HomeMy WebLinkAboutBLDP&G-18-000472 V
- iiiIASSACI-IUSE—::S UNIFORM APPLICAT IOi I FOR A PERItii1IT TO PERFORM PLUMBING WORK
_ CITY 1 L *-Md rat f MA DATE 76'YI7 t PERMIT* nPVg:-19432`i7:
Y.— F
JOBSITE ADDRESS I %i•d 1 L,FL •, y OWNER'S NAME J vG fi emori - s
'-
owniERADOREss LrA.►7,:,--- 1 TEL SVe-��:�s-y.�1FAxl -- .. ;
• TYPE OR OCCUPANCY TYPE COMMERCIALU EDUCATIONAL j RESIDENTIAL
PRINT
CLEARLY NEW:0 - RENOVATIO!N:0 REPLACEMENT ' : PLANSSUBMtLED: YES 0 NOI `
FIXTURES l- FLOOR-* - , BS;vi 1 2 ' 3 ` 4 3 1 6 7 1 8 9 1 10 ( 11 12 1 13 } 14
BATHTUB ' - I • -L i; r< i - it t- I 11____I
CROSS CONNECTION DEVICE -.-- -0-_ --11- 4-__7I_ _''._._.."i ., =L__A___-_4____A__.1.____1I
DEDICATED SPECIAL WASTE SYSTEM i _i ! __ _
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DEDICATEDGAS/OILISANDSYSTEM !I_- I- ____` ,I..�-_:
DEDICATED GREASE SYSTEM lh { II JL I u . I! ul i =1 3 J `';i_.__-'I
DEDICATED ED GRAY WATER SYSTEM ( s ' j J JJ-. '! 4 '_( •(—
DEDICATED WATER RECYCLE SYSTEM Il Ii{ _ `_ v y_ L�•_ ___i i, Il i;
DISHWASHER - --____4L_ ! l: I— - ..I,._...... `zL �`—ail ' ---•
DRINKING FOUNTAIN t;_ _ t. .
( FOOD DISPOSER - II___. —j1)—II — `I_- ' "= E=_;I _ _�— _ __11 1---�.s
FLOOR 1 AREA DRAIN Ij 4 .• _
INTERCEPTOR(INTERIOR) II tII lq_ 1 _I1---f�d _ __J;I" iI II YI - 11
KITCHEN SINK I it ill "L• I e i .al g =`i—i<
LAVATORY j - iL 1 r L i1;L —`(—"I— t
• ROOF DRAIN R �I_ 3_ ___-.__3t t1_ _II _.4I•__�__._!„ii(__,!i,_ LIIT 1---. I
SHOWER STALL t' -- T - - -� t
SERVICE/WERTOP SINK I�..__.._.1"•_I; :: a; is E ,!:-__fi:_____i____J: j _—_.
I l- III--1 Ii.____sf if _ '.—._i1 ;I____I t-_-__ I--
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URINAL
LET 1_1 U 1I—
Ii I1_._11 i I�`I_
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i. L T S [:
WASHING MACHINE CONNECTION ' IL___III ii III II Inirn, ' =1 =R z
WATER HEATER ALL TYPES II - L - r • i _ ,- y
WATER PIPING - I !I iiE—" i G'— — II 3 __.-i
OTHER '—3I MIME - - =I e s,_
- — - sl — 7_IIII u[�I G "
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l`_i III ti i3 = i! 11 t1 ii—i 4 'il Fl i f _I
INSURANCE COVERAGE:
I have a curent liability insurance policy or its substantial equivalent which meets the requirements of iikGL Ch.1§2 YES ErNO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
-
IJABILITY INSURANCE POLICY E------ OTHER TYPE OF INDEMNITY 0 BOND D •
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 0
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 i mpriance with all Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws_ -
PLUIJidER'S NAME r.fi n�:�r C,. �i C-'i 7 U �1 'LICENSE � ? � _ - N RE - .
MPIr JP O CORPORAATION& 3 eiCt r'Y 3PARTNERSHIPEN f LLCD - -
COMPANY NAME': _Oa.e/c�rie6,j jy iI )vM-s ADDRESS -Io Nfi}riv t- .."( 4;,ir-Zi' ./Y6 ,
CITY a7/e;victoa l STATE /W4 i ZIP G,2-,a. ! TEL Sao-3Lo�- j 4
FAX .. -� - .CELL, , ✓:va y�l EMAIL Lf'�f/(4 P 3 L..4/:�.-•-/11_,... � - . - t
iO$Right of Entry.•tJhcre kit nce anyto aaraanicsp,S.a:L to c.ac=rim pFaisions of tins o:,aai=sc the cior hosreosoaable auto to bet-meth:a there nits i.•tasatrturc oru.. .ta p:�n-ssa condnino'which is mrm^ry=m
inwslationorM cute tri"L:Ele=s Cho conaseorpsole=teLit: =or1=c r,tilt&coca.isocci iuJto tom-the ra,.S+.,orprocre,•+at ambLiconstoi or mot:frank the dunes L't aseilbyth8mdn.
