Loading...
HomeMy WebLinkAboutBLDP&G-19-000885 MAP: PR/2 a 6e : MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK __I_I_ CITY 1t) Vq t M p v t�l/\ I MA DATE ' /, j/jc 1 PERMIT#I)L)P fY"t flu JOBSITE ADDRESS �j) (? Q r r k O V rall,j OWNER'S NAME v 7r 66 J I5 Le►,/'I POWNER ADDRESS ! TEL?Of 9 j ?9Z�FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL L RESIDENTIAL 1 PRINT CLEARLY NEW:Q RENOVATION:Q REPLACEMENT:iip PLANS SUBMITTED: YES® NO t!L FIXTURES 7 FLOOR—) BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB —1 ''IJL.__,. LJL._.- 1 _____i.4 ._,l- ( (L. JL_-JLAIC CROSS CONNECTION DEVICE - K-JI. ,"_IL_ 1_ _._ 11— i '-i _ f1______' _Ji�__ JI _. DEDICATED SPECIAL WASTE SYSTEM ,L J I L,.__a_i ___ 1 11 _ ___'.1 _ L 1-.._1 �� DEDICATED GAS/OIUSAND SYSTEM L !1 1____- I --_1L_-51, m. ' _ -II ____I __„_it --'L-1 DEDICATED GREASE SYSTEM I. _a;r TL - _. �-1 L .. , _ f - __- I1- __ 1 DEDICATED GRAY WATER SYSTEM W _ I,r__ _� L� - DEDICATED WATER RECYCLE SYSTEM II. - J - _ �1 DISHWASHER -_ ;_ -_ L _ , _ _'I -- Lm DRINKING FOUNTAIN 1 _ e FOOD DISPOSER r-J _ _ _ I _ FLOOR I AREA DRAIN N 1f INTERCEPTOR(INTERIOR) \ _ _ .N=r _ ,,_...1KITCHEN SINK i _- _ - ' I LAVATORY ' _ _I i I 1 _ ROOF DRAIN M _ ,L___,,.1�'I I I _ L__il SHOWER STALL I -_;I II it , I—. _;.s i i I_I SERVICE/MOP SINK LJL I __-:L« JI �� -".-_._,I _I= A__ (_, J ____, TOILET J i-__. `___ _ _. ,.�_ L. .,I ..ay... 1— _ i I , URINAL _: .__Ir_ i= ._;I_. I . L.__I ..JI . L., _ 1 _ . J WASHING MACHINE CONNECTION 1 al a rg 14 _ I ti_L A_., ;,�.__ I-____.,i=___ __4 4..�}_J WATER HEATER ALL TYPES _ I _ ,i' -__ ,:' ___.:.'I_.-j; - -...i ---'i._,-9 . I!—i ,__.�. I_ it _ I,..�,. WATER PIPING 1 L � _4��rs1� -'L_ 1 _ 'I jd.� (_' 31 • 11 'L - I 1_..1 _ _ LJI_ __ 31 __ ji jL _ jI _ . IHL __�_-. _ ems. - !r.- ; _ 1 __ L I_ -- . J L _ 1. _.a.I l __ 1 1 _ 1 JIJL _I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES LK NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY W OTHER TYPE OF INDEMNITY LI BOND 0 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 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ff r. 1" ris. hi 1 LICENSE# I ( Ie'I I SIGNATURE" MP® JPX CORPORATION LI# - PARTNERSHIP®#, LLC0# COMPANY NAME M � p se 1v ' ,ADDRESS I , A -Pt fi,.je .c � cAr Q CITY � )1 G►f-JA 4_4) F.-AA I STATE ZIP V ?4 lP U ! TEL 7 7 ei . S 16 oi 17 Z FAX r CELLEMAIL '71-1,,^ J�'` •_n� t G j 1 CC ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT 0 0 FEE: $ PERMIT# PLAN REVIEW NOTES A 11' LtPP , Mt, Ar WO' ID dryt' . �' -'' MASSACH SETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 _6, CITY MA DATE I 1 1 PERMIT ft inP r�erO67S— <�� JOBSITE ADDRESS 6-00 3:tivl a q T aC L Q OWNERS NAME J C ()CO Q 51q1 /1 GOWNER ADDRESS TERP 1 1 i 3 Cl7 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 10 PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: PLANS SUBMITTED: YES❑ NO t6 i APPLIANCE T FLOORS—h ? 8 � ,9 I 6�I�A 1 3 � 5 6 9 10 'I'I � '13 14 i BOILER BOOSTER I CONVERSION BURNER, _ COOK STOVE _ DIRECT VENT HEATER DRYER ' I FIREPLACE FRYOLATOR FURNACE _ GENERATOR GRILLE ' INFRARED HEATER i LABORATORY COCKS MAKEUP AIR UNIT I OVEN POOL HEATER _ ROOM I SPACE HEATER I ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER CX,*\irM INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MU.Ch.142 YES [12' NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY S4I 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. 1 CHECK ONE ONLY: OWNER ❑ AGENT El1 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 Pertinent provision of tile Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I PLUMBER-GASFITTER NAME LICENSE# SIGNATURE MP ❑ MGF❑ JP 1: JGF❑ LPGI ❑ CORPORATION❑#i PARTNERSHIP it LLC❑#x COMPANY NAME ii\J\Ar t t O i--it, ADDRESS CITY 6 ° t L r © J STATE ZIP D 4 TEL V TEL '77 t/ . G (0" T/zz FAX CELL r))y <l 0 ( L2EMAIL t�l 1�� Ql— t�QQ €I 3 -4) C '►� ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES