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HomeMy WebLinkAboutBLDP&G-18-007115 • - I I1ASSACHUS;_a=S UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - IA= . - - V._ - CITY' •,bt. , ��PqqA . MA DATE}(,�112_1i�_ Q»r P-l�- 7ir " JOOSITEADDRESS �1V[J7f7 j'Lr� ? OWNER'S NAME a*¢-Lbi,L' I0c t»,,.- - I P OWNER ADORESS qG Lbiy, )201 Ta) -off 36�J a3 4FAX . TYPE OR OCCUPANCYTYPE COMMERCIAL 0 EDUCATIONAL RESIDENTIAL _ PRINT CLEARLY NEW:0 - RENOVAT I:ON:D REPLACEMENT :PLANS SUBMITTED: YES�;ii MOO FIXTURES 1. FLOOR - 1 BSM ) 1 i 2 1 3 I Lr. 13 1 o" 1 f 1 8 1 9 } 10 1 11 12 1 13 1 14 BATHTUB - 11 `I 3 =i __i tll__I! - i 7. *I =I LI_ J1 CROSS CONNECTION DEVICE a _ ' M r 11_ J 4 1i DEDICAtEDSPECIAL-WASTESYST8UI L _I! - - Ji—_ i{ 1 - � __ it �_.- .11 f -- . li - _ _i1.-,_0 .i. ._ I DEICATEED GASIOIUSAND SYSTEM - 3 _ - DEDICATED GF.EASESYSTEM ii . fi =1 i�`I^i( i tJ III III j—i__ 'L'��i DEDICATED GRAY WATER SYSTEM R 1 U N. - Jt li t • U :i_ r(—(—! DEDICATED WATERRECYCLESYSTEM jl r9__I}1 U . x( s 1i ii i'—_" `! 1 —7-1U-7 DISHWASHER - 1_---1—_I1 al L al_ -.i1__J1 I—_I— `I._ 14___;l 'I 1__1 DRINKING FOUNTAIN iI I7 __III __11 _J ;' s, 1. i-`� ;I '[ } `I ' FOOD DISPOSER - II i1 l; i _ 1 ! i, r�=_r I' t U 1 I FLOOR// EA DRAIN 1 �I_ ;l r__ I — li 11 is is _I - 4 I IN ERCEPTOR(INTERIOR) II iii !.1 I] gI 4 U U t4- €j p y1 -{ I KITCHEN SINK - li _ ir - l i! iii 1, ii UI i'l it €J_.. 11= t—:::1! LAVATORY - II !LI _ t°I ??I_— l !.1 `U-1!I it 'ill <aI • ROOF DRAIN =' _ ___I: a • I!_ - '! 11•____[7.71 SHOWERSTALL II_- i1 JII —11 -fl 11 "I II 11. 1 iL_i UI, z1 A il SERVICE!MOP SINK I_if ii_11_.__11__ill - -i 1___tJ il ii___ i_ '_ - t __ ,I TOILET II 71_ U II .il is_1i __ - F=I U •"h—ll URINAL I L______I —i =_ " iI— i� B � ;Y ,1 g{ c WASHING MACHINE CONNECTION ' L - is i;I I i i II ti WATER HEATERALLTYPES i `l.._.E�__._N_`{ ill i3—.__jC1ii .____.1^: t i;i 1 11 ..1__.11 WATER PIPING II l!l EI {i N. il___�L _.�1—__;1. d'i--.i: Ii1__; '"1 '{—_--_1 OTHF ( . i I 11 =! _� t �l ;1 JZ a! 5i l 1.—, - - ,I 7 1l_ 1i gi i:i it �5- �I 11 ='I Ui LI—._Ii - { -- - — !F =1 iii 11 =i____II =1�_Sy =l -i U 11 [ �____.�_ - - I Tt;r _I IL__il q - it =(—IIi F til• rill =L rU { =1 - INSURANCE COVMAGE; I have a curentliability insurance policy br its substantial equivalent which meets the requirements of lifiGL Ci.142 YES ErNO Et IF YOU CHECICE':D YES,PLEASE INDICATE THET=PE OF COVERAGE BY CHECKING THE APP:OPRIATE BOX BELOW IJABIU T 1'INSURANCE POUcY 2----- OTHER TYPE OF INDEMNITY 0 BOND 0 - . OWWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required bl Chapter141 of Lila • •Massachusetts General Laws,and that my signature on this permit application waives this requirement. - . - - CHECK ONE ONLY: OWNER U AGBIIT Li SIGNATURE OF OWNER OR AGENT - - I hereby certify thatell of the details and information I have submitted oreniered,eya,db g this application are true and accunaie;n me nest of my knowledge and that all piumbina work and installations pefformed under the permit issued forthis application will be in compliance with all Penmen pmvision of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws PLUMBER'S NAME }p5 Oh 67,a;.'t;ig C.Cts7•R., -t) 'C f° I.UCENSE.I 93:�i ; - r `S1GNAT URE , '" / _ MP 1r JPD CORPOR�ATIONE# 3CICUY}PARTNERSHIPCr 1LLG � - - COMPANY NAME!3 ,r>/ r�f/9.r ADDRESS9 ?�- if j U cf 1 `7)U' fa u/ % 'Jt/� �!1 f+�If v—s✓rri/i3r, 7 ,J �' ;STATE 1 ZIP ,' f. !EL . o ``'�.