Loading...
HomeMy WebLinkAboutBLDP-15-000057 =\ MASSACHUSETTS UNIFORM APPUCA IIUN 1-1.JKA etruetI ru rrotruicm rv-u w,=.1.44 i, vvVrra tej CRY OLlu i 1 MA DATE 7I�3/I-I PERMIT n /2/5--03-7 1t" JOBSITEADDRESS 1 © Ia qi'1' St OWNERS NAME 6055 Alger Churct1 POWNER ADDRESS TEL FAX TYPE OR OCCUPANCYTYPE:E COMIv1ERCIALX EDUCATIONAL 0 RESIDENTIAL 0 PRINT RL NEW:❑ RENOVATION:❑ RE LACEdiEIT:❑ PLANSSUBM SUBMITTED: YES 0 NO ❑ CLEARLY � ' FIXTURES FLOOR-. I sag 11 I z I 3 4 1 5 1 0 7 8 1 9 1 10 I 11 I 12 I 13 I 14 BATHTUB 1 1 I CROSS CONNECTION DEVICE I I I I I I DEDICATED SPECIAL WASTE SYS 1 1 I 1 DEDICATED GAS/OIL/SAND SYS I I I I DEDICATE GREASE SYS 1 I I DEDICATE)GRAY WATER SYS I I I I DEDICATE WATER RECYCLE SYS I I DRINKING FOUNTAIN I I • I I DISHWASHER I I I I FOOD DISPOSER 1 I I I FLOOR 1 AREA DRAIN I I I I I NTERCE1 I UR(INTERIOR) I I I • I KTCHEN SINK I I i I LAVATORY 2.. I I I I ROOF DRAIN- I I I I SHOWEtSTALL I I I I SERVICE/MOP SINK • I I I I TOILET I I f • I I I URINAL I I I 1 I WASHING MACHINE CONNECTION I I I I I I I WATER HEATER ALL TYPES WATER PIPING I I I I I I Il I I OTHER I I I I I I I I I I 1 1 l 1 1 I • INSURANCE COVERAGE: �/ I have a currant Erablity Insurance policy or its substantal equivalent which,mets the requirements of Mal Ch 142. Yes,�`No 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1EC OTHERTYPE OF INDEMNITY 0 BOND in OWNER'S INSURANCE WAVER I am aware that the licensee does not have the insurance coverage required by Chapter 142 of t Massachusetts General Laws,and that my signature on this permit application waives this requirement CHECK ONE BOX ONLY: OWNER 0 AGENT 0 Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to• best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this ap. -.-,:on will be compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of� ► f� /� , try, PLUMBER NAME p 1 1 I eX a rod Q if well UC# 15 G7 Cog wen(JP❑ CORPORATION,r'# 36 /° PARTt1P ❑i LLC ❑i COMPANY NAME Br-co a &05. rwc ADDRESS J 10 13 r e ec1�'5 h; 11 Ra f-,g art 14/fa'11'-11 S STATE/v V f w OJ V 0 E AAd • TE.77 Lb (e 2" 905/ Cpl FAX RECEIVFD rt1 : � 6CBUILDINGRTMENT )� • Y FIA A Ii T l NG -rE _. ROUGH PLUMBING INSPECTION NOTES THIS P' CR FOR hSP CTOR WE Yee No � 9 .p _ Ci 06g-IVES:9 _• 1 0 ❑ fEE: 5---- PERMIT 11 - PT AAS gna • • 1