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Home My WebLink AboutBLDP&G-20-003576 /nAP : Pig Ae6c : MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ot�:> L�r = 1_-` CITY L Y,,Qk'(y)O oT I i I MA DATE ISTMANIII PERMIT# 2ci'0 C'35 7 JOBSITE ADDRESS , . f!'n P 1gorn,_. Ln OWNER'S NAME 0 m ° sn n 1 OWNER ADDRESS -- -_- - -= _- i TEI(5C 364-4LfiS5 IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL L.-_I EDUCATIONAL Li l�✓ RESIDENTIAL PRINT CLEARLY NEW:Li RENOVATION:0 REPLACEMENT:Lj PLANS SUBMITTED: YES . J NO© FIXTURES 1 FLOOR-P BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 'r—ice ' i CROSS CONNECTION DEVICE _'i + - III r�; DEDICATED SPECIAL WASTE SYSTEM lam. _-_ jj ,l11 M Mt NM 1 !, 11 j DEDICATED GAS/OIL/SAND SYSTEM ingami DEDICATED GRAY WATER SYSTEM I -_ .a __ -_ _ — - - - .I - i. DEDICATED WATER RECYCLE SYSTEM W_ _!WWI 11.,M10.1,__MMIUMW1_ -1- --"--_, .1 DISHWASHER "MIIITI,ffla _ INEFAMIlinai rOlAillig _ i _ !Ey!!! DRINKING FOUNTAIN iniplargapikl - .MIS - ' ,...nirdiwzglaw, - _i, FOOD DISPOSER , ii ___J uri,___ , _ _ _ __ _ . r, .TH,_ _,,_ _ , --- INTERCEPTOR(INTERIOR) illarlliffrillniMilffin - • - SERVICE/MOP SINK • STALL ' __ i __-FOINTSItri __ 111111TIER,INII?Millilif-- - - -- ---i �imuminkm Willy.11,11SELIME11111111 WASHING MACHINE CONNECTION 111111111111111111111, , WATER PIPING r,...,#....„",...„,...,...,, it...I._ ,..,,,,..., OTHER Mang - iligglikillIKRIERIELEINERNIKOMPIC-M. WATER HEATER ALL TYPES pplillt!Eklinr_IIMI FFNATAI - -' ' --In", i i Mg - 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 Li IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW „....,,,,-- LIABILITY INSURANCE POLICY "l 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 corn.s'n with all ro ' ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME KP„A1 r rf r-,.8ri O ., 1LICENSE# 1II19u(.O I SIGNATURE PARTNERSHIP J#- LLC[ # _ _ MP d JP D CORPORATION�#a'�' x,�;, ._ . ...� COMPANY NAME ,!t._Peic,arjz._C_;}JHa._. 11:.., J ADDRESS _ _I L.__..L/ s;. r.., _ ._._l !?,--- ---._ --,._ ________.__ _ J (L CITY w, t%,:rn.,0sa4A_. jSTATE1 �A I ZIP q�L` .� a TEL O0)777" t 4 FAX (Sof 71 u-ts kl CELL 5&)30-324 EMAIL „ .._._ L-. K C . .�. % r?�i 0, c/o tr-! ' ._;>.r�e.4_ ... .._ I iyi\ 1 ti� I C 0\ 8- *- ., /12/9/{) /Mice/ MASSACHUSE 1 t S UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY !Town of YA( (no f. I-__ I MA DATE:V ,;;r) !` ;PERMIT#?-a -6 a 3 5 7` • JOBSITE ADDRESS! R('o P e1'rr. �� _ OWNER'S NAME r �n n- (31-7n 4 OWNER ADDRESS I - J TEI j5rt )3 E,4.. zik6 fFAX i 1 TYPE DR PRINT OCCUPANCY TYPE COMMERCIAL i -t Fil11CATIONAL; RESIDENTIAL 0/ CLEARLY NEW:L RENOVATION:jJ REPLACEMENT: PLANS SUBMITTED: YESLI NOD APPLIANCES 7. FLOORS—+ SSM 1 2 3 4 5 6 7 8 9 10 11 - 12 13 14 BOILER C -, ___ t_--- ,--_--1._— 1f. 4 l BOOS I ER 2 ti 'L § I _ CONVERSION BURNER a 4 ..7 'I A COOK STOVE _ . �Y1 _1 :_ .t1 DIRECT.VENT HEATER _I 0 � DRYER =z _ :_ :• 'W FIREPLACE - - - FRYOLATOR ;' E . , -� FURNACE _IiiMillirmillifillir Still ' - GENERATOR E old _0_ __ ' _ _ GRILLE NNW. + .._LIWT t1: . :7.T._t 1. __ • INFRARED HEA I EK _ LABORATORY COCKS 5�•' f's a r' '' biri•; MAKEUP AIR UNIT • F r':. _ M:. O.;. in - POOL HEATER ' _ le.. no. _' , ROOM!SPACE HEA I _ 's ROOF TOP UNIT • _1MI 'f�;a rti� (.' ; TEST • - « 1 � •^_._ - UNIT HEATER 1- -$. — vz-Li__ __it_ 1I �' UNVENTED ROOM HEATER =' .- __ --( 1 ` -WA I ER EA ILK ... ..4- ,. c._- at OTHER !i; i- M t E INSURANCE COVERAGE I have a current liability insurance policy or fts substantial equivalent which meets the requirements of MGL Ch.142 YES D NO !i 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY f 2 OTHER TYPE 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement • CHECK ONE ONLY: OWNER 0 AGENT 1-1 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicator)are true and accurate tope best of my Imowledge and that all plumbing work and installations performed under the permit issued fur this application will be in compliance • n A', provision of the Mascachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFI I I ER NAME lieu,x Pia(-Br._j I LICENSE# 117 O: - - SIGNATURE MP MGF 0 JP F] JGF D LPG1 I_j CORPORATION 61 c3 8(,.4 C. I PARTNERSHIP CIA LLC U#L s COMPANY NAME40n(tY Br;C2 Plum 4 1ercJADDRESS f 1_ C.r?'ite_4a 204".v`_-_ __ _ ._ -, CITY W. `/r,rrnr);.J+I - 1 STATE MZIP 6=73 _ hTEL� / o ) ?7g_' ! 55 I - F , m- Z! 1� CR 1 50 (,[4-37,71,4 ENIAILt k M C.,pi V' b f c:,()er•f" s- �n e3 1 rzlz��lfi - 5/440r-if,- dj) ' � k .