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HomeMy WebLinkAboutBLDP&G-17-003630 MAP : PfiReec MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �_�, CITY _ �/�!L t 11'U t! ._ 1 MA DATE PERMIT# 42r "/7`O�73Jp 0 JOBSITE ADDRESS ,�.5 A,1;c J Ins IA- 1 OWNER'S NAME Qtin ( -xv re.l3 d u 3 k I P OWNER ADDRESS _ = TE11500776 '464 $FAX TYPE OR OCCUPANCY TYPE COMMERCIAL L] EDUCATIONAL ® RESIDENTIAL ►d PRINT CLEARLY NEW:© RENOVATION:© REPLACEMENT:Li PLANS SUBMITTED: YES® NO® FIXTURES 7 FLOOR-' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB , CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM !, Mt ___; __ _, . ;,, q I 1 ._...__ ' DEDICATED GAS/OIL/SAND SYSTEM ; -All I' --_,a _ _-- I I; J _•_ DEDICATED GREASE SYSTEM ' , DEDICATED GRAY WATER SYSTEM __ i1_- _ I _i, '........11......: __ . it 1 - __ 'I___. .. I -. DEDICATED WATER RECYCLE SYSTEM _.__h _ ___- _ I _. IT!. . '--t__i �- I, DISHWASHER — _ ;._ _ I - I - -._-- _ -- DRINKING FOUNTAIN ' is 1-----.!� li~.- -- i— - i1 I FOOD DISPOSER _�I;T, 1_.._- II II II FLOOR/AREA DRAIN _ __ . ._ INTERCEPTOR(INTERIOR) __ . I KITCHEN SINK _._ 'i _=..I__ i �;_____I i ___ - ., :---- ._i - -- I, ; ROOF DRAIN - __ ; I— __._. _ I_._. __ _____ _.__ _ _ i SERVICE/MOP SINK j ; � I I �' ' SHOWER STALL1111111111.11,i , i I I W I W ! TOILET ' mmiiiimingian URINAL WASHING MACHINE CONNECTION U R iiririllaTIENNIIIIM.1.,11,12VESIMIEWII WATER HEATER ALL TYPES 1111111111111111111111111111111111111111111111. 1111111111,1111111111111111110111111111111111111. WATER PIPING _ 'i _^... II _- ...__ OTHER __ _ -- .,._ ! !! ! ' :, ! _ I INSURANCE COVERAGE: I have a current liability insurance policy or substantial equivalent which meets the requirements of MGL Ch.142. YES D NO LI IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 (,.__I 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.: +nce Berfinennt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Kw r_ ti_Gler'ci P 'LICENSE# I &ao j SIGNATURE MP(III JP J CORPORATION rzi#c;2$6k C_PARTNERSHIP 11# - J LLC(I# COMPANY NAME ,, Mc,(,,/jfrJ4.)4 ,�.a�;'.,G,. 1 ADDRESS _._--IL_(7,_o_ �L ti—__.__—....__ ___ _r -•-- .- CITY W. y n,0„,41., 1 STATE jr A I ZIP_ 0a L 7'7) TEL (5 d E)-7-? 4554 I FAX 4of 7Zo-b--il CELL 1 EMAIL [ T.- ---6-- JAN 17aaii . . ytD AR 1= P / p / R c e/ MASSACHUSE I I S UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Crry !Town of yAQ M o 011-4 ° MA DATE' i` -�- 17 `PERMIT#&PP-(7 10 6$6 - JOBSITE ADDRESS! ''), Ili r jir)I C,‘„ Dr _ !OWNER'S NAME I Don { -z vz-,n/' lit', - GOWNER ADDRESS { illat:0 )776'1446 1-t )FAX1 — 1 TYPE OR OCCUPANCY TYPE COMMERCIAL LJ EDUCATIONAL ri RESIDENTIAL' PRINT CLEARLY NEW:Li RENOVATION:Li REPLACEMENT:i_,i PLANS SUBMITTED: YES Li NO; APPLIANCES 7 FLOORS--+ BSM 1 2 3 4 1 5 6 7 8 9 10 11 12 13 14 BOILER - I f - .- --- _t_ —T.JI U Ii BOOSTER i i_ CONVERSION BURNER ,` r'. _ _ ; __I I JL__E_ —A ___T L^J COOK STOVE r _ J _ ;L__ - DIRECT VENTHEATER _--_ 1L J I III .1 -_ 1 ' DRYER _II "_a .NI �M ! _ 'i 1.111r. 7-1 FIREPLACE , � I _ 1 T..l _ I FRYOLATOR L---__ _--3' 1 -� _. --,-$ i. __ —,Y. _ - — 1 FURNACE7 - - • -- .1 I 111 __ ,1 i _ if GENERATOR _ _'_ .J _ GRILLE ' - �; '1T - Irv,■_l7l.: - INFRARED HEA I EH ' _ i . A;._ _ ' ' - . _ _ ; LI fit I d LABORATORY COCKS �_ _$___ _ 'I_._ i" ; J •-,' •i •in• -6--- ! s MAKEUP AIR UNIT � � -177 OVEN J4 r� .l�.. tto'ILgI+�I( - POOL HEATER Inca ., t "�' ROOM I SPACE HEATER1 _ M ' 1 ROOF TOP UNIT �' TEST ' 1 -- � tea_- _ __ '_ k UNIT HEATER I . : UNVENTED ROOM HEA I LK i __i R_ ____.,t '. __A__ 0____ ::_...___IL___.._ ._,_ Lam,-- WA I EH HEATER - ' - , - ,,` v _ - ' . c-�L - tii OTHER I - _ _ <�_� _ .-_ ,. 1 �F_ - MEW INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [J OTHER TYPE INDEMNITY D BOND !_�..3 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusfttc General Laws,and that my signature on this permit application waives this requirement • CHECK ONE ONLY: OWNER D AGENT C] 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 a bett of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance .IT ' provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFI I I ER NAME lip;n ir C r. 4' . !LICENSE 1 j�1 Q n I NATURE MP Ia MGF Li JP IJ JGF Li LPG!0 CORPORATION #1a 8 0'G 4 PARTNERSHIP LLC Li I COMPANY NAME416,,),rnc'6r;c)e Plum--1-1- .2,-_-4 i cAADDRESS! I I_.- C'__ .. __ A._ _ :_ • CITY W. `r.r'rn,)„-+1, • STATE IM ZIP _4.P'67.3 4TELI 55 ) 17g- 4 56 1 - FAX(r5u87=tc)-r-;7k5;CELL EMAIL ' 1 - JAN 17 L,I, l i . t` i PARTMr , cae(i., • .. .. •, ..-...f • • 4 5,. • • • • • • • • r . r -