The URL can be used to link to this page

Home My WebLink AboutBldp-19-005351 • MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK CITY f k•Y 1MU IA MA DATE 3', t / ? PERMIT#APPR T/ 1 1 JOBSITE ADDRESS 3 ?c e Be c«L W C'- v OWNER'S NAME 1-4 e +'�Z POWNER ADDRESS S 141 E? TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:[IT— PLANS SUBMITTED: YES E NO❑ FIXTURES 7 FLOOR-- BSM 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) KITCHEN SINK LAVATORY • ROOF DRAIN C. yE ' ; SHOWER STALL ` 7 a SERVICE/MOP SINK TOILE- URINAL URINAL WASHING MACHINE CONNECTION ) cAR— t WATER HEATER ALL TYPES f t 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 eNOI ❑ IF YOU CHECKED YES,PLEASE INDICATE THE PE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ❑ BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 11 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 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 comp' n e with all Pertjnent�of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME are e LICENSE# 511. SIGNATURE MP JP❑ CORPORATION Err PARTNERSHIP❑.# LLC❑# COMPANY NAME �L o f,/-C ( � U Wt IC 1'a ADDRESS try I A,G(�J cr ad, CITY Y elk t 0'-" STATE ��I ZIP 42 lO t 1( TEL 6 FAX CELL .52) lJ �3 1 J EMAIL (C.I3e1"1"+e. IL-, C.o(41 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ / //fri � v FEE: $ PERMIT# / g4 PLAN REVIEW NOTES oti • -- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ` t . s' CITY kick-r ItA G iikii#1 MA DATE 3 — / -I ( PERMIT# /` %''79r'd --1 JOBSITE ADDRESS 3 Pe e.tut c. 9 eat w Wk.—OWNER'S NAME H e Vt1.-- OWNER ADDRESS S atM t TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ EDUCATIONAL E RESIDENTIAL CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO❑ APPLI.A.NCES 4 FLOORS--+ BSM 1 7 3 4 5 6 7 8 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER -- II FIREPLACE FRYC)LATOR FURNACE GENERATOR. GRILLE INFRARED HEATER 1 LABORATORY COCKS I MAKEUP AIR UNIT OVEN _�.. i 1 POOL HEATER . C ' I V 6 ROOM/SPACE HEATER - �� I ROOF TOP UNIT 1 , TEST -- . UNIT HEATER ''vc. rir A_4=F i_jj-f_ UNVENTED ROOM HEATER , WATER HEATER i OTHER _ _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of IUIGL.Ch.142 YES FIND ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY e OTHER TYPE INDEMNITY ❑ BOND ❑ • 1 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 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7 i PLUI�>i6E �ASFIT ER NAME c�,�`' @ ` e.v # LICENSE 1 5) 11 SIGNATURE MP Vi MGF ❑ JP ❑ JGF❑ LPG! ❑ CORPORATION F PARTNERSHIP❑4- LLC❑It: 1 COMPANY NAME D (�U-p j C Q t u VA 1C ADDRESS 1174 &V I�MI6 it) £,d CITY 1'le_U yv10 4 STATE Ci. ZIP n 2 G I L/ TEL 66 d 13733 1 FAX CELL .4i y 0/ea / -r ✓TAIL j41,1s.s in j e- )2.3LQ ice tai hj C6 M API{ kirl() -CY/ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ 1 'vi &// 9 $( FEE: $ PERMIT# Z-X)/7L. /� PLAN REVIEW NOTES