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Home My WebLink AboutBLDP&G-19-000198 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1W:' CITY d GC f,(u1 D c) 1" 4 1 MA .DATE 7 ei k . PERMIT#ii4/+'i/9-C"a/g4 JOBSITE ADDRESS CO J( ,v 1\ POND Ph•1 OWNER'S NAME G 4-r'-/ (9 Al ra ,cc no I ' P _.OWNER ADDRESS TEL 10 13,7 if Q 3s aFAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL I L PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:® PLANS SUBMITTED: YES❑ NO[ FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ..__.__.Iv__ I IL._.. 1___IL_: L JL,.4 . . _.L___ I _ I ) __ IL J CROSS CONNECTION DEVICE )_ EST. fI !i €f.�_ _III_____ Ei- ,, i_ _11_ ,(_j DEDICATED SPECIAL WASTE SYSTEM ... . Il i I L_-._-.I_�. ; ,. _.JL-_._.J I _A$-ti 1 ) _. I___ DEDICATED GAS/OIUSAND SYSTEM L [L1i51_ L —IL1 -.lf.�.-JL_. ICI_ _ .__...I DEDICATED GREASE SYSTEM I i _I -. JL -- _ _- � I _IL_'. .._I_.__, ____ I - ( _-.IL�I DEDICATED GRAY WATER SYSTEM I ,,.. I .. I—� I JI J_ l_.__- . _. I. ,�, L .DEDICATED WATER RECYCLE SYSTEM J , i]L.� II I il N.._._ , r_ LJ�I _ L_ 1I_ _. .I DISHWASHER I a__.t I____.___,____1{_ .,I( _._.II _I':i. 1 _ ii II !_..n. JL�. _I _ I DRINKING FOUNTAIN 1 I_ .I; _ _ � ! 1 ._. _.I�^ _, j__,,�,.� I._,�_1 FOOD DISPOSER I �1.�.�_J'JI- 1 ��_= _ ._In,. _ _-. I..__.,vJ _.._II_ �I . FLOOR/AREA DRAIN .,..._,I___IL _ _ I____I ___It_.. 'L. __ L .s____ t_J INTERCEPTOR(INTERIOR) 11 il I I _ _ i LJ L. ^IL__ -9I Ii KITCHEN SINK 3._ _d ;,.�I I _A: _ t!��i __ " ____. 1 __ ,: LAVATORY L,.._IL...-=Is_..._ _____II. II lL-'L____._L ?,--L 1 ROOF DRAIN I.�.___I' II._.,.—EI�.y. _ I I L II :,_ L___ JI -= �6SHOWER STALL 1 ]1 V V- I .J l L_ III___;I : ,_ I __L _...J=L J_..._J . J h__J!�� SERVICE/MOP SINK i- . L .,..I In..„_._a L.v aL -1 - I __.I Lz___I L_.._.,r,I I -#.---_. TOILET L. it__ II ___I .._,I _ _.._._2L it ___I_J lL,,,___ II .�,..�IL...._ I v I URINAL __ L_....II_ ._II __ i I� Y,,,._II. .L__ L J .__ L I(_..,..._.J WASHING MACHINE CONNECTION . 1-� 1 i_F.I �• I;,___11,_..,-�..)I_ _ �I_.. I7. _II .sl .__IL2 _ I,,R._�_.,�.,_ WATER HEATER ALL TYPES 5 j,Q/) I- __I'L I��a'S.� ,3L____iL.., ii _ J ..�I;_, II. I�__£L I I_�_I WATER PIPING pi___ _I� J _ _._s sT _!I. IL�11_ sL...,_.I .�� _..I!_ $L I L....sL__ OTHER - ' L...�...�II� �,:III..,.- _IL JI 1 it___JI w�U �IF lg.._ 1. L i ..._Ii___A=._-I=L__I I, L IL _ .LL - I�_n IL 1 L II d i _ ti c,.IL II _ ! _IL 11,_¢ INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESW NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1Z 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 compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.+ 1 ,K_Q A -PLUMBER'S NAME �rt�'('. IA L - r., R LICENSE# k I_I SIGNAE '< � � 8 l� MP® JP Li- p r` 7 CORPORATION❑# PARTNERSHIP❑#, LLC❑# COMPANY NAME I ('I p +44 I ADDRESS ( � i- _ _ CITY 4 STATE OM ZIP 0 7...(,,, li I TEL .1 7 it < t ® <j I 2_2 FAX CELL EMAIL �--I f ,_-er • M__c_g-r` , ,f`4.I t , C-0 ili 1 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT FEE: $ PERMIT# PLAN REVIEW NOTES , Itv NY* 4*/"N Arvt 1 -I. "- `. MASSACHUSETTS UNIFORM APPLICATION FOR PE tT TO PERFORM GAS FITTING WORK ,.tea ::==. "/- CIT( S0 MA DATE PERMIT /'��9 OOP�7$� JOBSITE ADDRESS /� P t_IA-8 OWNER'S NAME 6 kty (9 et1'a N 11O G OWNER ADDRESS ID f TEL 37it _0 FAX FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT:gi PLANS SUBMITTED: YES❑ NO 1 APPLIANCES FLOORS-4 6`M 1 2 3 4 5 6 8 9 10 11 12 '13 14 BOILER i BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER I DRYER I FIREPLACE i FRYOLATOR I FURNACE GENERATOR • GRILLE '• INFRARED HEATER i LABORATORY COCKS MAKEUP AIR UNIT OVEN - JiJ POOL HEATER ROOM l SPACE HEATER ROOF TOP UNIT r TEST _ . - _ 17Cif pm UNIT HEATER INVENTED ROOM HEATER WATER HEATER cJ l __L_ OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of NIGL.Ch.142 YES N NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW • LIABILITY INSURANCE POLICY [ 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ I SIGNATURE OF OWNER OR AGENT r . 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 they LE) State Plumbing Code and Chapter 142 of the General Laws. • ..1•_ PLUMBER-GASFITTER NAME LICENSE# SIGNATURE MP❑ MGF❑ JP n JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# Pro tJ• LLC❑#: COMPANY NAME - ADDRESS t q''LOt4 .er (__C47-1?.._ CITY S 0 a t` Pilo v "\ STATE ' -"C ZIP D 7....Cel01( TEL 77 t( <6 1 0 7( a FAX CELL EMAIL '`J`rtA1-et, Nc in c Q a) / I.COth 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