HomeMy WebLinkAboutBLDP-15-002655 •
__ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
•
=�nH � CITY U t n A • DATE // / PERMIT#$2 DP/S-DO 2 GO
JOBSITE ADDRESSar
` AI i L .s,>(�� OWNER'S NAME PM
P OWNER ADDRESS I__S.__.9_ :TEL EignialliNg FAX
TYPE OR OCCUPANCY TYPE
ICOMMERCALAL�� EDU ATONAL ❑ y'RE—SI.,D TIAL El '
PRINT NOV 12 2014 i
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:D PLAN SUBMITTED: YES❑ NOD
FIXTURES 1 - FLOOR-. BSM 1 2 3 4 5"`'Lir IVA "8'N =r9- 10 11 12 13• 14
BATHTUB —
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM - - - _ " : .m _ _ . . _ • "_ _ 1__. _.
DEDICATED GAS/OIL/SAND SYSTEM ,
DEDICATED GREASE SYSTEM I
DEDICATED GRAY WATER SYSTEM ' r _ .. —i .r— — —u
DEDICATED WATER RECYCLE SYSTEM n�
DISHWASHER _
DRINKING FOUNTAIN
FOOD DISPOSER
LOOR I AREA DRAIN
TERCEPTOR(INTERIOR) '� if— - —_ -- --:— --� +
CHEN SINK F
ATORY Z . __
_ _ -
.. .
OOF DRAIN _
SHOWER STALL _ _ _ _
ERVICEIMOP SINK -
OILET 2
6
URINAL
4-..'''' WASHING MACHINE CONNECTION $
WATER HEATER ALL TYPES
?HER
TER PIPING — --+
1
_
t
INSURANCE COVERAGE:
W 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW -
4 LIABILITY INSURANCE POUCY❑, 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
Iv) Massachusetts General Laws,and that my signature on this permit application waives this requirement
ICHECK ONE ONLY: OWNER IDAGENT-ID
1 SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true a • accurate to the best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in plian•' ,all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4
PLUMBER'S NAME ken duarte • LICENSE# 11012 • ` # SIGNATURE
MPD JP CI • CORPORATION D# 3541 PARTNERSHIP❑# LLC 0#
COMPANY NAME duarte plumbing Inc ` 4 ADDRESS 37 collins ave
CITY centerville - • STATE ma ZIP 02632 j, TEL 508-250-2763
FAX 508-775-9135 CELL EMAIL kenduarte37@hotmail.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES