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HomeMy WebLinkAboutBLDP-19-006542 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1-4fly r CITY '�;0(L si 2MWIT{ MA DATE fit Al 1l0 • ict PERMIT# "©O 6 JOBSITE ADDRESS 1. 26 g,0V i k Z g OWNER'S NAME CAPE COD V E re WI* P OWNER ADDRESS 1, 2 a U,rK 2 il S vvro rni TEL 5O 3 A y 2.311 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMI I 1 D: YES ❑ NO❑ FIXTURES-1. FLOOR—E BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER —~ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK I LAVATORY91 ROOF DRAINq •! L S SHHSTOWER STALL SERVICE I MOP SINK TOILET Cf . _ URINAL j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts Genera,Laws, and that my signature on this permit application waives this requirement. otl/ v �C" '� CHECK ONE ONLY: OWNER' AGENT ❑ `� 1 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 curate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance i all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S N E C LICENSE# ��r SIGNATURE MP JP CORPORATIO 0# PARTNERSHIP/ ❑.# LLC❑# COMPANY AME Pol; ADDRESS CITY 1 5TA ZIP 0 !7 TEL — _ FAX CE45 3(/�6 �EMAI Mil�r� %� O U Met l iC 3(e coo +-« 6-0W 1-vo c(6 6) 5 ,srs 4, NII 11 O Z Z 0 P U W a, Z Q Z o m .-� n Z >- O F- U] [IDLD cc H U4 O - a. mt Z U w r CI) Ce I O ¢ LLI a O cn •••:, cc W Z 0 z a o Q U ._t a. a. Q bs- co W H p) .w.1 0 Z U 4 1 A A., c.„ 0 Z w 'kx -,,-, ., . ac U O t G4 i. It Accepted Plumbing Products C X , } ,avaa,.w+ r: rr:e ua F: .u. ;:-irynnea®rnn+uuxnwiw:wnnuaxwmrwo. ..•a.av-,.,. , tea;g 4 '11iC p patr► /p search.asp, pe=P&manufacftt' _ - 300- ;"'t 4 q :. --- • 474 HyTronic(IR AC)Urinal Valve — _ — -- P3 0317 HyTronic(IR AC)Urinal Valve- IR U 08 Geberit Mfg. 116.026 3/5/2014 474 Monolith Monolith System for Floor-Mounted P1-0916- IToilets Geberit Mfg. 131.126.SE1 9/7/2016 113 r ', o Monolith f f Toiletry 113 nolith System for Floor Mounted Geberit Mfg. 131.126.SG.1 9/7/2016 I0916- n -1 Monolith-Black — x} , 'f Water Closet carrier system Geberit Mfg. 131.028.SJ.5 9/7/2016 113 • 0916 ,, Motlolrth Sand 3 s. ,� Water Closet tamer system Geberit Mfg. 131.028.TG.5 19/7/2016 1111 0916 ' r Monolith -Umber P1 0916 ifs Water Closet carrier system Geberit Mfg. 131.028.5Q.5 9/7/2016 113 x pb Monolith-White P 1 0916 �rT Water Closet carrier system Geberit Mfg. 131.028SI.5 9/7/2016 113 "i ' . �:' Monolith System for Floor-Mounted „4,F 0 , T r� Toilets P3 0317 Ar ? Morolith System for Floor-Mounted Geberit Mfg. 131.126 3/5/2014 474 ` . ' Toilets �� �� ��r�,�. Toilets r Monolith System for Wall-hung Toilets P3-0317- Gebent r',f 1 31.028 3/5/2014 1 , Monolith System for Walt-hung Toilets g' 474 y * r � SIG./IA 8cm 2x4 WC ; Concealed salt-r;ung v:a:e c .-.:set r_ P1 0916 .$ tar per ;ri,h taro ,e.bent'',fg. 111.798.00.1 9/7;2016 113 Me ° WC Omega 12 H82 90 US i GEBEPiT DUOFI/:• In:gait tank and P3-0418 k r Geberit t',fg. 111Al2.C .x 3/4/2015 7 carrier for watt hung bowl 1,4 pp,} First Pale 4 Previous Page �'� i a x ac ) 2007-2017 Commonwealth of Massachu•- t t S11c F'olud e , ,� r z 3" k �'d 11*--.v.-.1W. ?•;,:IS',- ",.'''.,..lr...'..'7;N.,; .';,.:-..,,,,',„014,,,,,i, • ,;0,,,.,‘ Y -41,-,,,-1.,.1,.# • `� E A A. } j 7 3 ad d ■ lRi: J 4 3n •aer > 4�' F �, fi k 7 • fy. �. < � * fv 4. ,.,.','. - .- , : .T•• '':•••.: 'r.,44k::14,:.-y, .‘t,'.' ' 4> ' ' -''''C'''''Ite'�#a A. "n • _ , s '''' •0 -4.,,,i" * 4? ' "0-,X't0-....*3,,i•••••40, • • f �r �, �F • . M '_. • • .#i € t 3. x