HomeMy WebLinkAboutElectrical & Plumbing Permits MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
* 1►= , Mass. Date �1�/1� r 19
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—`t�— Building Owners
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PNew 1: Renovation ❑ Replacement ❑
FIXTURES Plans Submitted Yes ❑ No ❑
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BASEMENT
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2ND FLOOR
3RD FLOOR
4TH FLOOR
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5TH FLOOR
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7TH FLOOR •
8TH FLOOR
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(Print or Type) /� ,�nP13-_
Check One: Certificate
Installing Compan Name 1 ❑ Corp.
Address h iv
Ary. Q_
0 Partnership
(10 0 Firm/Company --"-
Business Telephone /766__ /& 5 t Name of Licen anber or Gasfitter
I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under Permit issued for this application will be in compliance with all pertinent
provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
Signature of Owner/Agent
I have a cuff nt lia ility insura policy to include completed per tions coverage. ❑
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By
tl ) Signature of Licensed Plumber
Title
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Type of Plumbing License
City/Town _sli ka `USE ONLY) l 0 Master Journeyman
APPROVED
(OFFICE License Number v`
BELOW FOR OFFICE USE ONLY
FINAL INSPECTIONS SKETCHES PROGRESS INSPECTIONS
FEE`?i 0
NO.
APPLICATION FOR PERMIT TO DO PLUMBING
NAME a TYPE OF BUILDING
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LOTION O UILDINQ"
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PLUMBER
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PERMIT GRANTED
DATE /7/- 7- 19
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Vr/t6/'-f/4)--/tt PLUMBING INSPECTOR
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0.ILCC Use
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IThe Commonwealth of Massachusetts
✓: G� Prrmtt W.
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S Department of Public Safety
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-� Occupants & Fee Checked
t� ,�� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 &leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed In accordance with the Massachusens Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFO ION) Date -- A vliCity or Town of (V//7O/,a To the Inspect° of Tres:
The undersigned applies for aypermit to perform the electrical work desc ibel below_
Location (Street & Number) 3 ( cS ?A /,'l6-e4 ?! ��zik
Owner or Tenant ( /lit fa__ `‘-y c.2/1 00 S A- iO4 '/`• / cAuG I i 1998
Owner's Address
Is this permit in conjunction with a building permit: YYe/ss�❑ No ,{C�leck Appropriate Box)
Purpose of Building . Q -�{ L?CCi70.1 �U�t-t./1Sf 4i ty Author DonYYNO. � ��
Existing Service /( Amps/ -C I 90 Volts Overhead Undgrd ❑ No. of Meters /
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity n L
Location and Nature of Proposed Electrical Work /J/c7C / t;� j i'Gait T ivi
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures SwimmingPool Above In-
grnd. ❑ grnd. ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting
Battery Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
Total No. of Detection and
No. of Ranges No. of Air Cond. tons
Initiating Devices
Heat Total Total
No. of Disposals No. of pumps Tons KW No. of Sounding Devices
No. of Dishwashers ' Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. of Dryers HeatingDevices KW Local❑ Municipal ❑Other
Y Connection
No. of Water Heaters KW No, of No. of Low Voltage
Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current L ability Insurance Policy including Completed Operations Coverage or its bstantial
equivalent. YE NO ❑ I have submitted valid proof of same to this office. YES 3 NO ❑
If you have c cked YES, please indicate the type o , coverage by checking the appropriate box. �
' INSURANCE [2/BON'D ❑ OTHER ❑ (Please Specify) �j1l�C�1' [iaXv j/ltOA 3 2 l 1
Exp rati n Date
Estimated Value of•Ele trical Work $ 3� ////��`
Work to Start Inspection Date Requested: Rough Z /!/ lC Final
Signed under the penalties of periury: III
J1 FIRM NAME /` Cam/` C l/IQ�`'l LIC. NO. �� ���
sLicensee Signature LIC. NO.
�' ' / / g Bus. Tel. No. !�I _ ���-�f �
0O Address (10Sc,�C/i5 l.11�e (SO c/c(/Icooe � .
/ Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub-
stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit
. application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE S
(Signature of Owner or Agent)