Loading...
HomeMy WebLinkAboutBLDP-20-002590 : '_. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ _ CITY rrt MA DATE 12 L/-Z<))ek PERMIT# f '4g,6q6 JOBSITE ADDRESS 43 9v.),.S ......_ 1 OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL ® RESIDENTIAL PRINT A � CLEARLY NEW:U RENOVATION:'.;, REPLACEMENT:Li PLANS SUBMITTED: YES© NO FIXTURES 7 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB T CROSS CONNECTION DEVICE M MN NM NMMOMMN 1111111 MI MI 1111111111111;INN MI DEDICATED SPECIAL WASTE SYSTEM 1101 ,111111=1111M11111 DEDICATED GAS/OIL/SAND SYSTEM ] 11111111111 ,;..... 1I� 1 DEDICATED GREASE SYSTEM N IIIIIIHIMI MI 11.111111.11 MS N all-110001- Mil OM:11,11111 DEDICATED GRAY WATER SYSTEM ;11111. DEDICATED WATER RECYCLE SYSTEMI DISHWASHER MIII IIMM MI 1111110111 MI MR 11111111 LIS101111111111111111111 DRINKING FOUNTAIN 1.1111111111111 i1 FOOD DISPOSER 111111111M1111111.1111.11.11111111111 FLOOR/AREA DRAIN NMI1111111,AM11' __01111MM. INTERCEPTOR(INTERIOR) 0.11,111.111111111111111W111111MAINIIIIM_ KITCHEN SINK 111111111111111111.NMMIN NM MI NS IIN .1.111101.111110101101111 ,' LAVATORY € 11 1 ROOF DRAIN 11111111.1111111 NM NM MIN MIMI Nal MI , ,11011.11111111.11 SHOWER STALL . 11.1 ... SERVICE/MOP SINK TOILET MR 1111 IMF1111111111.111.811111111110110117 ; URINAL 1111111110111111111111.1 : 1 1.111. WASHING MACHINE CONNECTION111M1111111111„ WATER HEATER ALL TYPES MI MM.NMI NMI N MN OiMINNM MUM 11111 MI WATER PIPING ! , 1 11111 11111111 OTHER ,1k• 14,, ' .IA R,' S ' 1 MINIM IIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIIIIMIIIIIIIIIIMIHIIIIFIIIIIIIIWIIIIFIIIWIIIIWIIIIIIIIRIIIIIHIII INSURANCE COVERAGE: : , v,.. - �4' b' , I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Chi 142,7 YES - NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW f NOV 0 4 ;jo 19 r LIABILITY INSURANCE POLICY U OTHER TYPE OF INDEMNITY ® BOND ® t i OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by_Chapter_142 of the ` i Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ED AGENT 0 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 est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertt nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Sean Hanrahan LICENSE# 15822 SIGNATURE �... MPUJ JP ID CORPORATION Li# PARTNERSHIPS# j LLcLj# COMPANY NAME Sean Hanrahan Plumbing and Heating I ADDRESS PO BOX 688 I aal CITY Centerville STATE MA ZIP 02632 TEL 774-238-0286 FAX 508-775-4615 i CELL same i EMAIL hanrahan lumbin mail.com 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 ,�- /02 6 2ie/j i///, /