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HomeMy WebLinkAboutBLDP-19-001372 MRP: FIR 12c et ; MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK il•-_'i,=74, =ti = y CITY 3 1 MA .DATE q'7 ` g PERMIT# l .417- -c'o ;.,�� JOBS ADDRESS 7 1 +41-- 6 74 OWNER'S NAME j fit_ _ C�_ ._ ' POWNER ADDRESS' 4.-,-i' UN.ir rC g TEL 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ID RESIDENTIAL® , PRINT CLEARLY NEW:❑ RENOVATION: REPLACEMENT:0 PLANS SUBMITTED: YES® NOD FIXTURES-1 ••- BSM 1 2 3 4 5 6 7 8 9 10 MEM 13 14 BATHTUB !Mt ____:=E_II.. _1 __...,:i 1._M IMINIK=IiiillE__ I DEDICATED SPECIAL WASTE SYSTEM _____ 1. „ _I[ _II:n=1= DEDICATED GAS/01USAND SYSTEM 1 r i , DEDICATED GRAY WATER SYSTEM , ._ ' DEDICATED WATER RECYCLE SYSTEM 1l h. I_ —__ i—''�. J-■.�—I_�L_ �i DRINKING FOU z __�, (_._t MUM IONIA FOOD DISPOSER ao '.11 _ - __ _ .M.L . FLOOR/AREA DEAN o ' i. 7I.Mr,---i=i ��,i._... _`? .�__, INTERCEPTOR It? 2IOR)_ a 1 I- I-- 1... __ I _ 1.-„--- KITCHEN SINK I W, r% _ - I I .� ..'.i 41-- '_ LAVATORY « I_. it 1 -:i. __ I, L ROO SHOWER .-. L -ice _,; - 3 MOW I_ SERVICE/ •'z, Ii �I _ __JI J ___ LE__AL_ _ :— TOILET _ ' ___5}} _ r 3 WASHING MACHINE CONNECTION WATER HEATER ALL TYPES e 1 -.._I 1 , - INSURANCE COVERAGE: I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES® NO El 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 signatu on this permit ap.Iication waives this requirement. L �,5 nre2 rui0 L L L. (11 • CHECK ONE ONLY: OWNER AGENT (� SIGNATURE OF OWNER OR AGENT V(/�,,A (441 .G �2 • I hereby certify that all of the details and information I have submitted or ennfered regarding this application a e and accura: lei- y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in mpliance with�,/..' • ision of the Massachusetts State Plumbing Code and Chapter 142`of the General Laws. fad PLUMBER'S NAME f L 1LICENSE# d SIGNATURE — MP JP® CORPORATIOND# • PARTNERSHIP®# - . 1LLC1#MOM •COMPANY NAME 17 \ge l P , ADDRESS Grp 2 > ' ..f�f'0 <_ •, }'6.- - CITY (Ll+ ,SI 5 'Peel 1 STATE Wiri ZIP OP ircf.— 1 TEL j 0- 3� 1 FAX 1 CELL EMAIL 1X251 (�`'< ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ ?(0.11-/ �'" �� 7( FEE: $ PERMIT# PLAN REVIEW NOTES lv r "2 /7/. /✓ • ♦ ?AI