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Home My WebLink AboutBldp-19-006669 • s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK . 1 :t CITY �G�/''"O` ra f MA DATE IL1ly :�3//�1 PERMIT# JOBSITE ADDRESS /5 7 PI, J I. OWNER'S NAME itAthitz" aviddr 1: 4 POWNER ADDRESS TEL 2W7'3e',/—74 2- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL F PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Er PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOOR—F BSId 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER _ FLOOR/AREA DRAIN _ INTERCEPTOR(INTERIOR) I RECEIVE- KITCHEN SINK -- _ . w_.., ----7- I LAVATORY - _ ROOF DRAIN MAY 22 g _ 9 SHOWER STALL SERVICE/MOP SINK P_.__ , BUil DING I;I= ARTMFyr _ TOILET 'r3 URINAL _ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I WATER PIPING - OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES["NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY IYr OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Ic Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 1 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will b compliance with all Pertinent g---‘e't vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# IV 76. SIGNATURE MP❑ JP[E // CORPORATIONL 0# PARTNERSHIP❑.# LLC❑# COMPANY NAME p_c( tK )4,242 -tied/ ADDRESS 70 4e rr'� 17c- /,<Gl� ' 11 . 7 Gil ZIP 02D G TEL�V1-4 ()`OCR/2- CITY S ion � ��1 STATE� //n��, /l n ^ /' FAX CELL EMAILC Cock rH n[.3 0 ytAGO ,`O ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No '1� THIS APPLICATION SERVES AS THE PERMIT [I] ❑ F-PAJ // (� /9/--/6 C.� l FEE: $ PERMIT# l 57 PLAN REVIEW NOTES • , -,i _. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I MAW d CITY .l' vT L> POC.'t MA DATE XX,eQ3/9 PERMIT#e41/9P 19°661 JOBSITE ADDRESS `5 7 e 1/4f 5I . OWNERS NAME L4/7Te/' �- /' ij_ GOWNER ADDRESS TELRO7-Sa/ - L FAX TYPE O ARINTR OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW:E RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLIANCES T FLOORS-4 B3M 1 ? 3 4 5 6 7 8 9 10 11 12 —7171-17-1 BOILER --1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER —� FIREPLACE FRYOLATOR FURNACE GENERATOR. GRILLE INFRARED HEATER f LABORATORY COCKS • MAKEUP AIR UNIT t OVEN �� I �_ E POOL HEATER • ..- .. ROOM/SPACE HEATER i ROOF TOP UNIT •. MA 4 , , TEST . . . .- ...._ .._.... .. . UNIT HEATER 13 it bIN :- i --. UNVENTED ROOM HEATER By D_�r T WATER HEATER OTHER . 1 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IVIOL.Ch.142 YES [NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE.BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ITI/. OTHER TYPE INDEMNITY ❑ BOND ❑ I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the iI tMassachusetts General Laws,and that my signature on this permit application valves this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT J G-• I hereby certify that all of the details and information I have submitted or entered regarding this application are true 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 c liance with all P rtinent provision of the- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. L / freoz PLUMBER-GASFITTER NAME Pf Aei'7 (2(.99 t LICENSE#23174 SIGNATURE MP ❑ MGF❑ JP*❑ JGF[r LPGI ❑ CORPORATION❑# ,r, PARTNERSHIP❑it LLC❑#I: COMPANY NAME tJP k ik/Ai frily Zj, 7C/ . ADDRESS K ep'At pc CITY ,42 1962 MA- STATE /"C a. ZIP tJ 2 o 4(7 TEL 5 -9 -OGI Z - I FAX CELL EMAIL'2 c / PH „9,3 0 '4Ac rC61? 1 I lib , Am 111110 I , c r 4 Hco I I 1 1 G 2 r G1 64 0.w. Z I W r- cz r4 � z,- ? Q co 12_ .T.. L A co - Q 12,4 I cr.). Ly F"4 71 CC. Cd3 IEi 1 S LU 1 W 1 I-I 1 1 2 1 H 1 cc) a. co II I = I I1 I