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Home My WebLink AboutP-14-829 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK m_tlN=e ,,I,, I',� P/ CITY NJp Enol JW 1 IL--D,, Q n MA DATE (a I(p � _ PERMIT# RN"— flg JOBSITE ADDRESS �j3 Qls �Lx T Ra OWNER'S NAME' (dri.lan P OWNER ADDRESS TEL Ir'l77`nlfliAFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL.[] PRINT �{-, CLEARLY NEW:ID RENOVATION:❑ REPLACEMENT:I� PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR-• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB - ii Jr. _ _ _ I I i.. Ir _. IF _ r ii ._ i- F. .. ;. CROSS CONNECTION DEVICE _ DEDICATED SPECIAL WASTE SYSTEM ,r ,, d 6 r1 I: 1 I r I T DEDICATED GAS/OIL/SAND SYSTEMi 1 a. DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I i i , 6 I I ni _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER r I , r , DRINKING FOUNTAINv, iii " ,pa. FOOD DISPOSER FLOOR IAREA DRAIN j lRSRR.us11�i. ,rn' INTERCEPTOR(INTERIOR) liii � I u1111 KITCHEN SINK LAVATORY n a C I ROOF DRAIN SHOWER STALL � � W�4 r+R� „"SERVICE/MOP SINK ilii r II URINAL 11111111WASHING MACHINE CONNECTION rradi ,'l0 HE' VP 01 ,' itr - — - _ 'I- -1 „ _.-=-- -,r - it --- iii , ... ^ UPI m^� uU/LDtng:,ITpSrNT r INSURANCE COVERAGE: r . _lir I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES, NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application ars/rue and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be I ,7 mplian a with all Peril.-nt pro is on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER'S NAME L R e,p y I atom m wi _LICENSE# /29-4-1 dr SIGNATURE IsAMP ❑ I JPCORPOFtATION LK 3640 PARTNERSHIP■# LLC❑# COMPANY NAME 66-in PI Nn b i nal ADDRESS / (,Up I ( fn c./ -Fon CITY LI.4co J/4 !STATE I ICE ZIP OZ%t t TEL Lk 1 — ,3q1—_4841 FAX CELL EMAIL1.7741)0114 VYI efieY1— PLc i✓1Ct . 0CIWk 583-1Q3 ` flit ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT IP PLAN REVIEW NOTES 1 - • �� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK F_'i0 H a_ ` elaniff- V CITYMgyr11100+ MA DATE (011(414 IPERMIT# ! may-- 10>S JOBSITE ADDRESS 3\ 120Gyflh � (OWNER'S NAME' !t t�jp[ii--) GOWNER ADDRESS TEL.45]Tyal 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL RESIDENTIAL4 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NOD APPLIANCES 1 FLOORS-' 8SM 1 2 3 4 5 6 A 7 8 9 10 11 12 13 14 CONVERSION - _ ._ .. �� ( r. j al ;S INS BOILER BOOSTERCOOK STOVE isal - ma . . DIRECT VENT HEATER .; ....S_ S( lln.„Min55 DRYER 11111111,11011101.11111.10.1�,� �afla_ FIREPLACE _,__ _I_aI,_aii_MINM:i.__ia, • • WSW S'S gt.rearvaisa a INFRARED HEATER i , , i in in ass OVEN _ate; _,'VIII■ llinilialSllafma,milm1 POOL HEATER PINIMUSIIIIMMIIIIIIS1111110111.011.11MOSIN1 ROOM I SPACE HEATER OISSIM O •- ,rMll�r.�l�INOSIn.� r POPPIT�l. i ll�SrlSO ,S TEST .1001111111,11.0111011011111110a11.01114a NOS jjUrrN�III//T(��'H]E��AyyT�'�EER ��yy��y rr�I� SISMI n� �I�II�I 11.1�InLIrwM �LI�•I�IIIIasIs imJ1rtai''r-�-r•f1'' litni7 .1 i-55 S.5 SS5SSIMI �Al�[�w11E1 lu �� Fr/f)��'f'a�I_if�Ms sas�ass�Psa��1a_n MKS p�R MEIM AIMMI�•) IONSIM—; fglilI I•w•4r•155555 IRMWms rinilllia 1 ; ltil 'IA11 _s__IaISSSES. 111111S111001111- InlitiMPUIROPIIMMISMINISMIUMMOIMMISOPINIDWORIPI Iill.1=11111MI SSIMINNOO•McIIIINIllar(I■■ 1 01.111sSINI 1 By _ " INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES .NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY J OTHER TYPE INDEMNITY ❑ 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 ❑ 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 fru: - d ac urate tot b t of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In comp a'ce all Pert' t rovislon of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Larry' .ja.g nyscn ea_J LICENSE# /AQ19 SIGNATURE MP cc MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION #L j PARTNER• - '/# LLC❑# COMPANY NAME:a EH 1 71t1ry1villeYa•-Hor--}tieg ADDRESS I Nt,\It kon grri CITY Lind-in J `J STATE RI ZIP �W'UOt STEL gel L131 44141 1 : FAX CELL OilEMAIL-IfoyIncuryl (:J p\Urn1Sty5, CCnn 51c3103 30 , I-kif ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES e 7. 4