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Home My WebLink AboutBldp-20-003143 MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT TO PERFORM PLUMBING WORK CITY �( L ��T MA DATE Z PERMIT* '40--OG114713 JOBSITE ADDRESS.7 7 J L✓4 fit.--L Co (-1, - -1 OWNER'S NAME L 7�711'� OWNER ADDRESS '1�s 2 7 y TEL 6!l0 3 Z3 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 53 PRINT CLEARLY NEW:E. RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO till FIXTURES 7 FLOOR-4 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 • SHOWER STALL SERVICE!MOP SINK TOILET 71 4URINAL WASHING MACHINE CONNECTION �� WATER HEATER ALL TYPES / NOV 2 7 ZU19 WATER PIPING OTHER . B.U.0 r)!Nc trr :11v1LLL BY INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES;o NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ►. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 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 be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# SIGNATURE MP 0 JP[:0 rap CORPO ION 0# PARTNERSHIP LLC 0# COMPANY NAME< 'j r I fle7 l.� ADDRESS 4517_iiik. — � fir' l CITY Lk g d -AC'( STATE V" ZIP !) 6'7 T TEL 2 7 Y2IO ?( FAX CELL EMAIL /\c- pr „AA �3 .CX4c " `"'s-j v1 L.2 i< ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ r�'� � /9A 6 J`C FEE: $ PERMIT# 6/ 1-1 /P ri PLAN REVIEW NOTES • • • a i MAS ACHUSETTS UNIFORM APPLICATION FOR A PERM€T TO PERFORM GAS FITTING WORK iMap g.6 CITY t "I r MA DATE / Zip' yPERMIT# 4 ./,1r)- ,,;, 4/ JOBSITE ADDRESS �// � �)k n 144--L� ��{ /7'LINER'S NAME /14'.e)f Y 7bQ/ GOWNER ADDRESS /�C/A�- J 5 LA-9r`� TEL FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL ❑ RESIDENTIAL CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:[: PLANS SUBMITTED: YES❑ NO EV APPLIANCES 1 FLOORS-4 BSM 1 3 4 5 fi ? 8 9 1i1 11 12 I 1' BOILER 2 BOOSTER _ CONVERSION BURNER __ COOK STOVE _ DIRECT VENT HEATER DRYER FIREPLACE FRYDLATOR FURNACE GENERATOR _J GRILLE INFRARED HEATER 1--- -- LABORATORY COCKS I MAKEUP AIR UNIT ; OVEN • POOL HEATER 1 ,`1-E 1 ROOM I SPACE HEATER 1, ROOF TOP UNIT OY -?7 519 1 TEST - . UNIT HEATER UNVENTED ROOM HEATER RU LL NL uL r�R-i f NT WATER HEATER By�" OTHER —� INSURANCE ERAGE I have a current liability insurance policy or its substantial equivalent which OVmeets the requirements of MGL.Ch.142 YES Vf NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. • CHECK ONE ONLY: OWNER ❑ 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 compliance with all Pertinent provision of the '` Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME M`�e ='�j N (Cie LICENSE# ��-Q <___ / SIGNATURE MP ❑ MGF El ❑ JGF❑ LPGI IDCORPORATION❑# P rb PARTNERSHIP❑# LLC CICOMPANY NAM cFCI( �T7 t 17 Pi-€4 ADDRESS le( C rCJ r CITY V�J�Clr -±vl STATE ZIP � Y 9l c. 7} TEL 7(� FAX C�j _ �EMAIL n�/' ,N1C' (& n CELL 77yv0 Iyz' r Jo vt-1 ( (CMl k r-- ti 1 t I 2 Qj 1 u b H 1 - 1 . i � I i ❑ 0 g� 1 W -- Z w = F I- a w 1 co.. _ L. . .... . ... . - - I g w w > CW9 o a. 1 9 -I I a. a. 4.11. Ili 11, r tu 1 1 Co 1 W [-II 0 G 1 C) 1 W I CO 1 4 C C7 O I I