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HomeMy WebLinkAboutPlumbing Permit ""�—�. Mi,4S5ACHU5�i f5 UI�[IFOP.1Jf APPI.iCATiOtd FORA PERF..I-f TO PERFOI�.M r'wMt3�1yG WORK 1 '�u� I � � C� _�T,F}a P �ra. DH� �'a�y�i�' ?�J�rtr��DP—IS YJog25'S � �✓`u���'(�� ��� �oesre���,�ss�/6 St�v� r rc L � ✓.ti O�WIyEP.'S N.WdE Yl U�o U�_ � \�� � � D1�JIdEP,/�pDP.E55 i EL rA%�_ � �CCUP.4IJCY i rE COIuU�iEP,CIAL❑ mUCAil01�AL ❑ P�SID�J�i HL�( TYPE OR � PRI1� �I� CLEP.RLY N���-� P�IJDVH101y:I� P,E'L4CEhhEI�:❑ PLANS S115M iI i ED: YES❑ NO ❑ ��� �ooP— � sse,r, � � s � � � e � s �o � s� � �z � �s � •�a �"�B I I I I I I I I i � CPO55 COHNECTIOItl DEVICE I I I I I I I I I � DmICk�SPECWLVJpS7E SYS � � � � ( � � � � � � � DIDICk�Gl=,SIDIUSkPD SYS � I �EJ� 1 I I I I I I I I ! D�Ick�oGP��,sESrs I I I I I I I I I I I � DmlcH,ni. GRa,YI�JA�;Svs I I I I i I I I I I I I i �IDic,ar�w�.�t�cYc�s��s I I I I I I I i � IDwwaNG�Ounr.vN I I I I I I I I I I � DISFnrJqSHFR I I I I I I I I I ; FDDD�ISPOSER I I I I I I I I � nl � I I I I rL00R/Ar2EP,DP.AIN � � � � � � � � ^ � � . � � � I� I11�CEP i DR(IN�PjpR) � � � � � � � � � � � n�rCr�SINK I I I I I I i I I I �A��'-- I I I I I I � I I I I ! � P00=��rr- I I I I I I I I I I � I I I I '' s�ow�ats�n� I I I I I I I I I ; S�nct/n�OP SMK I I I I I I I I I I 'o�' I i I I I I I I I I ��� I I I i i I I I i I I I ' wasHWGM�a.cHln�coHN�cnDr� I I I I I I I I I I I I vu:�x�+�.ou�es I I I I I I I I : � I WA�P�1NG I I I I I I L b P�4 T I I I °i� � � `ro �a✓ I I i I I I I e " � � I I I I I I I I I I I I I I I I I I I I I I I � " INSUP.ANCE GOVER.CGE: h2n a cuTi'�r¢LabTitv insurance poGry or i"s suhsC3n3z1 equn2lz�whieh,mz�d�e 2quirmz�c MC-L Ch SL Yz;�iNo❑ . Ir YOU CI-IcCfO yE6, pLcp,SE It�D1CAi c TFIE �1'PE OF COVERAGE SY C}icC1QNG THe PPPROPRIATE BDn6EL0lN ' LLASfLTTY FhSURAN�?pL{CY�.. 01'c�R iY2E OF INDr�[HIT`7 ❑ BOI�ID ❑ OWf�fER'S WSURANCE WAIVER_t am awarr.ifx3f 3-,e 6eensae dces not havz ihe insurancz coverage requird by Chapter ia2 oi�! Idassaehuse�;s GeneraI Lav.�s,and ihat my sgnahirz on this permii appGcaSon waives�is rzqtairemznt CHECK ONE BOK ONLY: OWNER ❑ AGEN'f ❑ � $I I13hl2 6i�1NI1Ei Df�WI1�5 01'1T J1 hereby cer6ry fh��II oi the dz�s and iniormaYion 1 hava submif]�d �or erR�redj regarding 3iis appfica5on a2 hve and accura�x to best of my Knowledge and 'ihaf aIl plumbmg work and installafions pzrietmed under fhe permit issued for fhis pG 'on un11 be Icompfcance with all perfinent pro�ision of the Massachuseff's St�e Plum6ing Code and Chaptes 42 of ihe G er PLUMB621�AME .i'� l`HA �y-� • SIGNA \ uc� /0 3��— w,�� ,�p co�ow,�or� p� PAR1�2.SHIP �# �c p� coi�a�.n�nianre_ � •�' :�A C d�e �n�ss: � S A SS r� Fr f�S �-., crrr /-�f+rw i c h sra� � � � cEu...���-�9Y— S3d i FAx �if