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HomeMy WebLinkAboutBldp-19-005431 't MMAP. A t C . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY C5l,[)PtA /G 1 J '10lr/ , ! MA DATE ) /p PERMMI'T#/J42/ /? 005-4/t( JOBSITE ADDRESS J Vl/ 6) CI L/i L:G-- OWNER'S NAME fie l c(?r() s"' 7 1, I ' P -OWNER ADDRESS 6 r 3 I TEL 3/J U1 YS7l FAX TYPE OR OCCUPANCY TYPE COMMERCIAL© EDUCATIONAL ® RESIDENTIAL gi , PRINT PLANS SUBMITTED: YES NOD CLEARLY NEW: RENOVATION:0 REPLACEMENT:Q FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB y C OSS DEDICATED EDICDICATED SPECIALWASTE SYSTEM ,Willinilr .i _ _ _1 �� . �� __ DEDICATED GAS/OIUSAND SYSTEM -�—� - _. r DEDICATED GREASE SYSTEM .. - airlallr 1 ill DEDICATED GRAY WATER SYSTEM S M - , DEDICATED WATER RECYCLE SYSTEM .11 - � ' N PEEK DISHWASHER • - DRINKING FOUNTAIN ��.�� FOOD DISPOSER FLOOR/AREA DRAIN r����i�1=�► _.,__. ,_ ��� � - ` mff INTERCEPTOR(INTERIOR) limunit KITCHEN SINK u LAVATORY1 ROOF DRAIN _ =IN , SHOWER STALL �� _._ � , _'i= ,. �- .---_-. . ' tI TOILET E!MOP SINKgiwirlEffinOwinnuil. _ u ! URINAL 01111111111111111.11111111111M.S.11 WASHING MACHINE CONNECTION - S -- - ' , siiiiminuff WATER HEATER ALL TYPES 1111.1111111111111111111WIwaii WATER PIPING ninfilfilMill UMW OTHER -a�_- � ` "'Ir_l� 1 _ININVIIIIIIFINIMIP0111111111.11111111,111111111•1111 MIN WI , illiiiiiiiiIIMMINIMEMAIIIIMINCEIMMUINialliiiii INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL"CrEFFIVIET IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW '""`"'""'""'"`""""' 04 LIABILITY INSURANCE POLICY in OTHER TYPE OF INDEMNITY® BOND ❑ MAR 2 C 2019 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required bo Chapte 42-of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. tau I I R CHECK ONE ONLY: OWNER AGENT Li 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 oof the General Laws. PLUMBER'S NAME vl (�f`i' '� 'I Cy1.G�P L_ LICENSE#Ct Iv° 1 i SIGNATURE` - C MP JP tl.. se(..P PrOP CORPORATION0# (PARTNERSHIP®#, LLCD_ # I COMPANY NAM 1 v 1 c) (`i,t P' � I ADDRESS el / t/L7 77C I) r Irt/`i° ! , CITY &) Y q t r14 'f/ zi I STATE 'I ZIP 6 (2 -7 - TEL yr / ?_-. FAX 1 CELL 1 EMAIL s5fi n)e/'. M C ( r r�D @ y/►4 /L' ( efr-,-,,� I ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# �4� 1 PLAN REVIEW NOTES 9# zd‘Vyfr J �Y*5 A • 7" > -'�Er, -' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "Ii` ki .* CITY �CN` v\ I CO"VI ,v l MA DATE I q"il PERMIT* /. '26"-1 O Z JOBSITE ADDRESS `li( s{octvi ejiu ,�, 55�/4 OWNERS NAME pickawki kwi -IkG � GINNER ADDRESS TEL�j O� � '�b JF lY, TYPEOCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[ PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES/ NO ❑ APPLIANCES -I FLOORS-+ BSM 1 2 3 4 5 6 7 R 9 10 11 12 13 14 BOILER -- I' BOOSTER CONVERSION BURNER —~ COOK STOVE 1 DIRECT VENT HEATER -- DRYER FIREPLACE FRYOLATOR FURNACE I GENERATOR GRILLE INFRARED HEATER —y 1 LABORATORY COCKS I i • MAKEUP AIR UNIT OVEN 1 POOL HEATER1 ROOM/SPACE HEATER ROOF TOP UNIT TEST _ UNIT HEATER UNVENTED ROOM HEATER I 1 WATER HEATER OTHER bJ ✓t``A I INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of c'y r% ,. - I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX B; Cl -- • LIABILITY INSURANCE POLICY 66 OTHER TYPE INDEMNITY ❑ n 2019 • OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage re.uir .Ctti r.1.42.ilft Massachusetts General Laws,and that my signature on this permit application waives this requirement au i ;%/ CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT ,:'t•• 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 Li Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME LICENSE# 196S1 SIGNATURE MP ❑ MGF❑ JP g JGF❑ LPG( ❑ CORPORATION❑# !vro P . PARTNERSHIP❑# LLC❑# COMPANY NAME ' l CB- (' tcO p (\� `{ t 4- ADDRESS 1 r (-15 17 C !�f ! V'e CITY ` �1 If' (VI STATE VA- ZIP TEL 77 y �j O 9) 2-2 1 FAX CELL EMAIL C '&"4' /Cam• C U` 17 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FFIAM-6 ' / Z1'/f V�9 FEE: $ PERMIT t� /`� j� 0-6k PLAN REVIEW NOTES