pm cw videt!et Tamil pvnk^s bor.,- a noh•r1thatri^mahis he prtzx5ed to the oxeparszrd mtty requested.lfsudtasuaure c-ptcnises in uLtaatpiwi,tit i p_n a9 firs ratkuccorW=e r ei'tcr to t=te ttm ern_:or UC"
other pesaihavingc.'wrgeortwrdarafth.scu-msrcpsmkes and requ nt catty.Itsencyisreieavi,the i,ue t rsha1havermorsecotherzm-1re5po ddedbyiasvtos,ivaeit:.
c ti'_A$SACHLIS I"s S UNiFOR I.APPLICATION FOR A PER,IW£T TO PERFORM!GAS FITTLIAIG WORK
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z:c CITY '1st Xny_ _t Tz1_ iA. DATE L. LZ [ PERM€r#// -i'f/(-oc{'%72
JOBSITEADORESS ) / //,j/r,_ L.9Nt _ ; OWNER'S NAME) p u Cr /i' i)ci
1
i;. ,� OWNER ADDRESS: 1 51971'J-:--- I TEL:1.S-G -7 j -37Y FAX: --- j
``- - OCGUPANG Y TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL
LEA ,_Y Nat 0 RENOVATION:1 ii REPlJ CEMENT:J' PLANS SUM I I tit YES II NO
FIXU T!'ES ?- FLOOR— I Bsnn } 1 - 2 } 3 . 4 6 } 6 1 t I B 1 S } 10 11 1 E2 13 1 1 I
BOILER I i } I BOOSTER
} - f I - I-
COWERSION BURNER ! I - - ! I
COCK STOVE -
OIt 'LL! 'vlEiliT HEATER ! - 1 I (
DRYER: I } `
FIREPLACE }
FRYC2:LATOR. } -1 I
2E -_ATOR I i 1
I } 1
-.:_-CF a oRY CC-C S I I _ } I
AIR!;;!IT I I I } .
O'JE.I: I I ( I
POOL HEATER i ! I 1 -
ROOM 1 SPACE HEATER
TEST - 1 ! ! 1
i..INUi I? i_R ! ,
LtisiVEi I ED Roo'r i HEATER i j--- -
— -�— 1—}f-- .��.
WATER HEATER „`_ i / } } I }- `1 } _ - `I 5 V
..__� f } I I 1 I ! } } �•
.
! ( ( I I ( } I I I I
INSURANCE COVERAGE
I have a current tiabilitv insurance policy or its substantial equivalentwhich meats the requirements of NGL.Ch.112 VE5 t ND 0
If you have checked YES,.piease indimte the type of coveragebl checking the appropriate box balo i.
LIABILITY-INSURANCE POLICY EL/ 011-IER TYPE INDS-0 f 0 BOND 0 . -
OWNER'S INSURANCE WAIVER:I am aware that the licensee doss not have the inalfaliG8 coverage required by Chapter 142 of the -
•
Masssachu5ett General Las,and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER 0 AGENT 0
SIGNATURE OF OWNER OR AGENT .
hereby cerdilr that all of the details and information I have submitted for entered)regarding this application are Tree and accurate to the best of my,
Knowledge 2nd 11121:211 plumbing Wort:and lthiallaiions performed under the permit Issued for this application will be in compliance e with all Pertinent
provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,� � � w 2
EI�r1 W; . NAME: f14- 6 G ` iy eGt8r� �LIGEDISE � SIG\ IRE
Pt unri� C�rsfl i I Lt.(( n ��• �R I1 J _ �� ���
COMPANY NAiv1E: ,T t'' Ai�.� �; r ! ' �•- -�r'� f
�-� f.(r� t'!c-�?.j l�t!'C•L I rl►Da,ES$:i�r1�S�'ll-��ii c
Cl 1 i: l�l�Jf V/ -.rl' ./L (STA E WA ZIP:I D`9 r7 77 _I F1 I-SV%:?9`1/j9 14.5Y
TEL: vr- %,=38"�S 1.CELL:IE5 2Qi&I EMAIL: cF'j Lr& 3c,r" v_r7S,h<9.!JCam✓ 1
MASTER 1 OURNE'MAN 0 LP INS i ►A4 ERF .0 CORPORAT!ONgK=) '-'PARTNERSHIP 0#1LLG 0#{