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Home My WebLink AboutBLDP-23-005202 Planet Fitness MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK e CITY ERMOUTH MA DATE 3/22/23 PERMIT# BLDP-23-005202 JOBSITE ADDRESS 7 LONG POND DR OWNER'S NAME PLANET FITNESS P OWNER ADDRESS C/O STOP&SHOP SUPERMARKET CO 1385 HANCOCK ST RE DEPT QUINCY, TEL MA 02169 TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO El FIXTURES l FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY❑ BOND El 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. 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'S NAME John Shaw LICENSE#1574 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME JOHN W SHAW ADDRESS 17 FRANKLIN STREET CITY READING STATE MA ZIP 018671118 TEL FAX CELL EMAIL doe 440. ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE El ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK '"--.771.1: . e5 CITY &42,111 / VtTMA Wv DATE J 17- 2.3 PE IT# JOBSlTE ADDRESS 174. L- in.(nci Re.),-, -Dt' OWNERS NAME E'l i -] D �a ' ' - `•RESS �J TEL FAX R c P 'QEER--! OCCUPANCY TYPE COMMERCIAL Er.° EDUCATIONAL 0 RESIDENTIAL❑ PRINT CI1y7 2fi :CIRENOVATION:❑ REPLACEMENT:[��r PLANS SUBMITTED: YES 0 NO Li aa BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Sa,eo L06R� UB ATHT CROSS CONNECTION DEVICE _ DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ , DISHWASHER , DRINKING FOUNTAIN FOOD DISPOSER FLOOR!AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK _ LAVATORY ROOF DRAIN SHOWER STALL _ SERVICE/MOP SINK TOILET URINAL 1 _ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER r INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 2---c40 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POUCY OTHER TYPE OF INDEMNITY 0 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 ant e and acc ate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will in c! liance wit -II Pertine t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - t_12._ lb 4 PLUMBER'S NAME a\„) t„s 6- ,etW _T LICENSE# 11514 SIGNA lqii MPP❑ CORPORATION 0# PARTNERS ❑# LLC 0# COMPANY NAME%u/QC-4 (41kk►-t.,t5 /Ll I L. L‘'CADDRESS ) 4/ i3 Plc K SrCITY /Vvr REA>0'ke,3 STATE M14 ZIP 0/ec._y TEL FAX CELL() -4179 !4O' - EMAIL biij Y 7"0,1,er L . t1i$,„S csie)m