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HomeMy WebLinkAboutP-15-723 a -MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ij1=v` CITYNiirri J ► 1 MA DATE V 101 4 PERMIT# ft/DP-Slav T.cj JOBSITE ADDRESS 39) t ,' ICl lime_ at) OWNER'S NAME CQa P OWNER ADDRESS _ 1 TELL )(0.-2 rj3R IRLP{JFAX • TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL ❑ RESIDENTIAL* PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES 0 NOD FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ ..,r, 11f,_._ e ,- r.._ it r- i_ —r r CROSS CONNECTION DEVICE DSPECIAL WASTE SYSTEM 'i , r , i ,ii, r ,, :, , , , DEDICATEDEDICATED GASIOILISAND SYSTEM i I DEDICATED GREASE SYSTEM ; i I - DEDICATED GRAY WATER SYSTEM 1 i .i 1-— n .-- I DEDICATED WATER RECYCLE SYSTEM I r DISHWASHER w DRINKING FOUNTAIN r FOOD DISPOSER ; i i II . FLOOR/AREA DRAIN AIME INTERCEPTOR(INTERIOR) f ! ii�Wee KITCHEN SINK � IIIRHIUIIIU RCEIMOPSINK RiiRiUhRiIiiii WASHING MACHINE CONN�CA• Wj A ER •TE'AL PES: 16 .511111.1111.1.111, 1111.11,11111.1111 , IIA a • l w—, PIM, w■a,Iww�wi��a��i�f�w, ; __ M Mil iTH R 'Y L -, U I• ii4 r r 1- pi ill i4 r.utill:'.IG f�pa�t TMENT _ � Ma 111111 l ,� -� r—_ - r �I ,/� r I I � I _ I - av,---W INSURANCE COVERAGE: I ave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES kl NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW - LIABIUTY INSURANCE POLICY pit 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 ONE ONLY: OWNER ❑ AGENT 0 SIGNATURE OF OWNER OR AGENT 4 I hereby certify that all of the details and information I have submitted or entered regarding this application a rue and accurate to est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be j phnce with erti nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LP ell`1 I atom m kli LICENSE# 4291-e/ SIGNATURE MMP JP CORPORATION #3/04D PARTNE' HIP # _ LLLCQ# COMPANY NAME Clem PI UW1 b 1 nc, ADDRESS / (,0.2 fn c +0n r,Cfd rt. gag,CITY /42/00 /hi STATE C Z ZIP 0 Stan TEL Lib I- �3 ' 7 ag,I FAX CELL EMAIL hr )Xhlq yyt IO C71 YY1 Plu'nbj act , 0(7� Q 5o3aD Ott ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT II PLAN REVIEW NOTES ' -A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .bin c • yCITY �,ra, /re�i �/� MA DATE`AQ IZa PERMIT# PJ OP-ii-v�7a, MIME ■ JOBSIT ADDRESS OWNER'S NAME itinZC e G OWNER ADDRESS TE,II iolnitea FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL sp PRINT CLEARLY NEW:Q RENOVATION:Q REPLACEMENT:Old PLANS SUBMITTED: YES Q NO El APPLIANCES T FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER a:5 .iralra Ilitillaillillijillmaa,pm BOOSTER IN.-MOM WON II.:M,lS•MSS,* CONVERSION BURNER IIIN [I5_ 5SJellia ,[ llaillima COOK STOVE MIK iiiiISIna MI ailliliala me Mill IIIIIIIIIII 1 DIRECT VENT HEATER —...5[1nSONI,111Ma; Ian.MOM. DRYER as a MB MUM la reTri:' I, FIREPLACE PM NIS--—a,�at a a s aim FRYOLATOR SOME 1•111111. ;i.MB Wail lja 11•15 I , FURNACE55fiS5r ,rmimmajoi _ Sim_ GENERATOR N;:0.11;imimialis ININamOmla wowrim GRILLE L SISMISSAiiimumilling son p,s. INFRARED HEATER FM..Maisitiriiiiillat MI=atm ins LABORATORY COCKS ..5 ,unitiout alma Jim;a Nola MAKEUP AIR UNIT OM(illialf5r�;(�taala Ma aa. OVEN S. 55a,Mra�aWs�5as POOL HEATER MK ailliaaa_,_M.MPS_a_j ROOM!SPACE HEATER S1 i5Sigill; ilillMKS S5ISISIN SUS ROOF TOP UNIT UNIT111,11.111.1.0MMOSIaaa;na'sa . TEST 11101.11=11111.1miliiii.inialentism SU,SM O UNIT HEALER ff5, f';I�,S,a '�.i;',�1, UNV NTEI ,ea , R M� I� _.nilella: llitaaatill1Inailvsulg a.--rim NE li WNW SliallailliS IlliniaMilat:as OTHER IllitiM1� 4 S__ _M .ss ss IIIIIIIIIIIIIIMUMNIEWalliiiiiMiliiiiIKSISMilimillSMISS MINIMVi A^� •. aaa saa arlaa BUILDING �.5 'Sra: 51[ SSIOn la's ur: INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES , -NO Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LZI OTHER TYPE INDEMNITY Q BOND Q 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 Q 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 to: 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 In co, a lance with a Pe.''Knt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i A /� r PLUMBER-GASFITTER NAME 11 mrp,i J arm rrl la I LICENSE rani# SIGNATURE MP Q MGF Q JP Q JGF Q LPGI Q CORPORATION �lo PART IP Q# LLC Q# COMPANY NAME: �rn-[PtuMgrn `, ADDRESS inVainnr. CITY I ihfrio I l Q STATE 2T ZIP c(,l OZ TEL ff/ - . 'I - $ N FAX CELL EMAILh /OXhnM( Gem Otrm\oincr Con, r590 3a-& tier W& ' ROUGH CAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERM* ❑ ❑ FEE: S PERMIT R PLAN REVIEW NOTES