HomeMy WebLinkAboutBLDP&G-20-003954 (2) t MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WORK
- 7" CITY Marrx\O041 MA DATE I I I 1 tit) 1 PERMIT# ,- _i
I JOBSITE ADDRESS 1-1 cc I,G,N .. OWNER'S NAME "l--ix u l {:eC& -is 1
POWNER ADDRESS 7 'r- (c)jt 2 ` air on.Ov kit-1 TELITic 13c4-c$35 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL.
PRINT
CLEARLY NEW:❑ RENOVATION:Li REPLACEMENT:U, PLANS SUBMITTED: YES❑ Ncjip
FIXTURES Z FLOOR-. BSM 1 2 3 4 5 16 1 7 8 I 9 10 I 11 I 12 13 ' 14
BATHTUB
CROSS CONNECTION DEVICE .
DEDICATED SPECIAL WASTE SYSTEM I
DEDICATED GAS/OIL/SAND SYSTEM L- I .--1 - i T
DEDICATED GREASE SYSTEM
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DEDICATED GRAY WATER SYSTEM i
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DEDICATED WATER RECYCLE SYSTEM
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DISHWASHER ' r ,
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DRINKING FOUNTAIN
i ..FOOD DISPOSER -t-- --- - - - - r f
FLOOR!AREA DRAIN + {- { i _. 1 _ ;
INTERCEPTOR(INTERIOR) _-Ir�
KITCHEN SINK
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LAVATORY 1 _
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r -- ! ___ �_--_-T - _ -- + __
ROOF DRAIN 'I`
SHOWER STALL
SERVICE I MOP SINK
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TOILET
URINAL L. 1
WASHING MACHINE CONNECTION r r i {-
WATER HEATER ALL TYPES I __ _ +
WATER PIPING I
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OTHER - -- - `7-� . j - {
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INSURANCE COVERAGE: 1
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES j NO [,J
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
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 m lia e th all Pert en vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME(Clifford Sands LICENSE# 13103 / SI A RE
MP❑ JP CORPORATION❑# PARTNERSHIP❑# LLC❑#
COMPANY NAME Master Tech Plumbing Inc. ADDRESS P.O.Box 876
•
CITY Mashpee STATE MA ZIP 02649 TEL 1508-444-2822
FAX CELL 508-444-2820 EMAIL Cliff@mastertechplumbingandheating.com
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;,._. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
:. CITY (Lori')IA MA DATE \ 1' `V ,,, U PERMIT#/ /) 395
JOBSITE ADDRESS .-' ( I_Q, 9-- OWNERS NAME -'C .t ,v
OWNER ADDRESS ��
�._�..� ���- �Cn1'n'14uT'J "rEl' IDS l'-S -k'( FAx
TYPE T OCCUPANCY TYPE COMMERCIAL:
6 RIN 6 EDUCATIONAL RESIDENTIAL
1. C'LEARLY . NEW: RENOVATION: REPLACEMENT: X PLANS SUBMITTED: YES _ NO ,
APPLIANCES Z FLOORS-, BStil 1 2 3 . 4 ' 5 6 1 7 a , 99 10 11 12 : 1 " 14
BOILER .� - + , . ' . . _ --- ---t . --=.-1
I BOOSTER
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER _r_--_, 1 .._ .__. I __,- . I �_j
DRYER ► _. .. ,.. _
FIREPLACE.
-`- -}-- _-�.._--i --I• 1— I--- - -i
FRYOLATOR - i___—r_ ,
5---- -"
FURNACE T
rGENERATOR
GRILLE , -
INFRARED HEATER _ - - --- { _.-.. .` 4 _.: - t t �.At .... .` 1 } {
f t ` I r !
LABORATORY COCKS , 1
MAKEUP AIR UNIT - r - } . I .: '
-- JL
OVEN 1 L.. 1 i
POOL HEATER ---- —
---- - - } i _ _ I . } L _ l
� � _ I� `
... t }
ROOF TOP UNIT
ROOM/SPACE HEATERI
TEST _._... - — } f { ! ,
--- — — {- --{--- .i 4 - -�
UNIT HEATER
-i-- ---!- ----I-- ._._}. . ..-r ---.-- -----i —--{-..-_-_.._ .
UNVENTED ROOM HEATER
WATERr
HEATER {- .— }.. ;— -I--
OTHER --_I --1---____ 4_ 1 I ..
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL.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 IidDEM GITY BOND 1
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.
i
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 co li nce ' all Pertin t pr ision of the
! Massachusetts State Plumbing Code and Chapter 142 of the General taws.
•
i PLUMBER-GASFITTER NAME Clifford Sands LICENSE# 13103 --
___NATURE
' MP = MGF JP JGF LPGI CORPORATION # PARTNERSHIP # LLC #`�
COMPANY NAME:Master Tech Plumbing Inc. ADDRESS P.O.Box 876
CITY Mash pee ____-
p STATE MA ZIP 02649 TEL.508-444-2822
' FAX CELL 508-444-2820 EMAIL CiiffCmastertechplumbingandheating..orn �� I