� 8 s L f? CITY /��'7liil/IJ� �i�l �'`�r � � G� 3� TEL 1 FAX .7?C " r%?CELL,�S` ,5-d;a0 j EMAIL tr(?�2 P sly'%�rLA3 r'2 %,� ---i 0'.55 t:offntri.•tlha o.tirs are^ :acadtarecirg*""mMil=t`•p IniST2•sa4des..'"hcethai7M=rtus= a Ja�tn6.,neth_.the.a.b, �n..ssL.v=ecu n=2. Lnks1=miLhtsiso=n.• y=x _.��.,.' :i-.rs�C-:.,_cm�^rn�tnrr?.'����^.'c*--tea-". t .. art1 H=xL'-"l' a= lha�.vLuetarF r--cr'. arF=-.71 ^'=---i=s=t*C'=-itc5.s= `-=-_� Imrndestitetif •rtittaurecrCeratrs me retleatacimrsisimpcse=a.dto:he^ =�^�=sip=Ctaeate..tiwdtstm..vrcapersa=suas.,..sn.rtar. .. raaEc�t �-u t tc:h a•r. ar ahuplron1=•laEdurv"ar=raztaitirocF='-n�ao3rFrpe csrr.Iicrmyiscevard,t}r_insa siaeFauc,r ut :oriverevspt ztr•=ciInv:asttv:ccirri: 349fR--5-9'4Ci i2.SETTS 1,11WFi RIE APPL4G4. c71L FO.R Ll?EMT(?O S•"GS`:FOREr GAS F.,Tr ie li OR 1"----.3--4 My CITY L �ki MA. DATE /i)11 , PEi?iit1lT r 1'IP 71"474' 7 ii JOESI 1 EADDRESS 1`-I/., t jr} i/v-,Y�%(�-, / ci ! OWNERS NAME t� � - tQ�l /dl I OtrYitlER ADDREss: 1.qC _ 0 �., ,. ,.�-. I!'-:k I �I'. .. ? ) ? i FAX I --'•�`- OCCUPANGY i''PE_-. r ui E- •r, - t PPmr7 �Oi i��S��Cif,L❑ �UCATIaf��L LJ RESIDaTI►0 CLEARLY SEW:0 RENOVATION:i i REF ACE?MEN:0 PLANS z&HAI !i tU: YE-SO MO 0 FInid T Rit8 7• FLOOR-- BEM i 1 Z } 3 - 4 5 6 1 1 18 I 9 I 10 I 11 I 12 13 1° _BOIL PR I I f ( 1 ( 1 I I aOOS I ER - 1 1 I - I 1- 1 1 1 I CONVERSION 3URN1=P [ • 1 - —I E f { I 4 COOK STOVE. • DIRECT'kit-ENT HEATER 1 _ I i - I I 1 nr,:y_. I I I '_1 I - P!r_ ACE I - l I I ( F TOR 1 I I —1 I I I i 1 ) 1 __.= OP 1 1 I I i I - _ E i E - f if . -'VF'A CRYCC-C! i I I - I 1 ._ ' ^.ER LINT I f I I_ } . O\/I.� i I 1 E f FOOL,•1rATEI;; 1 I -1 I I ROO'rdi I SPACE 1-Va� I I I ! ! 1 ROOF TOP UNIT - I 1 f ( I I I • I =v - I I 1 ( i I I - I I F '-INtlr1 AT_R I I f i I I I U,ii/2tii=0 ROOM Maki w� I 1 E t • 1 1 1 I Vl' iL<<„ i�.R I I I I I I 1 1 I 1 I 1--1 i __•_�____ 1 I I i 1 I l 1 I I I 1 j f 1 1 I I I 1 I I 1 I I I . •i I 1 I i I I 1 f 1 I f E - I I I I I I f I I ( 1 I 1 • IM uRAr CE LCCVO,,AI E _ I have a current iiabilr':insurance polityorlis substan2ia:equivai sfaicd1 meals ilIE)iu i i is of PiiiG ..Cif.«G YE it NO 0 Ir you nave chocked EES':pi2a.48ifl!c.'ste EIS i.3ruaof cover-doe bych cidngtheapprDP.`ietebonr'=..Ios,- LITSILCT KS. U ftilICEPOL iCY IL' OTHER TYPEIi'IDE.la U BOND 9 ' 1• 0i'Ui iEI'e IILISIIP,A JCE WAIVER:I a_oi aEBre that[fia ilc esE doe Jno=gala the insurance cella-alga required by Chap a f42 or to _ M a szachusetim Gene:si LE,,and tilaZ niy.Signa©re cal lifts pa It appIlea"Lo1!=giys this rquia"amenc CHECK ODE ONLY: QUIVER III AGE.Ii T 0 SIGNATURE CIF 01,1 NER OFF AGENT' - Hereby cerdij that all dine dales and in" m,ailon 1 ban subi'iiiiad for entered)raoarding This application are Ise and emirate to i12e bast of rli y Kliemiadge 2nd ittiai'21I IiltlrntingwQ;i arid InsiIla;ions psrfoimed under ilia pailssu&d for this application will be in c ri pllanoa with all Ijarinsnt provision of tiTa fausaahuseM Sip Plumbing Cods and Chanter 14-2 of the Ganeceel lit=s. - PLUMfGIG1i I I I R NJJ) In4-.Jrri cJAI/eRcCGTu1l'L ICE-MEL-I, SIGN`l U L• COMPANY NAME: 5- .,1; -,- i—/- & -C I ADDRESS: 1�P-fL'/ U=cc,/1 • i - r2F--_ CIi • .J,=7Jfr Llttr-r rr,J^J ________ ;ST.IkTa j/fir; ZIP: ___— 1.5�� "c —..- Li‘ CS-1:�.� a-7 tr;.9IE1�L�;IL- t'g'fiVii 0 ,rs'r-1 u ' 6r3yJ--a C�.f . itt-: Vn /n :; Er—JOURNEYMAN 0 LP 1N Ali.F,O, CORPDPATIOi�I-,< I.� 2� P tiiNERSHIP 0 it• ILLC r i_..,._..�. MASTER , o-