HomeMy WebLinkAbout2017 Plumbing#? 10/03/2017 08: 45AM 5084870436 FLYING PLUMBER_ P 01/01
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At ., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT ii0 PERFORM PLUMBING WO
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JOBSITEADDRESS I - few- 'beJ L A( OWNER'S NAME 'df ic(-:-4 0e39J_ I
POWNER ADDRESS 54 .e_ TEL FAX i
TYPE OR OCCUPANCY TYPE COMA RCI' EDUCATIONAL Li RESIDENTIAL� ---------
PRINT
CLEARLY NEW:E1 RENOVATION:ri REPLA EMENT:E PLANS SUBMITTED: YES NO—
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FIXTURES 1 FLOOR- BSiMI 1 2 3 4 5 6 7 B 9 10 11 12 13 14
BATHTUB 111.1M1111.111.11. .._ .. .._ ._... �— FMN ?�
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM . M101
DEDICATED GAS/OIL/SAND SYSTEM .Ma m.gm WilliMmimiimmilliit.ME
DEDICATED GREASE SYSTEM ; .jimmiting_
DEDICATED GRAY WATER SYSTEM •��� - T��.-_.._ _ ���:
DEDICATED WATER RECYCLE SYSTEM �` _ -- - .
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DISHWASHER ;�;0; —' . _
DRINKING FOUNTAIN 4 ;M .; .......
FOOD DISPOSER NIBM; yr !
FLOOR 1 AREA DRAIN _Mai illilkM1-
INTERCEPTOR(INTERIOR) !1M I—�.1111. _ -
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KITCHEN SINK osi ii _ .a ---- ur.i� _
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LAVATORY 'NM:; :NW--- _—:1_' t i.�..._,.
ROOF DRAIN `; ! '
SHOWER STALL -
SERVICE/MOP SINK I I
TOILET i I ' =- -�
URINAL _ n_ Imo- _ I—, wrisitmumm
WASHING MACHINE CONNECTION r W 1W116.111111111111.11111.11r
WATER HEATER ALL TYPES 1 � � _
WATER PIPING i��l.�' - iI -
OTHER i yi a. 'J2 la. '{� __
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IN^URANCE COVERAGE-
I have a current 11ablIlty Insurance policy or Its substantial aq ivalsnt which meets the requirements of MGL Ch_142 YES NO Li
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERA e E BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POUCY.4 OTHER •E OF INDEMNITY ^} BOND I 1
OWNER'S INSURANCE WAIVER:I am aware thatthe limn-—does not have the Insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this ,ermit application waives this requirement
___. -_ CHECK ONE ONLY: OWNER fl AGENT (_
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have auuxn :•or entered regarding this application are d a E st of my knowledge
and that all plumbing wail(and Installations performed under the pe -t issuers for this application afll l be In compiia II Pertindnt provision of the
Maseachtcs�+tt.State Plumbing Cn4 and Chapter 142 of the Gene_ Laws_
PLUMBER'S NAME R.0 N S 1 N G-ETZ LICENSE# tQ-1 SI RE
MPZI JP E CORPORATION i t#- - Si111 PARTNERSHIP` # LL l#I i
COMPANY NAME FLY 1 r4 &- f'l..0 In R.r�1I-4 i ADDRESS 3$ C e_k_E-K ir,-D -
CITY P R QU i w.-G-jCX J^-J STATE 1'11 itii ZIP ' 0-4-C S') TEL 5o -4 1 - 3 O6c1
FP H S 1 oy3ki LL Saco-' 491 EMAIL JF 1 y l N5 pi uriloe:.s @_v Z ot�e$.i l .r\1c, r-
j i OCT 03 2011
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