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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