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HomeMy WebLinkAboutBLDP-15-003262 • PIerr - 2 4/7 C ei! II) MASSACH S 5 S UNIFORM APPLICATION F R A PERMIT TO PERFORM PLUMBING WORK -C CITY Town Ofta.nnic ' n t MA DATE PERMIT#TY-PP/C--0O,9Gr2 JOBSITEADDRESS 1349 Q l.11• FP 4 OWNER'S NAME 0.,.0 ,)0.50b.:1 .. . _.. • POWNER ADDRESS) TEL FAX TYPE OR OCCUPANCYTYPE COMMERCIAL© EDUCATIONAL © RESIDENTIAL©! • ' PRINT CLEARLY NEW:Q RENOVATION:Q REPLACEMENT:137- PLANS SUBMI I I at YES Q NOQ laX'TURE57 FLOOR-+ SSM 1 j 2 3 4 . 5 6 7 B 9 19 11 '12 13 I 14 BATHTUB _ _Ip _ i I______ .--- -_L 4 _ CROSS CONNECTION DEVICESMU ' _ , - DEDICATED SPECIAL WASTE SYSTEM I . I I I - . . . _ DEDICATED GASlDIL/SAND SYSTEM ;�h A ^ il _;t. __ I .; 4 _ _ 1 Ii_ _-ll— T _ I_ DEDICATED GRAY WATER SYSTEM i . DEDICATED GREASE SYSTEM _.I____. III_. ..II.....__li l ._._..A........III ...._41 . ._- DISHWASHER TED�WATERRECYCLESYSTEM �T _ ....._.4.ri.. _..._ I.. 1�-_.. _' ...-. _ _. -..... I. 1 PI. _ DRINKING FOUNTAIN _'If jiiikiM 'M. __ Mt _ IWia'I _• FOOD DISPOSER . . .Il . .AI _ . 4. I I . 4 :J . 111 I. —11 iN FLOOR IAREA DRAIN _. ..IL_ _ _ .—.l— - _-_II INItHCEVTOR WIERe' fl 1 1__ I ' _ _ ;_' SIM •KITCHEN SINK = —�_ LAVATORY inailWii1 ROOF DRAIN ' ■1—■I[ M.Il .; Imo : IIMI— . •SHOWERSTAU. u-4 .• 1 I t Ill 41. . 1 1 SERVICE IMOP SINK • 'IFL_ fl t •111 —11:---11I , —4---1— ' • TOILET '• — *__ Ifl 1___OF M• : •s URINAL ` 0 __.IL_..._111_._-.I)..,_.-I.__ 1 4.. s _' 1 WASHING MACHINE CONNECIIs I !-- --' I- ' .-_ laik' erplJptn.• Ir u:r; - Ti3iF(EAFERAI� t L. tF -nnCi'IeNcI B in TEft ray ' . • NAL--• 112_--.W1-11 __ mai D�, L iA lu 0 s ^ V gI�I l __t II d m • . >ihall n$� • nrCJ n n 9111 t - B I._—! __9 J_ • "••- -- -- — —__I_l_.IIMIMEd a 1i'►rl+�^ s,.a vets m _ I BY Lin).--- INSURANCE COVERAGE: �` I h • to t lite Insurance policy or Its substantial equivalent'whlch meets the requirements of MGL Ch.142. YES 1• . D _IF YOU CHECKED YES,PLEASE1NDICATE ThE3?E.OF COVERAGEJYCHECIQNGTHEA?PROPR1ATE BOX BELOW -, •_ , • -• . _ ' UWLflY INSURANCE POLICY 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 DNE ONLY: OWNER Q AGENT 0 SIGNATUREOF OWNER OR AGENT • I hereby certify that all at the details and Information I have submitted or entered regarring this application are true and accurate to the best of my tnowiedge' ' and that all plumbing work and Installations performed under the permll Issued for kis app6m6on will be In compliance with all PeNnerd provision at the Massachusetts State Plumbing Code and Chapter 142 of fie General laws. (¢.� . • PLUMIBI3i'SNAME Q.' Mit-rIAtakt' LICENSE it ��^ SIGNATURE • MPO JP El CORPORATIOND# fPARTNERSHIPQ€ %LLC[}# • COMPANY NAME 6) 'fyl pc-Tr I f1-J5 1 ADDRESS 670 o%p bAsrs atone R O 1 • - CrfY 00...wts (STATE MIII 71Pa TEL fall-501-a-?2_5 .1 FAX.i____I CEL . EMAIL allaINSIMMill V