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Home My WebLink AboutBLDP&G-16-004637 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _ ,�� /k-V '/b 3`7 ti®;t Y CITY P yAr2mocr� MA DATE a i I c. ( � PERMIT# Y�P- JOBSITEADDRESS I-J`I CQuni Y 1.0A , OWNER'S NAME L.i i_L, q,n 5G+--111El...L. POWNER ADDRESS ,_ _ _ ,- TEL!;3i"`CIS-I 3 c IFAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ® RESIDENTIAL L PRINT CLEARLY j NEW:Li RENOVATION:J REPLACEMENT:® PLANS SUBMITTED: YES❑ NOIjj FIXTURES 1 FLOOR-• BSM 1 2 l 3 4 5 fi 7 8 9 10 11 12 13 14 BATHTUB l�� !MI _. _ 1 I i I i i ... _ II n CROSS CONNECTION DEVICE I 'I I �� i 1 i `I I DEDICATED SPECIAL WASTE SYSTEM I ( I _ 7 4 i i_--- I __ _ '1 --I � 1�� II I i in ,. DEDICAT D GREASE SYSTEMSTEM � � DEDICATED WATER ECDEDICATED GRAY YCLES SYSTEM 1IIl 1111 MEI lf mI I ��:m'nom� I Il DISHWASHER I '. i ! '.NII I - DRINKING FOUNTAIN ' . ati MN AM ON"illiiiinflinli FOOD DISPOSER inrinriniiiiiiiimminurunirowslionminr FLOOR I AREA DRAIN li Illsourim INTERCEPTOR(INTERIOR) Oil IIMIUMMIl M MIS mg.10 1 1, KITCHEN SINK _� IINMpaw ! if LAVATORY '—' i II 1 ROOF DRAIN . ' SHOWER STALL ; II �! ! I! SERVICE/MOP SINK i I 11 i l I I I i{ 1 TOILET 'I II i URINAL i --- ------- WASHING MACHINE CONNECTION r - I(-- ( , ! _._ ' WATER HEATER ALL TYPES _ I I WATER PIPING I 11 li I OTHER , ' I MIIIMIN' I j i _i -1 1 III IIciilllll INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ( 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Li 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 Q AGENT Q 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 c mpliance wttb-all�t.provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Chris Briggs I LICENSE# 12901 I SIGNAT RE MP IA JP® CORPORATION D#J3238 IPARTNERSHIP[1# lac 1# COMPANY NAME Briggs&Heino Plumbing&Heating Co.,Inc 1 ADDRESS P.O.Box 538 ` CITY Centerville I STATE MA I ZIP 02632 I TEL 508-778-0816 1 FAX 508-775-0404 I CELL I EMAIL rbrihji aol.com aii- ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES - Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAIN REVIEW NOTES 1 - J 1 - 1 1 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1 f=„" CITY (HEST VA1 1 -a-! MA DATE I r 4 14 �I PERMIT# 1��/�l '/b JOBSITE ADDRESS .5 C_et irtiT'y koc 4 OWNER'S NAME (.tJ I Lt_a i ,7] SGran ELL. GOWNER ADDRESS —1 TEL 63/ -.54C-/884 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL Li RESIDENTIAL LA PRINT CLEARLY NEW:® RENOVATION:® REPLACEMENT:® PLANS SUBMITTED: YES ill No Li APPLIANCES 1 FLOORS--' F 1 1111111 vw9 1111 8 9 II 11— 12 13 14 BOILER I�'� � i ii 1 BOOSTER 111111111111.11,1111111 iiii moilmen ME MIN min limiimi. CONVERSION BURNER lipliggpr,mil.'um gm minammessim 111111•11111E INN IMO COOK STOVE MINUMMilliii11.111.aim ME m�;I DIRECT VENT HEATER ice. 111111i11111.111111I I' II I DRYER nilintimm• I FIREPLACE ' i . FRYOLATOR —i=il i�l ink NMI I IN"MiI Millaill.11111110111.11111 f J l FURNACE --- URRRIWUIIIi GENERATORGRILLE II ' ' II_i_iINFRARED HEATER LABORATORY COCKS I MAKEUP AIR UNIT is iningoll 1 1 11111 !1 '�OVEN I I I POOL HEATER I I,i1 ROOM/SPACE HEATER I�i �l�l ��i��l�� All ROOF TOP UNIT I (�I�� I��I�I TEST MN i ' Ii ilk, UNIT HEATER 111 " I _._ In.11111111111111111111 I UNVENTED ROOM HEATER Ifi I I r :I mu mu N ismI mot immiliiiiiWATER OTHER HEATER iUINNIR m'IU R.0 � -. 'O1—� I —1111111111111111111.—i——1— amlium INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO Li I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L.d OTHER TYPE INDEMNITY ❑ BOND ❑ 1 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 compl ce with a rtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. s PLUMBER-GASFITTER NAME Chris Briggs I LICENSE#112901 �� SIGNA R�7{� MP ,.1 MGF(-I JP❑ JGF _ LPGI❑ CORPORATION D# 3238 1 PARTNERSHIP❑#r— 7 LLC U# COMPANY NAME:Briggs&Heino Plumbing&Heating Co., Inc ADDRESS P.O.Box 538 j CITY Centerville STATE MA ZIP 02632 ITEL I508-778-0816 I FAX 508-775-0404 I CELL 1EMAIL rbrjhj@aol.com 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 .� 1 1 I - N