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HomeMy WebLinkAboutBLDP-18-001198 . \ PAACEL: ---,- ft.0. mossialusEns',REFORM APPLCATION FORA PERMIT°PERFORM PLUMING WORK- , , . 1, ,,_ .w. an' 1' -!'-'-- 1r— YA e m ocTITIT—---- Mik I EATE1q3 1 17 1 PERISTS/*4P-ircoliFt ._, . . .. ...._ . .. . ..7N.... ..... - JODDITEADORESS 1 14. 1 I-Ja mi e...4 ad. 1 miters -a-niln ,f-. 't I' r‘(...4,cL. I . p . iANERADDRESS I - - • - 1 TE4617)q0/ -5954k-Axi II TrAPE OR _ OCCUPANCY TYPE- - COMIABLOWL 0 EDUCATIONAL U RESIDENDALE( . PRINT . CLEARLY Nat La REtIOVATIOREEI FIERAMENT:LI _ - - RAtissueurnek YES 0 NOCJ . MURES 1 Ialm I i 2- 3 4 5 a i i I a Ia II 12 0. 1 14 WOOLS - _ OROSSOONNECTION- DEVICE , , DEDICATEDSPEOW.WASIENISTEM • , 1 -DEDICATED 640011E/SESYSTEM DEDICALEDGPEUESYSIEN i . , DEDICATED SEWA,INIERCASTENI DEDILIATEDINATERRECYCESWISI l lb 1 . DIMMLASHER •DRINKING FOUNTAM . _ . FOOD DEPOSER . FLOOR/AREADRAIN - - - -• :, NIERCFORNITEISOR)- )(OCHER SDK LAVATORY • - -,. 1100F DIVM - .___ .. - : • w ..- ,w- • -- SW:-- - --). 11, i SHOWER SOU. - • WINEE/MOPORK . .____ lilt ___ am TOILET r 1, • _ . MEWL - '' Auirlsips 1 w WHIM IMORECOMECI1011 . - ' Idle ...._ . YMOERSEATERALLIWES t 11 f 1 _ - . A ,FALTER kiL,-.1" -ODER - - MIR UWE WM NEM NNW UMW VIM SIM ,_ _ _ • a . : I - IIIIII. iir-' '' — _______ _ _______Ji ilili _, INSURANCE COVERAGe I Malta CONS2100111131110111•Kapaliaj arils mistalliderlude.Mviick Nods ibingakuseits ellia.CIL*IL YeIld NO El . . NYouCIIECKEDTES.PLEASEalletaEllEDIVOFCCIVERACEWICHIECIOISIMAPPROMIMEMENEure . . . wat.nyasumacErour:irl( - 0MBITYPEOFINBANDY CI 9000 iNIENSISSURANDEENVEt Ian avowethatika Icansaalba bowamscaaaragoopqdrial bj assitruz Nee IlassacliaNtsSeaeraltamadastiaistrvamvamelapandtappacadesseismplannaal. - CIEDKOREWILY: OWNER 13 AGM 0 • MINIKIIMEOFOMERORASENT . -I booty cadirest dares debit eadtoksalbal lums sobaillew d afted ourgallre eft asclbdas ara imeadlimeigab bin" elasyllasivIedipi =dead,pluidiram et and infielbleas peNbatedisuleraspomitiosadrodlalsweidal irM be 11!celecart, - ..,,,,,,z atlas • Ilialsomboolts Me FludisiCsitlid Chiptar142411wesnoll taus. .---- - - Ftumetswhel few.o 1116/31*je.... lucenEttfill - ---- - •=--- swinge . peril ptj ccepoRATE•iffiiiilic,JpAgniamisciii-- luec-ki I. i - - ccopmy Nat 7,11,,T77:Apriggsimp-itine MERSIN 31 /7_mminwri• /,Arnil -awl W. ‘tic.0-nr ouw4L 'STATE 1:1N3 7P1 02473 I 113-I t60,3-7rt- .4654 1 FAX Is*-148-6-601 CELL ifeti EMAL . . • . . • P.-\"` r Y= MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS H i i ING WORK • n- t _..- curl!Town of Yj Q FYI()U i J I MA DATE, f` PERMfr#/,ham/$-V)I9 (0 JOBSITE ADDRESS I -A I Dame - ) , IOWNER'S NAME I�Ohn SCAT eyie3n I `.T OWNER ADDRESS ( ' 6►l)9(2;••5�t 54 f FAXI✓✓ 1 TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL D, EDUCATIONAL ij RESIDENTIAL CLICARLY NEW:0 RENOVATION: REPLACEMENT:0 PLANS SUBMIiitU: Y€Sfj NO 0 APPLIANCES 1. FLOORS--1- BRA 1 2 J 3 4 5 1 6 7 = 8 9 19 11 I 12 I 13 ii 14 BOILER _ f BOOSTER CONVERSION BURNER 1 * • - -_ = __ COOK STOVE • DIRECT.VENT HEATER 4 DRYER • FIREPLACE FRYOLAT'OR FURNACE - 4 • GENERATOR GRILLE _ . 1hFRAR®HEATER = -All LABORATORY COCKS =]!t._-- if , r t W1`I j AL ., ...•.�,s MAKEUP AIR UNIT _Il i i 1r t W MIL iii .. IC Lri I r; ,,s,.':.Ira .i LL.:, li+'d.' OVEN" our_- 111: IIII: ,41 :0&J 4'La' u. ,-, ' POOL HEATER ' r f ,� :, , Fr- ROOM/SPACE HEATER I . 5 • , - ROOF TOP UNIT UC ��1 ;- ��; TEST !r, UNIT HEATER UNVEND ROOM HEATER ___ WATER,IEATER - - — — - 111111lie T -- w — — e_ AM- 3 _ i INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES WINO D I IF YOU CHECICED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Er OTHER TYPE INDEMNIFY jj - BOND 0 OWNER'S INSURANCE WAIVED 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 C SIGNATURE OF OWNER OR AGENT I hereby carWfy that at tithe details and kiksmaGur I have submitted or entered regarding this application are true and-•• , to •— and that ail pkanbing work and performed under the permit Issued for this wN be in a - my knowledge Massachusetts State Plumbing Code and Chapter 142 of the General Laws. OF of the PLUMBER-GASFITTER NAME key;n m C� P IC = 8 r � _ � ENSE�J�t�ao� - SIG TUBE MP MGF© JP J JGF[3 LPGI Li CORPORATION gli# 8 86,F C.I PARTNERSHIP I LLC L . C 1 COMPANY NAME J n'mcfl ri aB plum-k 14 J ADDRESS I I I (1,-,J1os 4 Ycr4-k I CITY 1 W. YGeynnc.- 1, • f STATE ZIPJ Q673 f-I (560 .4554, I . FA*074:10-5785 CtB' ) -erm4tEMAIIl i(tr G pit,nr!k) © r,ne cws-f ()e4 I