31C-046 (9) ‘ ) — oL o /7Y-----
MASSACHUSETTS UNIFORM APPLICATIONS FOR A PERMIT TO PERFORM PLUMBING WORK
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JOBSITE ADDRESS �adl�a l ,l OWNER'S NAME 60
POWNER ADDRESS L, TEL �JFAX
TYPE OR OCCUPANCY TYPE COMMERCIAL 1 EDUCATIONAL D RESIDENTIAL
. PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NOQ
FIXTURES 1 FLOOR-- BSM 1 2 QM 5 6 7 8 9 10 11 12 13 14
BATHTUB NOW®111111111.111.1111111111.111111111.111111111111111111111111111111111111111MOIM .,
CROSS CONNECTION DEVICE MIIMININIMMIII-111111IIMMITIONINIONINTIUMMor
; DEDICATED SPECIAL WASTE SYSTEM MIIMIWIIIMIMEMWMMIT-WMOMMIEM.111
DEDICATED GAS/01L/SAND SYSTEMIMOMMTMINNIOMMIMIIISINIM 1 lMIINEM
DEDICATED GREASE SYSTEM UillIlliSIMIIININIMMIIIIillntVIWMNIMfiilirdiMMIIIIIIIIIIMIIIIT—
DEDICATED GRAY WATER SYSTEM rM
DEDICATED WATER RECYCLE SYSTEM ��� I , ENM
DISHWASHER —� ms _____� l � �
DRINKING FOUNTAIN � . !mt MI4T:T
FOOD DISPOSER MilliBMWRINOWINWWWCZEZIEr'laillIMITTIM
FLOOR;AREA DRAIN MIONIMMIIIMMINIIIIIIIIIIIIIIMIONIIIIIMMI
INTERCEPTOR(INTERIOR) W,MINIIIMINNM. M1ME
KITCHEN SINK 1111111111IITIIMENEMIMMammommummillIMMEW
LAVATORY 111111111111MINIMMIMMIMMIliniriMMIMMIli
ROOF DRAIN 11111111.11r IMIIMIMITINNIMIIIIITUTIMMINIMMill
SHOWER STALL all inaM' —MN NEM M~ NEM r--- MINIMIIIIN
SERVICE;MOP SINKin1111
TOILET __ .111111111111 URINAL __ MM__
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WASHING MACHINE CONNECTION WMAr'A,1,itaq, , M , IMM
WATER HEATER ALL TYPES IMEN111111M1i 11 =
WATER PIPING _ _ MWM—IIIIMMM ��i01 MIMI MIN
OTHER :11.11111.1011111111111111111MMINIIIIIIIIIIIIIIIIIIIIMMMOINIM
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO 0
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 AGENT
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 a to to the best of my knowledge
and that all plumbing vaosic and installations performed under the permit issued for this application will be in c p1 c h ail Pertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
--
PLUMBERS NAME Paul Graham _ LICENSE# 12322 ATURE
MPO JP Q CORPORATION❑# , PARTNERSHIP[ #t LLC1-1#
COMPANY NAME)Paul's Plumbing&Heating ADDRESS P.O.Box 303 _
CITY Huntington STATE MA ZIP 01050 TEL 1413-238-0303
FAX j CELL 413-626-2145 1 EMAIL paulsplgxhtq@aol.com
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY ./6).0- #.4-7y-7J-✓ MA. DATE C,_5—A PERMIT# /19(12 14/'51 9
JOBSITE ADDRESS 73 Kll6.,e ,ii/ 3 Al OWNERS NAME L✓
OWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE: COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL pit
PRINT NEW: RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO ❑
CLEARLY
FIXTURES 1 FLOOR-, BSMT 1 2 3 4 1 5 16 7 8 9 I 10 r 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE _
DEDICATED SPECIAL WASTE SYS
DEDICATED GASIOIUSAND SYS ,
DEDICATED GREASE SYS
DEDICATD GRAY WATER SYS '
DEDICATED WATER RECYCLE SYS
DRINKING FOUNTAIN 1
*
DISHWASHER I _ i _
FOOD DISPOSER
FLOOR/AREA DRAIN I bLUM;ING&GAS INSPECTOR _
INTERCEPTOR(INTERIOR) I `�r 'Atv1PT(DN
KITCHEN SINK I 'kV-0V
-NO APPROVED
LAVATORY a _
ROOF DRAIN _ G7 -
SHOWER STALL I
SERVICE I MCP SINK I I
TOILET a. — +
URINAL _
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES / I I
WATER PIPING ( I I
OTHER I '
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch.142. Ye0E1 No 0
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 6 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 General Laws,and that my signature on this permit application waives this requirement.
CHECK ONE BOX ONLY: OWNER ❑ AGENT ❑
Signature of Owner or Owner's 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
compliance with all Pertinent provision of the`jMassachusetts State Plumbing Code and Chapte of the General Laws.
PLUMBER NAME FA,/ d:e..4 SIGNATURE
LIC# i,-) 3,). MP la JP❑` CORP/ORATION 0# - PARTNERSHIP ❑# LLC ❑#
COMPANY NAME 1 I/5 I% I4I015 ADDRESS: /6 .OY
CITY / L:v74.y]` 4.- STATE AW ZIP L5/OSIS EMAIL
TEL / CELL -271715 FAX
ROUGH PLUMBING INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
I -
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 0
a l e-VA. 14?) • / fre. PERMIT#
PLAN REVIEW NOTES
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