HomeMy WebLinkAboutBLDP&G-17-06081 AIR P" MR :
.s \ . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK OS'i
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arY E YX far)0 Li:1W —1 ' DATE IINAWA1161. Marl-it
ICBSTIE ADDRESS I 1,9 6-, IIT. 09,krk.,., rr,-),4,9 J1 al ovvNars NANO got pA i
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P OWNER ADDRESS I - _...-1 T14500776 -1464 Imx I
TYPE OR OCCUPANCY TYPE COMMERCIAL ID EDUCATIONAL El RESIDENTIAL Er
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CLEARLY NEW:El RENOVATION Ej REPLACBAENT:0 PLANS suslirrEx. YES 0 NOD
FIXTURES 1 FLOOR-I. Elfal - 1 I 2 3 4 5 6 I_ 7 3 9 10 11 12 13 14 ,
BATHTUB 1111111141111.111111111111M.1.0.111.11111.1.4, T 11111111:R=1111111_1 1
CROSS COMECTION DEVICE 1111•111111111_ - ' - - -,.-1 _ '
DEDICATH)SPECIAL WASTE SYSTEMPs ' jam a ---i
DEDICATED GAS/01UAND SYSTEM -
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CEDICA1B3 GREASE SYSTEM 11 .111111111, t.4 r '
DEDICATED GRAY WATER SYSTEM - -'-' , :WILI_ E
DEDIC.ATH)WATER RECYCLE SYSTEM _ i-; ',3, r , Ill- __11111111.1W 3,----; IIIIIM.1.111111111
DISHWASHER _ ,-,, _--7, - - _-. _ . 11 AMIN(
DRINKING FOUNTAIN . __, _:"_..._ i. . - ___'-', _ ','. _ ' 1 .4111. _ 1 , • z.=
FOOD DISPOSER 4 .
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FLOOR/AREA DRAM -1rI1 , -__ P..._ ___ .__ _ —
INIERCEIOR(INTERIOR) L--. E'.-- j---i _P _ 4111111•1111, Li__ _ ___ __ . ___i____ ' •
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ROOF DRAIN i _ 1 L _ .
SHOWER STALL ),_- _ _I i_ ___(._ *:_____, ____ _ _ ' __, A --t- -J. .---, L-
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SERVICE/MOP SIIM , .,, . , , -,--1, - ..--;-----..,".-- ' :
TOILET -_ _ . - - __ _ : ___ -.....-:
URINAL
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WASHNG MACHINE coNNEgnoN z. J, t._. .1 t-____4 _I• __;______ _ 7,..,.. .. t_.. _ft__..i
WATER HEATERALL TYPES ft 1111111111111 fillitiMaint _ - IIIMMIII1M111.1M- MIS- - .
WATER PPM Iiiiii.illinglitiniiiii _F_ __f_ _ _,____P._
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ASE.
II have a current DabSty insurance pca,or hs substantial equivaMut!Milt meets the requisnmests et MI_Ch.142. Y81Ef ND 0
w YOU CHEMED YES,PLEASE Le2:0CATE ME TYPE OF COVERAGE BY atEatms THE APFMDPRINTE MX MOW ..
L1ABILOY INSURNME PO=cZi OTHER TYPE OF INDEVIITY 0 amp 0
=ER'S MSURANCE mink I am aware that the Umeirtsee does nt have the in resume requised by CI arer 142 oftha
Massachusetts General Lams,and that my*mane on this pawn/agr-rica'.....---.-.;zs this itakiAnt,mat.
CHECK ONE°MY: IY"RIER ET_I AGENT J
smarm oF mail OR AGENT .
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• 1 hereby°rely thqt effl°tale Imes and Edtpin..A.ut I tr,.--s.submetect ar esateced reganalag f1213 appftean are tam szad...64/1A...to Ire d ray lataartedge
i arKi bot ei pNot_go wark Eid hae_r-o...,perfoorml under-the p3s. mit tnited for dds arrrboon s-1 b3 to conbsunco- govedon:elm
MSFhordtv Cods sod Ctern 142 or ths Gems]Lzcv...
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PLUMSEKS NAME I tr‘P_AI,•
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MDgir .0)0 CORPORATION eg _Atilr JPARTNERSWP OLLJ
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1 COMPAPW NAMEVelqkjeSa_114. ,j ADDRES. SI.,, ,L,_ la)s
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'MA (6 of)-77i- 4.554 1
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FAX 14t.s-7,10-61C4 CHI foF 3M Sw4 MIL 1",_12(14,1(21__VI_L&C,01114:4talAnek_ I -
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MAY 23 20J/
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_ _ MASSACHUSE 1 i S UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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CITY !Town of yA;2[yin()-i-) x MA DATE 5 17 PERMfT# Al-12p'/7--a0 oa gi
JOBS1TEADDRESS? L (. 14;2;ers i - '$.�� :1i I_ ;OWNER'S NAME ! &. b E°i - ' 4
GOWNER ADDRESS I i TE�'•,5l�t� —77E —i L FFAXI q
TYPE OR OCCUPANCY TYPE COMMERCIAL' Fi11 JCAT1ONAL I_1 RESIDENTIAL
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CLEARLY
NEW:L_._. RENOVATION:Li REPLACEMENT:0 PLANS SUBMITTED: YES Li NO Li
APPLIANCES 1 FLOORS-4- BSM 1 2 3 4 1 5 6 7 • 8 9 10 11 12 13 14
BOILER - .. ! 0 fr- -'
BOOSTER 1-11 __ ' _--._-1' . _ -_n f ___�x
CONVERSION BURNER ' _ ='— v I _ jj— --.r ! C —
COOK STOVE :::-1:-:--_. :_Ri,---, �- ' _
DIRECT VENT HEATER _ ,I _ l;_ _ 0 II
DRYER L . -, _ _II ! 'L—J-— I i .I..— !-.
FIREPLACE v 4 ;f
FRYOLATOR I C- l„' MC__ ri
FURNACE �;. �' I- ____I _ -�' 'I _ _ -
GENERATOR 1 _ T_
GRII I F � - l `. • . . M.Trtrt ,
INFRARED HEA I EH .1 _, _,_. 1 1 - :
LABORATORY COCKS , :, ; - ��0 .!y . i' •, ;;O ME
MAKEUP MR UNIT u an •sa i ; n9 P ' 0 Alt.
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POOL HEATER ' ` . - '' i '. t ;�
ROOM/SPACE HEA I ER i _ _ M. _� t
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ROOF TOP UNIT • ':
TEST anrimilliori- :` _..: _
UNIT HEATER 11111113111111 111111111111111, ..$ - - -' - . -
UNVENTED ROOM HEATER �___.-.,0__ , ` `_ ':
IIMILL
WAIERHEA1EK . _ Ef_ .:-a _- _ _t __
OTHER _ AMW
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INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES NO U
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LABILITY INSURANCE POLICY d%; OTHER TYPE INDEMNITY 0 BOND ID
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 I i
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 e best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance - p- ent 'sip of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFI I I ER NAME[key; 11.1 c_.-B r.Jr, LICENSE# 11 6 O b - - SI NATURE
MP MGF 0 JP 0 JGF L.j LPG!0 CORPORATION att�c� (�S C. PARTNERSHIP LC j#1, 1
COMPANY NAMEF ,-,PIT'6 r:(le Pto + .,: ADDRESS I (1ncltvSP P -A -'
CITY 1,V. `/'i'rnncJt% - STATE 1md-I JZIP, 0 67✓ RT L1 (56* 77. 4 5 k - I .
FAY a)no-6786I CFI I !EMAIL' 1
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