HomeMy WebLinkAboutBLDP&G-24-890 -RFC 1 V
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING"�INORK
= -/y7,,/,//-h , MA .DATE J I PERMIT#&UP 2H— 9 9 °
CITY J
JOBSITE ADDRESS /I q /•-'(c1..t S f' C.Rh-C• 24 OWNER'S NAME` j>-t.i` //ewe/Ye/ I
p .OWNER—ADDRESS I //emit il I f W(_3[*efz/r q'/I f" I TEL J !FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL Ir EDUCATIONAL ❑ RESIDENTIAL 0 ,
PRINT
CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:1a-- PLANS SUBMITTED: YES❑ NOD
FIXTURES 7 FLOOR-. Q0 2 3 4 5 NE 7 8 0 10 11 ®® 14
BATHTUB i CROSS CONNECTION DEVICE a'�
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DEDICATED SPECIAL WASTE SYSTEM o �_M P —,KI•;KIl'OM P—
DEDICATED GAS/O(USAND SYSTEM
I 111 III I, ill II DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEMIII I
I MINI
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DEDICATED WATER RECYCLE SYSTEM ! .�: (
DISHWASHER MN MINI MEW all M1011 MIMI NM 1111111111111'
DRINKING FOUNTAIN —'tM a—'I•—miff an'm i
FOOD DISPOSERiiiiiiiiiiiiili
INTERCEPTOR(INTERIOR)
KITC SINK
LAVATORY
ROOF DRAIN i, ,(!;
SHOWER STALL
SERVICE/MOP SINK niiiiiiiiiiiiiiimusionn
TOILET K
URINAL RR M'XR.R ,'M
,IR
WASHING MACHINE CONNECTION1..ill1li1ll.
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WATER HEATER ALL TYPES ' ` t<,
WATER PPING .I
OTHER ! l
INSURANCE COVERAGE:
I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES 0'-NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY a 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.
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PLUMBER'S NAME tJ�r' '4%S-'.�1 ' ;t? _ i'I-C. LICENSE#�41 ,fC`/1 SIGNA i
MP Er JP❑ CORPORATION Et#J•-, ; `� PARTNERSHIP®#111011111111 LLC❑#F
COMPANY NAME /l j/1 -��( , j C ADDRESS //( -;, .,
CITY /evr l f'A'l2rr"fr- l STATE ; J ZIP r2J A I TEL 77q-*.' ' Te=5,-) J
rAY I C_.," i I;e1 II I CIMAll I 6-rc.r;D 4
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
UT ' CITY: `A r 4 --Y I MA DATE I PERMIT#
JOBSITE ADDRESS' '.. M h, cF C R253�I*z .OWNER'S NAME -P �A s` ectc 1-
G9 S i /-lea✓trviy - ne5 4.�,anf.__JTEL':, . .FAX'
TYPE OR OCCUPANCY TYPE COMMERCIAL; EDUCATIONAL RESIDENTIAL c J;
CLEARLY NEW::2 RENOVATION:J REPLACEMENT:Sd" PLANS SUBMITTED: YES J. NO Li
APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER __I_J_J:_J_ _J 1�J,_—I^( 1 J:'_1_J ..-. I
BOOSTER J,--I"_ILL!=t"�_11L LI—J�__.—I . .r . ..f- . . I . . I
CONVERSION BURNER _;__,_J; :__j I ! I-J_J•_ I— i: I-1'-J _i
COOK STOVE -_! I__i__J-J IL]I-)—1:1 L_J'_J.—J_J__ _-1_1
DIRECT VENT HEATER •...___a__} 1.,_j_ —1 __1_--1 , __-1_1.—__J __..
DRYER• __!_. —J:�.—f J_�—J'_—J_ _i i_j —1_i,
FIREPLACE ,_J._J_._i_ t_J,_—I-J. _I_J__J __3_1;1,__I_J
FRYOLATOR :�_.!'_�;_J__ILL!,_ _I ..-J.._1.__i _I__1_!.—i
J FURNACE ._._ . ..
GENERATOR I f. I_ _I__I _-! I i__1_J__! _J��
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GRILLE _ - i . !__1- i.�!�'—J 1-J .!:__1_J, ___i
INFRARED HEATER —J — t-J.—J i —�—J'__I !•_� L_J'_J _J_1
0. LABORATORY COCKS - ( .T.
i___._�i.____1 . _..I i_-1.-_I__J-J-J_J-J_.1
MAKEUP AIR UNIT ... _ ^ . ..r ...- (F 4�J�l� l��� J_LJ'�:�J
OVEN _.-1 ,___ 1 I I ._ .I I__L i. I__J�J .-__._i_J.—I 1_I.
14, POOL HEATER
ROOM/SPACE HEATER __.____i __-J _.. .I__1_-_:__I_ j I- I_ _�__J I I , . .i
ROOF TOP UNIT _.--.I j I _ I_i_ 1 _-_i ! • J__J' .—! _J 1-_1,-__�__J
TEST _I__J i r I 1— —__Li I —I i I ( I ' I
UNIT HEATER I_'____I_J . . 'I I I_J_—J__I --J • i___i_ I ..- J
UNVENTED ROOM HEATER .[ ,l___t i " I
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,_J. !. .i __J_I__i i I
WATER HEATER..- --A- - - -:
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OTHER = i ____I- I_ ._-______I____J�I_LL_I _i._J I
• ._ _ . . =^..6. I '.'. I-___I - !—1 [ I_—I I-�_�. J_ _.-i _I I —i-1'.-! _J _ I
_ .._. I—I J.__ I ` I _.i. ► I__J_I '_ .._I__-J.. i
IIP I. I I i I '__I !-J.. I .... .i-.!_J . ... 1.....-.I
rrb INSURANCE COVERAGE _
b I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES I10 7
4 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ;,,J 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 ; I AGENT :_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 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. 12 /�-
PLUMBER GASFITTERNAME` l/ l!/s T t �Jl-�� -1 LICENSE# ff,�d SIGNATUR
MP ' MGF..J JP ID JGF; LPG!J. CORPORATION` #'52.3 y PARTNERSHIP #= LLC:_[#
COMPANY NAME::mil/Ar'/�/�S ,� �/ Z i !.ADDRESS. /r?Q�f;' .3".-
CITY /(� _-...._._ ..—_ /�-
�.�/rl��:'� �, STATE�GjGr �ZIP�-���� f TEL �77 'r �� �7 v 1
FAX— JJ CELL' I EMAIL:�lLP .�I63 9 �-7 . C�
OCT 16 2024 I