36-372 (3) - 5P5D c%CIC g
(� Ex .
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
ikiCITY /14cKTH79.1Y i PrO K.1 MA DATE 7/11 r 17 PERMIT#
JOBSITE ADDRESS /83 aa95o11.) (..t)14/ OWNER'S NAME ciaoC D uasFe.s.
i . G OWNER ADDRESS TEL FAX
TYPE OR
P OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL
CLEARLY NEW:, RENOVATION: ❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO❑
APPLIANCES 1 FLOORS—. BSM 1 1 2 3 I 4 5 6 7 8 9 10 1 11 12 13 ' 14
BOILER _
BOOSTER
CONVERSION BURNER
COOK STOVE t !
0 DIRECT VENT HEATER
I(. DRYER f r
FIREPLACE
v1 FRYOLATOR t
2 FURNACE ;.t , $....................._
t..0-7cd, GENERATOR `1`,
2.0e' GRILLE I ~` ` '
.12) INFRARED HEATER •i L JUL-
2 2��
LABORATORY COCKS _
MAKEUP AIR UNIT 1____.----
KK �1. ;11y (,•.-:-. 'of 9Cit
Y q OVEN I i ,. �' �;}�
, DSV. POOL HEATER ""�"_
Air- ROOM/SPACE HEATER _
V..) ROOF TOP UNIT _ _
TEST 1
UNIT HEATER •
i61) UNVENTED ROOM HEATER _
WATER HEATER
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 TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY • OTHER TYPE OF INDEMNITY BOND
OW14ER'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 accurate to th= b•.1 of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in c• • c 'th all Pe • : .rot ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
re '
PLUMBERS NAME Phillip GGHurteau --__________-__ _ :LICENSE# 10963._ _ _i SIG • URE
MP JP CORPORATION - #2974 ,PARTNERSHIP # LLC #
COMPANY NAME Phil's PIumbil�.and Heating,Inc __ i ADDRESS 45 Payson Ave_______ _ _ _ _ ;_ ___ _y_`M __
CITY Easthampton _ STATE MA I ZIP 01027 I TEL 413 527 0340
,
FAX 413 527 2406 CELL 413 626 9725 ; EMAIL pph45 Payson@gmail.com i
f3(j237,
5 C1 $OV eitte1( jdcf —
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
Pi Kli—
CITY I�JoR1 m�Tt MA DATE 7/11/17 PERMIT#
JOBSITE ADDRESS /83 Sr ev io wm-y OWNER'S NAME $ I,V O l6,izr
POWNER ADDRESS TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL*
• PRINT
CLEARLY NEW:A RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMI I LED: YES❑ NO[i
FIXTURES 1 FLOOR--I 8SM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB a .1
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM _ •
DEDICATED GRAY WATER SYSTEM •- - -
DEDICATED WATER RECYCLE SYSTEM L i:_ - '-----.L......:LI -
DISHWASHER I
DRINKING FOUNTAIN
FOOD DISPOSER JUL 2 2017FLOOR 1 AREA DRAIN I ,
R
INTERCEPTOR(INTERIOR) i
�{
, KITCHEN SINK I '.�•f; ; ----
ii , LAVATORY 4 I - ----..:_..._. -.,...
. °I.\ ROOF DRAIN
• SHOWER STALL I
SERVICE 1 MOP SINK ( j
:G,)--TOILET 3 0. - I I
� (�ft;fi L 11 URINAL
--� i W� WASHING MACHINE CONNECTION t
1 g 1WATER HEATER ALL TYPES
WATER PIPING I
;LQ OTHER
4" •
a� -_ _I
10 __ 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 - 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 I
SIGNATURE OF OWNER OR AGENT
hereby certify that all of the details and information I have submitted or entered regarding this application are true - d accurate . e b= t of my knowledge
' and that all plumbing work and installations performed under the permit issued for this application will be in;r• � 'P-with all • ., e • . - ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. VV ; j
PLUMBER'S NAME PhillipG._Hurteau __ _ LICENSE4 10963 .____E SI'.NATURE
MP - JP CORPORATION - 4 2974 ,_. 'PARTNERSHIP 4 LLC 4
•COMPANY NAME Philip's Plumbing and Heating,Inc __ _' ADDRESS 45 Payson Ave
CITY Easthampton _ ___ ____ __s STATE W MA I ZIP 01027______ I TEL 413.527_0340___
FAX 413 527 2406 1 CELL 413 626 9725 _1 EMAIL pph45 Paysonea g_mail.com