESIDENTIAL[f]- . .
PR NT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:®— PLANS SUBMITTED: YES 0 NO 9-
FIXUTRES T FLOORS-. Burt 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONN DEVICE Ofvk'm 90--6--A 671_
DEDICATED SPECIAL WASTE SYS
DEDICATED GASJONJSAND SYS
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYS
DEDICATED WATER REUSE SYS
CISHWASHER
DRINKING FOUNTAIN
FOOD WASTE GRINDER UNIT
FLOOR J AREA DRAW
INTERCEPTOR INTERIOR
KITCHEN SINK
LAVATORY
ROOF DRAIN
SHOWER STALL
SERVICE!MOP SINK
TOUT
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES • -
WATER PIPING _
•
INSURANCE COVERAGE
I have a current liability Insurance policy or its substantial equivalent whicbon owowl the requirements
of MGL Ch.142' YES Qj Nl). A 1
if you have checked yo,please indicate the type of coverage by cheddng appropriate I 11---
LS ni
��T 3 0 2014 " I
OWNER'S INSURANCE WAIVER I am aware that the licensee goes not have the insurance coverage required pyChadgt'eir 142 of
LJABIUTY INSURANCE POLICY OTHER TYPE INDEMNITY 0
Massachusetts General Lan 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 al of the details and inkxmatbn I have submitted(or enterpdj regarding INs application are true and scants to the best of my
;nowiedge and that al p umbng work and Installations performed under the permit Issued tor this applkation will be In complance with all Pertinent
notion of the Massachusetts Stats Plumbing Code and Chapter 142 of the General Laws �r�`
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�LUMBERNAMEI/I/!}�h CitrvGRcGvi2r'a TR !LICENSE 97•�V' � SI
OMPANY NAME & 6%3 ,O%,,s-,6Ay d- /167,95h-F I ADORES&I /6'2 /114,jv JY, Ri �A j
:R'!:Iapv/1-* r7' (STATE 7 21P: O,t6.79' I FAX in -.77r/61-37{
EI fr'-,T7,p- 36''/6I CELL•ISGRrcc; Wad ri}/Ac J9cfi/1/4e06a..4,y.IPr
L,STFR Er JOURNEYMAN❑ CORPORATION rl s I. °•^••• _ �--
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