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Home My WebLink AboutBLDP-20-001780 • MASSACHUSE I I S UNIFORM APPLICATION FOR A P T TO PERFORM PLUMBING WORK -=1 y CITY MA DATE /?G/ / PERMIT 4tRA7P-101/720 JOBSITE ADDRESS ///, A e7e 4,06 .. OWNER'S NAME c 4_. 1i4V WeyPdiL't OWNER ADDRESS J J - r -s -S4wil1- TEL �S 64 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:❑ REPLACEMENT: �. PLANS SUBMI I I ED: YES❑ NO❑ FIXTURES Z FLOOR—} BSIvi 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 SHOWER STALL • SERVICE/MOP SINK 0Ci' TOILET ( URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 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[VIVO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 12V 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 1° 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 an c to to the b f owledge and that all plumbing work and installations performed under the permit issued for this application will be in co is ' all Perlin n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 3600 C !f:5 LICENSE# I 5y76. SIGNATURE MP/V JP❑ CORPORATION 0# 3/(5r PARTNERSHIP❑-##�A LLC U# COMPANY NAME (U et^ S>�t'G.e ADDRESS 90 l c !,Q'/ 7/�r CCy eCITY14:57/514er j� STATE P ZIP ZV .5( TEL FAX OO �/ e)6 ELL EMAIL �6l .�dt y rdi f t-fGY r (.. Co A cic.44, No-7 z ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ kcrA (14—C--- /Q__ Ozr FEE: $ PERMIT# PLAN REVIEW NOTES I ' 1 S MASSACHUSE i i b UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r` CITY Xeifilt4 el* §Dr� i MA DATE PF T NSP-- -CO/ - JO8SflEADDRESS) /lKa' S' �a {OWNER`S ,NAME r.4 1.&nLv v X G OWNERADDRESS I r 6A sr Arm Ks l 3 $- os.51FAxL t • T'iPE OR OCCUPANCY TYPE COMNERCIAL.El EDUCATIONAL D issam NTIAt r • rig ARTy Nato ReaNATKRU REPIACEmarr _ PLANS SUS:YESt] NOD ' APPLIANCES 1 FLDORS-{ MI • i 2 3 4 5 . 5 7 - $ .9 10 11 12 13 14 BOILED - Weimilis mt=i— i • BOOMER . —— M CONVERSION BURNER :��; '_ _ _ COOK STOVE WINK IMAM,_�' mit . . DIRECTVENTHEATER • ;•: - 11= imimmumusimmummow DRYERn. ? • • FIREF4.ACE I•'M '1•i I .__�1�. � . • FRYOIATOR 1111ININI=agill FURNACE t`; --ma— ji`iNg moram mg;. GENERATOR Ei ' • GFtpiF law • NFRARB HEATERinenaloillEr011imMulimillingliKillitminntlintadi LABORATORY COCKS M __� 01111' MAKEUP AIRUNIT 1 -- ———.—MU OVEN . . •-- 111111111111K—WillitMillit' lot IM.POOL HEATER • I MM :MW -. i -.• ROOM tSPA(EHEATER • �'�1— '� . - ROOFTOP UNIT mini uNIT HEATER R UNYHSCID ROOM HEATER WATER HEATER • ? ---•` �;�:a �; .a': OTHER) P . INSURANCE . - MIS • J Ihaxe a current Rehabine inseam poky t$I s sehsiagnal equhraksitistich meals the ragalremeds alM:.Ch.142 YES 8110 Q • IF YOU CHECKED YES,PLEASE INDJCAIETIElYPEoF CHIECRIGTHEAPPROPRI1OEBOXBBDW .. . • • LIABILITY INSURANCE POLICYc ]$I 1TYcEPOL]CYa OTHFRTYPEMEti Mil O. BOID D • . . • . MEWS INSURANCE WAIkEt I am