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Home My WebLink AboutBLDP&G-18-005711 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r� PERMIT#J -�i�f Q J/ �— CITY yfri a ; ro c7Cg r MA DATE 7 / JOBSITE ADDRESS 4 o.k- tEIS l'^r7c OWNER'S NAME POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL_J EDUCATIONAL ❑ RESIDENTIAL' PRINT CLEARLY NEW:n RENOVATION:n REPLACEMENT:Z PLANS SUBMITTED: YES n NO[( FIXTURES 7 FLOOR-+ 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 '__ MI DEDICATED GRAY'WATER SYSTEM ', . I - ;m DEDICATED WATER RECYCLE SYSTEM 1111 � DISHWASHER Illlll NM_��_ t��' 111111111011111111111111111 MM�MOM FF RINKING FOUNTAIN FOOD DISPOSER 11111111.1111.1 MI MINI 11111.MIIIIIIIITIMIM FLOOR I AREA DRAIN I � INTERCEPTOR(INTERIOR) —, m � yi ni KITCHEN SINK IIIIMIIIIIIIIMINIMIIIIIIIIIIIIIO- 111111-611111.11111111.11111111 . ,— LAVATORY ' ROOF DRAIN SHOWER STALL --4- 115 a '1 I la / , SERVICE!MOP SINK I OIS TOILET �. . URINAL IIIIMIMIli , _ . W1 11111111 WASHING MACHINE CONNECTION -Fr � -IIM�M WATER HEATER ALL TYPES JIM-- --UltiON WATER PIPING MMl ! MGM OTHER LAIllan".11111M71 SIMMIAMMIi fiVa—g wwwwww- - NM- ,- . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES4cl'NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Li BOND U 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 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 pro/v°isi of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �' 7? - (CtA I PLUMBER'S NAME /!^ I , r�s (.:.ch,?6 LI e, ( J LICENSE# 4 f-3S�t7 SIGNATURE MP 2- JP J-/ ;' / CORPORATION®# [if-c;-7 e, PARTNERSHIP L j# LLC I I# COMPANY NAME /T C rit-o9-T/'J COOLS 1 - ADDRESS 3c' .�;',7(Z/S'S4-- )/Z/ CITY y4k:.44L>tU/-„- . STATE /111A, ZIP 6076 2,2. TEL 5UtF'73 -)i xi FAX I —1 CELL SO�' -'J EMAIL 7D 4i C. 14/3 c;f 6 /�?f>/L., CtJM. - v// 3 ' i\O- / °tic) MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK .ate_„„ tiTET.-- --° i�MdU,r O Jr.___----- MA DATE- CITY (} � —_ PERMIT# O��6= 71 JOBSITE ADDRESS k19-TES T A944, 'OWNER'S NAME f OWNER ADDRESS ; 1 TEL1 _FAX' TYPE OR OCCUPANCY TYPE COMMERCIAL;_) EDUCATIONAL _} RESIDENTIAL PRINT CLEARLY NEW:;1 RENOVATION:J REPLACEMENT:4 PLANS SUBMITTED: YES F.D. NCi APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I 1: 1._-1 1_1. I, 1 I—J_1_______I f_..-1—J BOOSTER . I i. I. I CONVERSION BURNER 1 1 I•_1 t 1_1. _1 , 1 ( E I._J 1 COOK STOVE I - ;'_l_I—_1 -. .f : l._____I (—J—J J DIRECT DRYER VENT HEATER I f _ . .i--__I-I_1 I._ 1_1 _ i FIREPLACE --I 1- ,1 . ._; ... 1 ..._ 1 1 - _I 1 _ ._1 I _. .__I—1__ 1_I FRYOLATOR FURNACE _ _ _.. 1 GENERATOR I- .. . I I 1 I _.._._I ..:J—1 I 1 GRILLE I J 1 I 1 _J. I______J_.1 ______I.____1_1.______IINFRARED HEATER - -I—_J Zi--�.—J 1-_1^l: LI--- ;—___t—j.—J_1_____1___-___1 LABORATORY COCKS 1 1 1 �I _ 1 1 I.. �_______I_______ ______II _1_ i_1 I___1_1 itMAKEUP AIR UNIT I I I I_.� I,__.-_1__,...1 I I _1_______I i OVEN I... 1i i 1 I s_ ..I ; I __V! .. ._:I1______1 1 POOL HEATER 1 1 ._1 I I_1-_.._�I I I_1_.�a'__J__._.J_I I ROOM/SPACE HEATER _. 1 - 1 ROOF TOP UNIT �...! i I ! I 1 -I: 14 I .'I I I I TEST _I } :` _I , I L ' I i . UNIT HEATER --' 1 ..___I .. J-_...---1 -...- -I I _1 UNVENTED ROOM HEATER �_ I. 1 _______I ..___ _____I_,__I_1 I___1 __�I___1 WATER HEATER .____. --_-..._ I I - L. I I I 1__I,�_I_1____I I ,_.-1 I ' OTHER I I ___ 1 I._ I_.�I I I I I -_ _I I I I. i i I 1 i 1 -_-_J I 1;____-_-___1 _ I 1 __ J _�.J I I i __._I�J.___J I 1 I , I I I_____I ,. I _ I_ I �! I I I I- I t INSURANCE COVERAGE _ CI have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES [NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY .iJ BOND 1_I 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 _I AGENT U 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 Pertinen ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _._.Y ..._ r_.. :__.... 1--- PLUMBER GASFITTER NAME: �'/4� OC�G�, LICENSE#;/191��a SIGNATURE _ J/brat! MPX1-MGF 1I JPste JGF LPG' CORPORATION '#7-- i G 1 PARTNERSHIP # LLC'J#r j COMPANY NAME;. /g}tC TW(r 11�-0O3 N(r---- ADDRESS .30 At2%554- -okU6— ----- - ----- __.—. ---I CITY 44, t,-,ei?, I STATE hi- 0-.J ZIP da.e7 2 ITEL 7 v?aO 1 FAX f CELL: EMAIL: 7`-04N,fl?f C 1� t '/I1/d/L , cam 1 ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 cto��& FEE:$ PERMIT# /1JO ✓STT—C6 S PLAN REVIEW NOTES • • \XIV,1.:• • i M 'F� 1'ice'd'.+a •