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HomeMy WebLinkAboutBLDP-18-004043, /NIP : PilACec : MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK __ 1= CRY L- 'YA 121'I��[4 -1 MA DATE I I I f( PERMIT# P/�� y JOBSITE ADDRESS j Q _,EC -P mn A ILA, o OWNER'S NAME a/'6_ Ve J ry ___ P OWNER ADDRESS SO46 tr,l u,:, 1 'rrrLcj' g ro,,x , TEL 646 ;qt.-917O FAX 1 MY TYPE OR OCCUPANCY TYPE COMMERCIAL® EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:© RENOVATION:Vc REPLACEMENT:® PLANS SUBMITTED: YES U NOD FIXTURES Z FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB .'I .�1-.�,._..1- --tL � ( . _IL. t 1 .-. La._ 0 _I CROSS CONNECTION DEVICE �._... - .__ .___--�__..._ _�.._._.-I -_�__ _��.1, __.;I -— DEDICATED SPECIAL WASTE SYSTEM . a_�L_,. ____.. .___._. ,-_.._. �..__ .__, . . ._. t __._ .__.r ,, DEDICATED GASIOIUSAND SYSTEM 1I = _ -_ . _.� 1 ,�I _ . _W. . _ M._ _. auil DEDICATED GREASE SYSTEM I _ DEDICATED GRAY WATER SYSTEM _., _____ f_ _ _. �I _ ---- Y_. " DEDICATED WATER RECYCLE SYSTEM .- -- _ _-.- ` _ — 11, I,_.ram . ____.1 1___ (-_-_.I-. DISHWASHER � I I DRINKING FOUNTAIN Itl1tl -_. i FOOD DISPOSER - i FLOOR/AREA DRAIN IIWRW____ - RR # —I INTERCEPTOR INTERIOR ,I II 1 M KITCHEN SINK iiii M. i1- LAVATORY -_ .--__ _. 1111111111$11111111I 11111111 ROOF DRAIN I ,..- -1-- SHOWER STALL .___._ 1 i_ s_ ___ l ,1 w._ ,' _ i __ .i._-_1 I SERVICE/MOP SINK .. ;__ _ I _ I_ ._ I _.._ I I I TOILET Y URINAL -.._ ( ,_.. ! WASHING MACHINE CONNECTION OWL_ ,. --I _-. ._---_ .�.__ -- -4- -- ._I ..r-„_1 ,. ___'- 1 _..__ --.,--: WATER HEATER ALL TYPES O. __ 1 _ ---�._w�_.__ __ T.- WATERPIPING /P _�..__ ___. _._.^ ._ __ .,-_._,�_. -- - -_ ._ ._,._. I _. -i- -1 __.I�,_.____ ._ _-, i OTHER .. _.._--._ __.._. .__-__. -_ __' __..._I.__e_ _'i_..__.__ ,.___.,t___ I _..,_.i . __ , --SC..,41 A i 4 c_ 1 i _ a- __ — _ _ __,I 4-—._IliffrE !III- -- 1 ---1 .._ l - INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES[2(NO 0 - , w 73 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW c LIABILITY INSURANCE POLICY EC,,{ OTHER TYPE OF INDEMNITY ® BOND ® z 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the p 1 ,._. ;m Massachusetts General Laws,and that my signature on this permit application waives this requirement. v i oo CHECK ONE ONLY: OWNER © AGENT EC c SIGNATURE OF OWNER OR AGENT K; o 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 t and that all plumbing work and installations performed under the permit issued for this application will be in co; nre with all ro ' ion of the tll Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _-, ---*4 -----6 PLUMBERS NAME t ir_,rj1r-! .Ci:jo J LICENSE# ,1,1i ot.O I SIGNATURE MP[ JP CORPORATION[ '#02 iaC, JPARTNERSHIP®#[ j LC[3# R- COMPANY NAME ,L �J t�: '.f'..,P-tA , ` I ADDRESS �L �� 1�C1 Q (�,�7j/ _LSl� _ _ __- CITY W —. 4A ,STATE[in - I ZIP I d (- .1 TEL 15 U-7 _ el es-4 I FAX Isof 79 o-ti 15r1 CELL601) tat1,370141 EMAIL I __. .k 'i c pJ LYl b 6 . o M Lot _ _r1-_1, _.._ . ll.)