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HomeMy WebLinkAboutBldp-20-003142 ' TAP: PARCEL : MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK '^=° / r• .DATE // .'.fa C� PERMIT#h,/)/1- 0-06 3/`7..2 I_ CITY A T!4f /7 a ') L/ / JOBSITE ADDRESS If I�_'(L 7-,)7__, A h, P I OWNER'S NAME/n-e)0 ) /17 e 1�7a,9 P _OWNER ADDRESS 10 atim 4 LO/5 ]' /`� 3a7 I TEL ✓ 3 7 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL L EDUCATIONAL ❑ 5.-0 RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:W PLANS SUBMITTED: YES❑ NOM' FIXTURES 1 FLOOR-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 I d BATHTUB � dui � CROSS CONNECTION DEVICE ..t DEDICATED GAS/OIDEDICATED �U AND WASTE STEM __ �' � _ ''SYSTEM ��m,� DEDICATED GRAY WATER DEDICATED GREASE TSYSTEM INIIIIMIUNICIimimmiiiiWANIELIIIIIWIIII DEDICATED WATER RECYCLE SYSTEM mDISHWASHER . DRINKING FOUNTAIN _�.4.11/111,01111,11101011.W FOOD DISPOSER WIIIIII111011111111111111111111111111jiil i ..FLOOR 1 __.._, ... -M .. NT RCEPT D INTERCEPTOR ��1 IN �� ��� �I� � LKITCHEN AVATORY SINK �1��1 ���� _.:.II 1_' `� Nit SHROOF OWER SSIN TALL low . ,� u I��l _ SERVICE!MOP SINK i� 1 - � �� 1��' �� _' ice. TOILET i'- . WASHING MACHINE CONNECTION URINAL 1 j W ,I + WW4 WATER WATER HHEATER ALL TYPES I ► ; --. .T-' , rr Ii1ilER 15 I y ° ; :RI 'RTP l �--I—IPA ' .r INSURANCE COVERAG : If I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES LIo NO ❑. IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY❑ 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 ❑ 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. {/() `� f �frt� qq,�, ri r LICENSE# f&7/,��L SIGNATURE PLUMBER'S NAME I r l I(" (j.lT< NI < � � MP Jp, Prof)/ CORPORATION❑# (PARTNERSHIP❑#1 ILLC❑# I COMPANY NAME A&( 3-- ( i cQO Q/44 I ADDRESS n11 e, )A0 1 L v- I CITY V j G 7'.s✓J d!) q STATE l 14/64- I ZIP 74 -7 3 I TEL 77 G "e5/% W 7 FAX I CELL I =. I EMAIL S 4 i IN5-&r,n l r 8 N c0 S 0,4-// , co /\.'�. I LIc(+ ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ iGrtti i `:/ 4 'mil/ FEE: $ PERMIT# / /'19 PLAN REVIEW NOTES 1111:p « 0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ti- n CITY ___� �✓ MA DATE --- PERMIT# eA/2/)d17--ag i/17'• JOBSITE ADDRESS` Al5� IO - I Z �c At)'SPa'- � � - OWNER'S NAME � � � (V\ `? GOWNER ADDRESS , f� �i I 1 CJ`�5,�4r'r- L 3&T r:_ //11 FAX —I TYPE OR OCCUPANCY TYPE COMMERCIAL; EDtreAvo AL_- RESIDENTIAL] PRINT —� -j CLEARLY NEW:,J RENOVATION:J REPLACEMENT:),L© Z69' Y PLANS SUBMITTED: YES.2.1 NO APPLIANCES T FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER -.J I__J_.__J; I___J 1 __.I_I_^I_1__J. I_._}__I BOOSTER _- I_ I : I I'— .J_ —I ._J I_ —1—_I CONVERSION BURNER _I I,J I J I ! _I I (_ I _ i COOK STOVE I__J_____I I__I I_I:—J_—I_I_____J_I—I DIRECT VENT HEATER _I_I-_I.—I__I i I 1 . 1._I_J —1 DRYER- �-1:—J— _ i__ �J- I ._. I�;�_I FIREPLACE ._I_1 1__1 I_J I_.._I _.1. 1____I 1 _I__ I-_J—1 FRYOLATOR !____J—I____I____J _____I -... _ I 1 1 _ ; __I_—J —1 J—1 FURNACE I: . ______I J i I i.. ____J `_--1----J ._.. J—I I GENERATOR GRILLE J.. .. . I I I i i_1;-1______J_I ...._..._.l'_I___.1._J__—I_-1___._.I._.__I__.__I____J INFRARED HEATER -J_ _I—J __I 1-1__I--I ---- I_1 -J._J_J i. LABORATORY COCKS 1 -1._..i I.._J— _I _ ___J,._!__I_._._.._I _JJ,J__I_J itMAKEUP AIR UNIT OVEN I _ _I I I I J __ I __I I ...__J _. ._.i I_.._.._I 1 POOL HEATER I�s___.._J I_ _I I __..._-_I:�_I____I_._I__I.._._...I_I I ROOM/SPACE HEATER ROOF TOP UNIT ' I I I ' I_ I ___ - ,.. • 1 1 I __-_1_^J TEST I. I I l _I I I I I_ 1 ( UNIT HEATER _1 1 .._�i —1.._____.1 �— __I 1___1_I_._.__I I .." 1 ____IUNVENTED ROOM HEATER ____I-,___J 1 __,__ I I ___,I ,_1_ J_I_ �__II._ J WATER HEATER ----- - -- -- _ I .. . I . I I�I_._I I _._...._1__J.___J ______I __I�J I OTHER I I / I I I 1 1____J _1.... J__-_J____J_.__I I I -J r ! _ _I I 1 -J I.__ __I__I ..___I__'____1 -I_J —I 1 I__.I'__....I I r _( I . .. - I ; I 1- I L ' I �_J J I I h 1 it INSURANCE COVERAGE kI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO J I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY J4 OTHER TYPE INDEMNITY ` BOND U 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 T^_; 1 AGENT ._I 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 IA--t4-k W-Pit - -) 1 LICENSE# SIGNATURE MP __I MGF_J JP J JGF J LPGI_ CORPORATION J#' f PARTNERSHIP:E# LLC #! I COMPANY NAME: I ADDRESS CITY I STATE J ZIP ETEL FAX j CELL EMAIL: II ! t V: C '-- F, c - rOV : 2Ol9j ESL ,, i1. it_F t, ;t, NT ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ ✓ G/T' FEE: $ PERMIT# G ab ji PLAN REVIEW NOTES NAVit t, • VA SAC _ .. ' `. s