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Home My WebLink AboutBLDP-23-11470 'NA c� p • !�GrcE vo ( � - 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK '"x , •IS CITY 'Y rrr�a�� h MA DATE -3120 I z PERMIT#824)4 Z3-gm JOBSITE ADDRESS 3 I/ U-trri Thrt OWNER'S NAME Di v s OWNER ADDRESS /I TEL 50b .NZS ' 1031o5FAx TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:16 PLANS SUBMITTED: YES❑ NO FIXTURES 7 FLOORS BSM 1 2 3 4 5 6 7 8 9 I 10 11 12 I 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 I FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK • I - LAVATORY ROOF DRAIN I SHOWER STALL SERVICE I MOP SINK TOILET E C F � v G _._ URINAL WASHING MACHINE CONNECTION ( ` JUL 24 2023 WATER HEATER ALL TYPES I WATER PIPING B i`Ui`I I l OTHER 'yv 7fI;_NT II 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 TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY igf, 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 ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 compile ith all Perti =- provision.f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. //� PLUMBER'S NAME art S. P ecl e I I LICENSE# `�'��(Q STATURE MPIA JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME C G r I F. R Cle e I I fi S c m ADDRESS 7 i 5- Ni c., rm St c e a A- CITY 05 -ervi11 STATE M/- ZIP 0 ;3Co55 TEL '5 - y - C23G5 FAX CELL EMAIL f �aJ �eCY rein.i '/F/)ELL_• i I ad' R H 3 9 ' r , rc c ( t(bfl _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I AV(p (,, a19=F CITY I..._ ZU,. � ._..... M ZQ A DATE _...� PERMIT# D(�` 3-//S/7D JOBSITE ADDRESS; 30 berry fVC OWNER'S NAME pails. . GOWNER ADDRESS L t1 ), TEL; • • FAX , , . .. .., _ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL D RESIDENTIALM PRINT CLEARLY NEW: RENOVATION:0 REPLACEMENT:X PLANS SUBMITTED: YES 0 NO APPLIANCES 1 FLOORS-, BSM 11 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER . _ CONVERSION BURNER 111111MIL ,, _.111111.111MIWILIMIntailniMMENIONESIK COOK STOVE 1.1101111111111111,11111111111111MMIII MEW DIRECT VENT HEATER l I II i ., I:. 11 . I DRYER . Ilr.<, I, , __.,1_.._ J. I( ._ I ,. F_ IIx._ h __ I FIREPLACE FRYOLATOR - -._._ ..._ I�. ice.__. . FURNACE i _ I '. !i , �i.. GENERATOR GRILLE I I t INFRARED HEATER i I I 1 IL i LABORATORY COCKS MAKEUP AIR UNIT I ' px f k IiI #I OVEN I it_ _ v< ., �:._ s..;- e . _ — POOL HEATER _ F h ROOM I SPACE HEATER II__A ,I ' F ,. -_: y ROOF TOP UNIT ' - 'i 1 TEST MO 0111 OM` MN I � UNIT HEATER L _-_ 1_,— E s ...1 1 UNVENTED ROOM HEATER '' .ffitor itti WATER HEATER • I a ' I LY (. 1 OTHER I , I I. ` INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 4 NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a OTHER TYPE INDEMNITY Li BOND L 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 SIGNATURE OF OWNER OR AGENT f,,,,� AGENT Li 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 complia ith all Pe 'aert provi • he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. �s PLUMBER-GASFITTER NAME I C G,r I S . R, e d eI„i,. ...,._,.. LICENSE# G S ATURE MP MGF} JP 0 JGF 0 LPG' CORPORATION #' a, ,._ PARTNERSHIPD...�# LLC # COMPANY NAME ..G..cAr) I R,edeil._,r.._._SG n. ADDRESS 1.....-.7...5... ..1.-1.G.!.n.. STTe e...k I CITY i.. S t e r u I I e ._ __ v.. . .._ ...._a_.I STATE MA 'ZIP1 C�a.co 5 5... TEL _50�5..- t-i .-S r.Co 3 C�.-.5_ . FAX '> CELLI EMAIL'