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Home My WebLink AboutBLDP&G-20-004038 iIflASSACHUSETTS UNIFORM APPLIG:�T1©I+l FOR A PERMIT TO PERFORM PLUMBING WORK r 1' I %%S r;o an `fine^,,„4-y-w---)-- MA DATE /-1 S'— (.59-C) PERMIr# 1%'A/�/''7- 0—(0'Ve)-3g JOBSITE ADDRESS 6' S- s 7.L ck Lh OWNER'S NAME St PLA ? I'.e.: Tuus OWNER ADDRESS Co I / SSF'li tit i\ L, D1 4LS TEL S l& `(sl Yz(76FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL PRINT�p CLEARLY NEW:0 RENOVATION:0 REPIACEMENT:E}= PLANS SUBMITTED: YES 0 NO j FIXTURES 1. FLOOR-, aSH 1 2 3 j 4 5 e 7 . 8 a io 1i 12 13 1I BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _ I f I , DEDICATED GAS/OIL/SAND SYSTEM I I i I I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I DEDICATED WATER RECYCLE SYSTEM DISHWASHER I I I I I DRINKING FOUNTAIN —111111L+___ FOOD DISPOSERI I I FLOOR/AREA DRAIN _I I I INTERCEPTOR(INTERIOR) I I I I KITCHEN SINK } I I I I LAVATORY ( , ROOF DRAIN ( I SHOWER STALL I I. I I I I I I SERVICE/MOP SINK _ TOILET _ I I I URINAL I I ( } I WASHING MACHINE CONNECTION I I I WATER HEATER ALL TYPES , WATER PIPING _ I OTHER - I I I I I I I I jj I I I I f l 1 I I I I �I I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MG3 Ch,142. YES{�'rNO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ 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 iviassachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT 0 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 Icnowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance ti:4th all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Latix s. //�/7,' — PLUMBER'S NAME 12,(.1..A 1 In t;"i ;titt;.,_, � LICENSE# a 5 3G7 / SIGNA, RE 1 MPQ. JP 0 CORPORATION 0# .0 C PARTNERSHIP❑# LLC 0# :. COMPANY NAME-:'l- -c- Or :tiro; 'l' -.-I- hi-�'....c^ ADDRESS /(i c� Win r).� i'" _ .) . (:) RECEIVED CITY `�:r}; ;.for c; i'r:,;= STATE l;�;`i ZIP i t:'rr 3 Gr TEL L FAX `=' ` �'C; ' i,'-i.�) CELL EMAIL ()1�i(".> i)-r` �1 i,v\{ :Maalai- --' �) ' llT 221020 1 BUILDING DEPARTMENT l Alm) f JA ,GEL: - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK N 7 CITY o MA DATE[ j—I,�=a)�PERMIT# r' JOBSITE ADDRESS'Cry SS t 1 CC, _ _y OWNER'S NAME . }-Qt tp • 4,--s6 -i J GOWNER ADDRESS V( +- tu..j2ky, s-----_ - i TEiI,SCj. ,a '�l7JFAXI TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESiDENTIAAI> - PRINT CLEARLY .;.�>. NEW:(� RENOVATION:(,� REPLACEMENT:Ef"— PLANS SUBMITTED: YES:3 NOO APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 i2 i3 14 _BOILER I i _ BOOSTER wig= , -"' CONVERSION BURNER ( ! ;I!, _..... Si l_ ' 1 ... I- ...,. COOK STOVE - - ' . 1< ,.... DIRECT VENT HEATER I i)1�„01,_I_I DRYER s 1. a WI .�� .._-_ FIREPLACE1 FRYOLATOR - FURNACE 7. ..___10-rwm. 1 ) MI I GENERATOR , _, it ;. , t, 0 —. .. .,� GRILLE - INFRARED HEATER .r i —! 4 f -MINNI .. LABORATORY COCKS =KM,,____g. , I MAKEUP AIR UNIT _ _ 1 '� Nr, .OVEN 1 --- ..' f r l I i 0' II [fl POOL HEATER _._. i ROOM/SPACE HEATER i p t. I ,� m„�* : ROOF TOP UNIT ---- TEST f � .. r.i . _ I :111111.IC_ UNIT HEATER Ernmumwm , 1 x 1! UNVENTED ROOM HEATER WWI 11 - —1 I WATER HEATER �A(: ' .. i� i M OTHER WI... r.-.....727 IMP . .. ini,0111111 OM OR 1.t�W.cw...,.c::..x.cn,s....xG.•x�rs.m^-"�^! - ` I' . .1 . :. c i i r._... ..._. . �:ll■111a ih! i.... . : ;.__ Imo:. _t 011110111110011 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO L] I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ID 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. CHECK ONE ONLY: OWNER ® AGENT El 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 withyerilnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / - ti �c /'/ 7.1 yr �iv PLUMBER-GASFITTER NAME lea {1 (,^y'-� O f . `-�r. I LICENSE# cj3.3C �/ SIGNATURE MP E4 MGF f-1 JP© JGF❑ LPGI 0 CORPORATION U1#la2a.Q.CI PARTNERSHIP®# J LLC D#[ COMPANY NAME:.1 S 1'l lvn ioi cl-- c,(41-1V ADDRESS l " /V�i� i-- w I CITY t) - r '3 TEL i1✓1t 5 �r:r'�` , STATEC�,alziP,(:,96 I I 'mg sa/v1 01 FAX I;S2ca-tht-1S1 CELL EMAIL — I i C IAN 2.2 20 """_ BUILDING DEPARTMENT C 0 \( 7 ".