HomeMy WebLinkAboutBldp-20-003057 i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
=7.1111IMI ' CITY G.. o MA DATE 1 -Z i PERMIT# / /J/°-114- ' 5(R7
JOBSITE ADDRESS \Si ( ,CL,J.`a'S ....,, ( OWNER'S NAME_Tr I' � ',r G ......,
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL ID EDUCATIONAL ID RESIDENTIAL
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CLEARLY NEW:0 RENOVATION:LI REPLACEMENT: PLANS SUBMITTED: YES L] N0[J
FIXTURES Z FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 I € l I
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CROSS CONNECTION DEVICE Oat NM MI 1111111111,1111111111.
DEDICATED SPECIAL WASTE SYSTEM minionrienimenriornorWWW WW MAW
DEDICATED GAS/OIL/SAND SYSTEM I W W 11 W
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DEDICATED GREASE SYSTEM MIS 11111 111111111111111 all NIB WM NM ONO 11111 INF NIP NM NM
DEDICATED GRAY WATER SYSTEM WWII �
DEDICATED WATER RECYCLE SYSTEMwI � � �I .. � �_._.. � ..._.. .
DISHWASHER B i_NIB 111111! MIR MIR MR I
DRINKING FOUNTAIN IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIN
FOOD DISPOSER 1111111111111111111111INNIIIIIIII111111/1111IFIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
FLOOR/AREA 1101111111111M1 NW I1NM all 11110111001 lilt NMI IMO la
INTERCEPTOR(INTERIOR) 111111111111111111111111111111111111111111111101110111 IIIII Ili NIII III OM IIIIII
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KITCHEN SINK M !��� NM ��NM
LAVATORY 1111111111 1111111111111 _wwW' W
ROOF DRAIN MOO MOM_INN MINI IIIIIIIIIIII IIIIII 111111_1101 NMI IIM IMIII III IIIIII MIN
SHOWER STALL IIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIWIIIIIIIMIIIIIIIMIIIMIIIIIIINIF
SERVICE/MOP SINK IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II
TOILET __NM 1111111111111111111 11111'
URINAL 111111111111111111.1111111111111111111111111111111111IIIIIIIIIFIIIIIIIIIIIIIII
WASHING MACHINE CONNECTION Imo INN
WATER HEATER ALL TYPES __ -.. . M 1
WATER PIPING IPW W i IW I WW MW
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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 NO L
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ED BOND ® `v''t I, I
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 J 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 a ertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Sean Hanrahan LICENSE# 15822 i SIGNATURE
MPU JP0 CORPORATION 0# �PARTNERSHIP Ej# —1 LLC0#�J
COMPANY NAME Sean Hanrahan Plumbing and Heating I ADDRESS PO BOX 688
CITY Centerville STATE MA J ZIP 02632 TEL 774-238-0286
FAX 508-775-4615 CELL same J EMAIL hanrahan lumbin mail.com
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ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT ❑ ❑
FEE: $ PERMIT#
PLAN REVIEW NOTES /0/3 `9f
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