Loading...
HomeMy WebLinkAboutBLDP&G-18-006597 �� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK '� � CITY _ ��f 6 % / MA DATE 7,;('/// PERMIT / i3l�/� ,C9/ • 7 JOBSITE ADDRESS 4 / 1 y2 il iY ,' OWNER'S NAME ,z4,4 4 r 1 -Su/,E'1./i.'/?- P OWNER ADDRESS TELL-,/')-' '/; ',Zc1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL 0 RESIDENTIAL►�Z. PRINT CLEARLY NEW:Li RENOVATION:0 REPLACEMENT PLANS SUBMITTED: YES 0 NO'I FIXTURES 7 FLOOR-4 BSM . 1 2 3 rr 4 5 6 7 8 9 10 11 12 13 14 CROSS CONNECTION DEVICE ... _. _j it T imminsimitiormotieemorlawincieur -- — DEDICATED SPECIAL WASTE SYSTEM pinidit imisitintigtauriiimunirmwmirium imiraur DEDICATED GASIOIUSAND SYSTEM juirmliprinwiniawliiiir IIIIIFIIIIIFIIMIIIIIITIIIIIFIMIIIIIMFIIMIF DEDICATED GREASE SYSTEM Rnien 'amonnummon DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM ;mil___ :I I_. ';I .. _':I—. -. I 1 1 1 I I DISHWASHER DRINKING FOUNTAIN mat FOOD DISPOSER FLOOR/AREA DRAIN _,! W iW INTERCEPTOR(INTERIOR) I _ ui o ROOFER ST ' _�. SHOWER STALL ' lialiltillg M MIWWIWPWPM ant MI! SERVICE/MOP SINK ! ( 1;'PIM Mk Pi 111111111111- TOILET _. , - Ulin _.. i URINAL 11, _ WASHING MACHINE CONNECTION 1 !,_ I . .._ Ii __ I. ,, ; -y WATER HEATER ALL TYPES I . . _ _.; `eir�` ..a* , WATER PIPING 11imii i . WO OTHER aii untimilummitaltillt . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES lei/NO [11 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY I!A OTHER TYPE OF INDEMNITY D 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 hereby certifyregarding thts applicatIott are true and accurate to the best of my knowledge I that ail of the details and information I have suhmltted or entered and that all plumbing work and installations performed under the permit issued for this application will be in comsat/me rgrfth all ' ro ' Ion of the 1 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / �. PLUMBER'S NAMEP,A). r .Ll L�' �a>1 P. ___ LICENSE#�_�W. ?,_� SIGNATURE MP VI JP© CORPORATION 0.#a$& , PARTNERSHIP®# _ . . , LLC©# _ ___ . COMPANY NAME irn._4 c,f r.,. e.. E d _. .._a ADDRESS . J.� r z ar,� p tA ... _.._ ___..__..._1 J CITY W. \%.Gr rv+p -ly _ _ __.._._._ STATE MA I ZIP 0 67 3 1 TE J O 2 _ FAX!4a `1-10-0 u DELL aril 3/A 37.;__ EMA1 r' l'J�i! �Y7.� ii .4a_.. _ MASSACHUSI;I 1.5 UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK C ITYY i Tawrt of Y 7D�/��: I MA DATE! ' -7..I(�/.1r I PERMIT#44/2P91-612 ` JOBSITE ADDRESS 1. ,"e " ?�k t: L%!fif Z .1OWNER'S NAME I t"-P;111 ,c-•/1't3, i,. , .` 1 OWNER ADDRESS # JTE4(e/9-71P-`/-5,-i AX' 1 TYPE'OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL 1-1. RESIDENTIAL PRINT CLEARLY NEW:LI RENOVATION:0 REPLACEMENT: r' PLANS SUBMI t i cU: YES 0 NO 0 APPLIANCES 1 FLOORS,-4, mkt 1 2 3 4 5 6 7 -- 8 9 10 11 12 13 14 BOILER ...r_ cc►.za ,s_ wx __..._.,was-wnw_ i-w a - BOOSTER CONVERSION BURNER COOK STOVE . DIRECT.VENT HEATER DRYER FIREPLACE t. FRYOLATbR ,- • FURNACE _, • GENERATOR . &iI1IU1PRUI imi li RR i 4- INFRARED HEA ��,LABORATORY COCKS , n : . , Mil!. r, min MAKEUP AIR UN FT l 111111.411111 - :4 .i L. u:t s L b- ty�i l Aidi°L>t ov€i • LLB _ I !• MINI MIN Aiii w 3111415! /..L. l+.t� 1:1 :41:AL ;la■E. POOL HEATER r M IMI ; , _: y e , ,: ROOM/SPACE HEATER ROOF TOP UNIT a u TEST UNIT HEATER t UNVEN FED ROOM HEATER WATER EATER'- __ INSURANCE COVERAGE Er NO have a current IiabiTcly insurance poky or its substantial equivalert which meets the requirements of MGL Ch.142 YES sa NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Ej • 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 C] SIGNATURE OF OWNER OR AGENT • I hereby certify that an of the dew and Informetiian I have submitted or entered regarding this app3cafion are true and <-.:,_ .to, : •-- my knowledge and that all plumbing work and installafirms performed ender the permit Issued for this appli=tion win be in campttance o -,, •-• of the Massachusetts State Fireating Code and Chapter 142 of the General Laws PLUMBER-GASFITTER NAME,key n s r.,)F'. 1 UCENSE# 1169 p - — - SIG TURE MP a MGF0 JP® JGF U LP' GI0 CORPORATION d#'a 8(, 'r✓I PARTNERSHIP DO I L1C COMPANY NAME p-McB rr Ja Plum-}1- f -ftc,t ADDRESS I 11 (1,n&-1rSPj' PG1;1-A . - CITY W. ykprincAL • STATE rnia 'ZVI OgG-7s !TEO �51e)fr) 77V 4 56Z, I • F �.o1ii7eto-67851 CEI4M)314-37.241 l k(Vt—p k U nut 1.1 tor,Qe Gc.S tp -1' i