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Home My WebLink AboutBLDP&G-20-003356 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -. t,,' ' CITY �GI,�RJWI .,. : MA DATE I l 2,//24/17 _i PERMIT# j /�a� .116rP JOBS1TE ADDRESS L144,13C 1 A_t-, tA, L. �1 OWNER'S NAMEIC, a_.L. 1� OWNER ADDRESS L _.... _.. .r _ , _y-6 i TELr .I- "5cj1 c 'FAXr—;.._._. TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL l 1 RESIDENTIAL yY PRINT CLEARLY NEW:Li RENOVATION:Li REPLACEMENT:i i PLANS SUBMITTED: YES l NO FIXTURES 1 FLOOR-0 BSM ( 1 2 1_3 1 4 5 6 7 8 9 10 11 12 13 14 BATHTUB a. ; 1 i i i . ! '' CROSS CONNECTION DEVICE i sm. � . i _ DEDICATED SPECIAL WASTE SYSTEM am mu am Imo i 'aII DEDICATED GAS/OIL/SAND SYSTEM mpg am a an ingicion Om alp aim imitaisajarnifftwat DEDICATED GREASE SYSTEM Illuollip _ _ . Wm_, xo _ ✓ alimgi Img mom DEDICATED GRAY WATER SYSTEM 1 DEDICATED WATER RECYCLE SYSTEM MI=min amp Mg ing ,—, DISHWASHER _,wg'pp porn nu . f' +J J DRINKING FOUNTAIN mg am 1111111011.Wm 01.10100 FOOD DISPOSER ON mom alui imml Imo INS NM�MO . o FLOOR I AREA DRAIN ? . INTERCEPTOR INTERIOR NMI III a w ._ iMit - MIR KITCHEN SINK inn LAVATORY I M. �: . _ I ROOF DRAIN b ONO :-= , MS lime ( SHOWER STALL t :I _ _ _ II[I amp mit SERVICE/MOP SINK -- ,. ^_ a'm am; "asi TOILET Ns MED NIS WI 111111 URINAL ' .$ § 1 WASHING MACHINE CONNECTION . , CI - , i N.NM WATER HEATER ALL TYPES Mk iii NMI NOS M N WATER PIPING _ 1 NM NM IIIIIII Ile!ION ', NMI OTHER E _ .._ y( - . .. � � - „� a �,-, r IIIIIII iM Sill lilt i..�, ' '��S�gF Y✓.;-.. • - .... 4 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Vti NO C I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ni OTHER TYPE OF INDEMNITY ; 1 BOND L 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 1 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 and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P ' vision of the Massachusetts Stale Plumbing Code and Chapter 142 of the General Laws. c PLUMBER'S NAME �:7 jj nalt ,t1�, ,C �1 - i LICENSE#[1 /�j'? --" `` E MPx) JP( .1 CORPORATION I#' PARTNERSHIP[ J#� Y LLC[ . # COMPANY NAME jjt ,,,f- (^A IN+'�.4s'}k,C1p�,,L44`l. ff ADDRESS-to C. utv ctLy _ O)EA. ,v c .k_, CITY "�__ tl- I STATE 1'\4 p c i ZIP t 42i(.t .,1 J TEL I ,5\9_ 56 a.S v FAX CELL 1 I EMAIL d WIr A-C,12 41.ti.,yV1_1c&.AICLC C_0 111 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ,t YI=C. s T.¢"G3 CITY MA DATE PERMIT#4 . / - 4- 1 JOBSITE ADDRESS`',�,1..P g �,,,,y„w Si--_ 4. — \p I OWNER'S NAME IC�,,,0.,1,e r,, ,, .. OWNER ADDRESS [ 1 TEI4 FAX L TYPE OR OCCUPANCY TYPE COMMERCIAL[„ EDUCATIONAL Li RESIDENTIAL. PRINT CLEARLY NEW:i ' RENOVATION:❑ REPLACEMENT:[ PLANS SUBMITTED: YESO NO APPLIANCES 1 ••' 2 3 4 5 6 7 8 9 10 11 12 13 14 J , .er .,�. I— DIRECT VENT HEATER _O ._ , i jai II tDRYERi . FIREPLACE - _ r- f'". ,— ME , GRILLE t tt INFRARED HEATER i -,, :•- •- CO MI � - - . t, . , . _ ROOM/SPACE HEATER MIMI INS 11111. . ,. . .aIIMlI AAMR wI=ICal i. l..ia uaps IIIIlINi an_ _u!. _-,.., _R. .._ .-:j ROOF TOP UNIT e_n., _TEST lam . UNIT HEATER —au R - ,. UNVENTED ROOM HEATER IN WM MI._ _ M WATER HEATER SIB f M __ M. . OTHER — t - i ow >� ____ _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent tuttich meets the requirements of MGL.Ch.142 YES NO L I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ki OTHER TYPE INDEMNITY [ j BOND ( 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 [ 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws PLUMBER-GASFITTER NAME Imoeutv146 rvv ,M __j LICENSE#1 i51,5 SIGN MP NI MGF u JP[] JGF[1 LPGI[ 1 CORPORATION( 1#C ___ -PARTNERSHIP[ J#l_y ___j LLC[_j#[�m_ COMPANY NAME: cc a cts,, Vi ADDRESS'it UlzadisA A k qi _ . -i CITY ✓Y n� ! STATE MIS J ZIPb-16 U, 1 1TEL �,o;7_5c, 5 —� '� FAX` 1 CELL! EMAIL!AI\rn, ce--r-e.CO.d ytAauavri.t,ww-t. 1p.R..42rs.e c4lt't i