a Matte kensee tines Mit bangle caeeags r Imt aptEsl42 of the — and that my sigma=on theperitialipliaraon waivestlist —•- --= • • CHECKONEDIU; OWNER[3 Ali 0.. • SIGNATURE OF OWNER ORAGENT 'I hereby carlffylhat ea c#he detail and Iaaassersa I have smbraterl or mimed re gating this aicaleafion ace' 9best of . and a!plvr w and nsribe pe¢aIt'ssued for t r,el ba In• Stale Mating gads and Cis 142 offs Gesse2d Laws. - °f .. • IJI [T1ER NAME I ...571/Gt - 62-f s�/mil.- E f5-I/ • . SIGMA I 0 JP 0 icfn LPGI[J CORPORATION I / PAR1 }V. 111-C D -• -t . 60MPANY NAtEi. eVe/ fer 4G.rr " tAtoilmst,90 G a/cc ,: e - e"U Grnr. • - P�PGt 1�rA' " i sTATg z /9 %fl -)'.—/-r J -97, .1 FAXJ hf-3 S C '=V51-(mil. (-516-t?4S JA 57 '6,9frra/• . .F1' ,3 {) al .. Yli • (2e).4":3 - C 1 (40.7 yO1 - ,- _ - . �Comaeq' � • - . ,�.=Y.=- . -• DepeTtenent of tIAccide - . - ; u , - 600 W in Sfreet _ • • Workers' Come t Iona-mice ce Affidavit' 1Coutractorsanothicians1Pimnb'ers _ - Mmlicant - •Please Piint "bi9 Name - . on • r tt.• N: • — Areyou as employer?CWe fire a1,pLvpriafn box • • • - • Type saiproject(required): . • L0 i am ar�ployerc 4- ©I amag�ca�radss math 5. ©ra !• . . eQcgiayrxs(fall an�dJar part-�me�.*, have listed� sheet • 7. Cl R�T'.��¢ - 2.�]I am a sofa vend etor or patter- • T sub-con have - .•F. 0 DeLaiifien • ship andar3do y lamesandhaveWaelsr '. 9- r] ga , far me m Lamm e - - - -• ion kcal re s sz'Y`'4s—• — req ,_n..�, 5.("'t •�6 are a c and�S - .. • - _ gt�` - - saWc .i.1. . cse '�rir• _ -11.E'PigiQp °raps-. . _ - x ''1dFt 1 -0 Rofrtf s. ]t . • , o.152,§1(4),sad yellers - aveno - 13.0 Other - • - � -]. - . • • •*Any tntabe4 abcZfl doSiaotthe 8 wed:cm' porsq • #Saeza aito subsatilis arcuinfitineengthey am doing aII volt and teolis mmtmizokanew erase infficarag suds- ItkierndEs tat *is box=st a Witiaaalsbentainniingthal==afte sdrcnnizactces E aist&mine=ornatrOs: ban_• —_ - • • • employees-ff�e ezir wadcn' r�•s _ — I eat as employer tiwt!spr gworkers'' b 1 for say�� gam,is the potty jobs . t Insancace Haz • . ' . s'kl - • ' ?o y#or Self-ins-i ic- . • Sob Sae Add�res� - � � �- rumba smd date). . Attach a copy of the workers'ape sation pa*demon page(sho the o er criminal of a Fatimetosecurecoer vageesregauednaderSedioa25A fMGLc.152canleadtothe impoOdott of 00.00 and/or oneyear as well as pemes inthe fo m of a STOP WORK ORDER and afrae • fine to$ Be advisedt at a copy ofT s st e�m be ceded to the Office of •of opt)$?$EI.OD a day8tc ]at� -investigstion • - s oftheDIA for ins vet- t�d tht pravi.ded ebape is true a::d caned • O • I do here �3'=d8't�ePams aadp �P�� ° � . - . • . . . . , - ,k rb..et . . • • . . . . prrl ure 6171Jr. Do not write to this area,to be tamper city or - • • . . `, City orT•own _ •. Authority f D cgartme¢t 3.C tyfrOwa Clerk '4.Xiec riealInspector 5.,P1mn r .O • phone { tactPcrsna -