HomeMy WebLinkAboutBldp-19-004366 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
® in , CITY , MA DATE PERMIT# /,�17/�`19-4o y0l�b OWNER'S NAME
JOBSITE ADDRESS a0aea __ ,
POWNER ADDRESS TEL FAX .
TYPE OR OCCUPANCY TYPE COMMERCIAL ED EDUCATIONAL Li RESIDENTIAL!'`4
PRINT
CLEARLY NEW:IU.. RENOVATION:p REPLACEMENT:Li PLANS SUBMITTED: YES Ej NO►
FIXTURES 1 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB .. 1 ____ - s I �� 1
CROSS CONNECTION DEVICE
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DEDICATED SPECIAL WASTE SYSTEM 4 # t I
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM , ,1 r
DEDICATED GRAY WATER SYSTEM (i . . . irT t int 1 I ..mom _. 1
DEDICATED WATER RECYCLE SYSTEM (,, €
DISHWASHER
DRINKING FOUNTAIN NMI��� 1� .� � _,-�-_�,.
FOOD DISPOSER 'j7 .
FLOOR/AREA DRAIN 111111.1111111 AM al
INTERCEPTOR(INTERIOR) MN MR MR
KITCHEN SINK
LAVATORY 1 i PIIIMIII I i 411111111111111111! I
ROOF DRAIN 11 , 1 .. r �, I
SHOWER STALL -,• 4 _hw ,
SERVICE I MOP SINK I
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TOILET
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URINAL
_WASHING MACHINE CONNECTION , „ L k I ( .�; _,.�am ON I
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WATER HEATER ALL TYPES �� yl „ € , d�. ,_. I :
WATER PIPING i� ...` .,iiiiiiiiiiiiiiiiiii ,,,.i ,.,. ..-
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES X NO Li
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY)4 OTHER TYPE OF INDEMNITY J 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 0 AGENT El
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 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 iance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Eiric, T Whifejecii,__ ,., 'LICENSE# I5gao„••j SIGNATURE
MP ] JP CORPORATIONF# PARTNERSHIPL# LLC #
COMPANY NAME I 1, VFXYI OV1 Whiter►rc ADDRESS L c�p 5 V 1 + /�y�-�I)1`1G
CITY .,.��,. „i a? �4�t. ...... JSTATE llj ZIP 1_,,._0 9 ,_ .- J ;�..(TEL ', . 7..- �_I C ..
FAX ry CELL' ]EMAIL [ _. .
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT El ❑
,Pa/ -- _pL /41°) FEE: $ PERMIT#
1o`�f /Q* PLAN REVIEW NOTES
6(y)i--/-(5 F
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__ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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. CITY MA DATE PERMIT# />LI)G'I C
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JOBSITE ADDRESS!„aQ ,x 1OWNER'S NAME g
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OWNER ADDRESS TEL FAX'
TYPE OR OCCUPANCY TYPE COMMERCIAL' 1 EDUCATIONAL I 1 RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION:X REPLACEMENT;` PLANS SUBMITTED: YES NO
APPLIANCES-1 FLOORS-+ BSM 1 2 3 it 5 6 7 8 9 10 11 12 13 14
BOILER j_ € 4
BOOSTER ;„ 3 L ;.. i1, [ i ,�, Jr.- i 3
CONVERSION BURNER "� �i '�-� ,mr.., a a. . �.=i1 �.,1
COOK STOVE jr- ;1 a3
DIRECT VENT HEATER _ i r--1 11- 8r -'
DRYER _ ' -
FIREPLACE f� r � � �
4
FRYOLATOR -� i -i III l 4 i }
o! .ice i.µme I
FURNACE ii' it -€ � 1 I_ ° M
GENERATOR , II !t-2-7—a11 ,
GRILLE
INFRARED HEATER 1, r ,. .,:c ,1--- -F -jf- T ' lE_.. r i M. �__..
LABORATORY COCKS
MAKEUP AIR UNIT I II . � .J .., . I i 1 1 i[ 3 H F
OVEN T 1 , E
POOL HEATER Ji ri � 1
ROOM/SPACE HEATER 4 x,
ROOF TOP UNIT ir-- it i H i a ;! $ _ H. ,,,, ,,, . . -x...i
TEST € i 9 a _t: ,,
UNIT HEATER 1--- i it i' r ' 1.<
ram ." ....,...,. Y ... F i
UNVENTED ROOM HEATER I, -11 ;, •Al, _Al__ i
WATER HEATER L µ�} r- i i j
OTHER H 1L I 1 i J, i( .._L
g �' t .. I
'...-. .- -.,.a._',. .,. .. l 1.�.>..,... 1_,._.ter :,'i 1 8 . 1 ...,._
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES IX NO ,,
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY a £ BOND 19
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 _ ry AGENT i
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 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 com I. with all Pertinent provision o the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. --1-1ji
PLUMBER GASFITTER NAME 1 Y IG I LICENSE#I{S�8J SIGNATURE
MP LA MGF L._> JP LI JGF ID LPG'ill CORPORATION H# ! PARTNERSHIPI 4# LC,, #
COMPANY NAMES 4 Ve. o la C ,!ADDRESS ` Vl1I L
CITY �%I t YY� STATE ,.mR. ZIP ( (p(, TEL ,.._,JQ .
FAX; CELL! i EMAIL s
LR 4_
ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
614- OA( FEE: $ PERMIT#
PLAN REVIEW NOTES
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