HomeMy WebLinkAboutBLDP&G-20-003954 t
tr-------4MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
*,a,,,.) CITY \kay-ronL4l MA DATE r( h j2. o PERMIT#AP/9 d't/" Y
JOBSITE ADDRESS f cc (0,0.2.... OWNER'S NAME Pcr,ul. N-‘
P OWNER ADDRESS - r ((kV "{-�trMOv I TEL 1 [-3SII.-cs1FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAIJ
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NV
FIXTURES 1 FLOOR—• BSM 1 ' 2 3 4 5 I 6 7 1 8 9 I 10 i 11 i 12 I 13 ' 14
BATHTUB r r--- r —il r_ -P- —
CROSS CONNECTION DEVICE _+ Ell
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DEDICATED SPECIAL WASTE SYSTEM L ,�- - ���
DEDICATED GAS/OIL/SAND SYSTEM rs��
DEDICATED GREASE SYSTEM _, '` Jr , _ i '
DEDICATED GRAY WATER SYSTEM I --1 r
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DEDICATED WATER RECYCLE SYSTEM ?
DISHWASHER * _
DRINKING FOUNTAIN , 1� 111111110111
r I --. rr -- =--• 4 �- } - t __�_
FOOD DISPOSER
FLOOR/AREA DRAIN i !
INTERCEPTOR(INTERIOR) [ - i _
KITCHEN SINK �- � �! — L ---r---
LAVATORY — + = 1
SHROOF OWEDRAIN 1
R STALL I - i.
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SERVICE/MOP SINK 1�-- ' 1 `
TOILET — — i i
URINAL I '�� Ij � r 1 �
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING i' _) ,— 11--
mo- — _
T i -
OTHER 1 I it 1 }
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INSURANCE COVERAGE: j
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Li:- NO
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY ❑ BOND Li
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 [ I
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
I and that all plumbing work and installations performed under the permit issued for this application will be in lia e 'th all Pe ' en vision of the
' Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
'
PLUMBER'S NAME Clifford Sands • LICENSE# 13103 SI A URE
MP❑ JP CORPORATION❑# PARTNERSHIP❑# LLCM#
COMPANY NAME Master Tech Plumbing Inc. ___ IADDRESS P.O.Box 876 •
•
_
CITY Mashpee STATE MA ZIP 02649 TEL 508-444-2822 i
' FAX CELL 508-444-2820 EMAIL Cliff@mastertechplumbingandheating.com 1
�:= . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
,. 3
4.• •5 CITY I MA DATE \ r PERMIT# B a ,,
JOBSITE ADDRESS -.-1 (-“-- \i-0•) - -_._ OWNER'S NAME (; t4 ra .'\
j
OWNER ADDRESS c LCL TEL fi- 'FAX
VP11 OR
6 OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL I CLEARLY NEW: RENOVATION: REPLACEMENT: X PLANS SUBMITTED: YES _ NO
APPLIANCES Z FLOORS-4 BSM 1 2 3 4 1 5 6 ! 7 8 ; 9 10 T 11 12 13 14
- - + . _
BOOSTER E i_ t I. H�_ _ - -} - -- a a
I CONVERSION BURNER_
I COOK STOVE •
DIRECT VENT HEATER t...-- - _, .i.._ 1 ._��.. .. _4-__ i --E __ I- I
DRYER _ : _ L. _r
FIREPLACE
_T - I I i --
--__,___--i---
FRYOLATOR i
FURNACE __ --- - I — I—
GENERATOR
a .__-. -1-
i.GRILLE __ ,
INFRARED HEATER { } '
LABORATORY COCKS t { I
MAKEUP AIR UNIT
I - -- { - .-. - {
OVEN
POOL HEATER -- -- ' - l I I j } f._ - , i a
.
•
'
I
ROOM I SPACE HEATER f
ROOF TOP UNIT --,___,, I i } I .. ?:
TEST i
1-
UNIT HEATER -r- I-_ __ _.. ___
UNVENTED ROOM HEATER - — I -1-- _ t
WATER HEATER .--._,.._. L --j— - -_-_.._ j..
OTHER ' I I
1
i ,
INSURANCE COVERAGE
I 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
LIAB!L!TY!NSURANCE POLICY - OTHER TYPE INDEMNITY 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 „I
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
1 and that all plumbing work and installations performed under the permit issued for this application will be in corAli nce - all Pertin t pr ision of the
1 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r 8
PLUMBER-GASFITTER NAME Clifford Sands LICENSE# 13103 // SINATURE
' MP = MGF JP JGF LPG! CORPORATION # PARTNERSHIP # LLC #
COMPANY NAME:Master Tech Plumbing Inc. ADDRESS P.O.Box 876
CITY Mashpee STATE MA ZIP 02649 TEL 508-444-2822
' FAX CELL 508-444-2820 EMAIL Ciiff@mastertechpiurnbingandheating.uorti