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HomeMy WebLinkAboutBLDP&G-24-54 MAP: PARE6C MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY cl/eMoll —1 MA DATE( / —Z`Y I PERMIT# LPia' V 5 JOBSITE ADDRESS /Olr02l-`�,a. OWNER'S NMEI/17`Goilcr/Ds' pOWNER ADDRESS I I TB-I IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL IJ EDUCATIONAL❑ RESIDENTIALPRINT ❑ CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED:YES❑ NOD FIXTURES 1 FLOOR QO© 3 0©0000 1u EMI®®0 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM al DEDICATED GAS/OIUSAND SYSTEM 1 DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING MN FOOD DISPOSERFLOOR/AREA DRAIN INTERCEPTOR INTERIOR all:.. LAVATORY NM �. OM MN_..11 ®;�H � O SHOWER . 1I,l, � SERVICE/MOP SINK TOILET URINAL WASHING WASHING MACHINE CONNECTION WATER HEATER ALL TYPES III 1 WATER PIPING 1 20 OTHER • - • INSURANCE COVERAGE: I have a current'lability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES( NO❑, IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I.J OTHER TYPE OF INDEMNITY❑ BOND❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not hive the Insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit sppliation waives this requirement. _ CHECK ONE ONLY: OWNER❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I knowledge and hereby Bred p bra work and installations peerfoormeld under theme permitted it Issued for entered this apW�non calla be Iinscomp i with ae end ll accurate provisest of ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I1&l//i/s, 'IS z IUCENSE# inqiactI SIGNA MP❑' JP❑ CORPORAT1ONV3Z3`1 IPARTNERSHIPQ# LLC❑#I COMPANY NAME) ,1/i 'iniT '4' /7( 'ADDRESS j I STATE /f�A/�Y5 ti ma O Z4-7 3 I TEL I CrrY����.e�no�i Vn. FAX I i CEi4 EMAIL I Ozt 6S2e2 7657 ego(Lm I a i , I H � l I 1 0 1Z. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ►� . _�!�i= CITY ��/rJ/�10`?�.,.. .�..�._,,__.�_MA DATE'-T',�7-,,�4I. 1 PERMIT# - _ JOBSITE ADDRESS/06 O/r/?�2 1 OWNER'S NAME ./?7 tL9cs.�a/49r - _-' _'_ T _ _.____. ____ `G OWNER ADDRESS i TEL FAX` 1 TYPE OR OCCUPANCY TYPE COMMERCIAL; EDUCATIONAL 3 1 RESIDENTIAL',..]; PRINT CLEARLY NEW:,J RENOVATION:-J REPLACEMENT:. - PLANS SUBMITTED: YES D NO Li APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _J_j;_J__1_-I _J_-!_-I J I I' t - ( - I BOOSTER —J—_ !:I I I__I_LI—1•- I_____:1_, .t 1. . . I 1 CONVERSION BURNER ,j_c,___i ( i .. 1__J_ _}_ J-_ I_ `� 1, I COOK STOVE ,_ — L 11 J_ _�.I _1 -): J"L_Lf- !LLI I I DIRECT VENT HEATER —J-J—J _.J_�; � —1—J . I (._. I DRYER- ...___I__I—!—J—1, I (__I...____1' �. J ._. I I I ( • FIREPLACE l—_I__J. t-__J;;��J._J__I I I I I . I I JFRYOLATOR I I—J,--( I _I—1_J,__-1,_—Ir_I-_I I. FURNACE —1-i-�. I (_1____I I: I--I -__J . f I 7GENERATOR I . I i— €_J I_J�J_J_—J ___J I GRILLE _J - I—� ___J�J i J.-1'___� 1—J____I:_J_ J f. INFRARED HEATER —J --h—J —J• !=—�• --_ ( -E.—J —}—J'—J_J—� LABORATORY COCKS I-J..__:1__J.._-_._i ! ! I. _-_J___._J L.-{.-_J__J I itMAKEUP AIR UNIT ' _J_—J__I-__J__J—J-__J ___I, I _J ,J: I OVEN _.I_J- I_J_-J.__-J_ -_I I `J I _I,—i I 1 { ab POOL HEATER ,...._;4,j__I-J ____.__I•_ J,J__I--___IJ J__ J _J.__J ! ( ROOM/SPACE HEATER _II_ I ` I I I I. I :L_,J __J - I_ I. I-" ROOF TOP UNIT �-.! ! J_J I ! !_i _J I -r.--' 44 t TEST —J___1 ", r }______I...,.__„1,__..I i ce{ rH. g' D _ UNIT HEATER ______I__J_1 I i _I_—J _J ! J i_:_ 1- I UNVENTED ROOM HEATER . _ _J ! I__J ! I___J ..—J.J I_ u Li I ( WATER HEATER. .--------- _.r__J_J'J ! I I I ___1___I___I i Jam! I I . OTHER !—J _I._ I I _ I I !_____I [-I. I I " I J..`J I_J--- I i . ...._-__Itier I _LI " 1__I. .. i I s r .._ _ _F'-f_ . '- --- r i_ .. . I _.... J-J I-J I .L__I. I I ' _i _ ' -... . I t INSURANCE COVERAGE ,� _ Z I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YES a"NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY TJ BOND 0 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-! AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that ail 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. _ _ �71/ i �fn6i ` Y PLUMBER-GASFITTER NAME T�/7/S fl ( r !LICENSE#''Idiot( SIGNA MP N!GF'TI JP 123 JGF'j LPG! I. CORPORATION: "# 3431 [PARTNERSHIP 4# LLC;_(#___� COMPANY NAME /}I7Ci P� 4 - I ADDRESS jl fCZh7r 57 -- - CITY L1-/') `-Gl/e <t rto , _...... / I STATEn� )2 6 1ZIP 73 ITEL 27(./-136- d7 / FAX ( CELL' . EMAIL° G�'�` ��- • G • C ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES • A.1 floc- C. •