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HomeMy WebLinkAboutBLDP-18-000995 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u=-4,c= =HI= u CITY j2,(Y1 :I MA DATE a PERMIT# ,�/nr 975 •- � Zklilt /4� J JOBSITE ADDRESS �(� a , � C /� rd..„� OWNER'S NAME P OWNER ADDRESS�__KQ f-cur.tS __P-r�t__ TEL !FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL a PRINT CLEARLY NEW:�, RENOVATION:K REPLACEMENT:Q PLANS SUBMITTED: YES D NOE FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUBI r I I .. ,. 1 -f CROSS CONNECTION DEVICE '; - r ) DEDICATED SPECIAL WASTE SYSTEM t Y'—}I I 'tom � �,.,, -- ��__ _ ' . .� _ DEDICATED GASr01LISAND SYSTEM � �_ .,-4-71-----0 t 4 J _ ii i 41._�i� ; �, DEDICATED GREASE SYSTEM .. ., 4 ' ( j r 2 �-- •-{ --- DEDICATED GRAY WATER SYSTEM ��_,.), 1.,1 -" ---)1----h-----Th� Y -� t '"'--'--° 'I==-_°; DEDICATED DR INKING uNTERN ECYCLE SYSTEM ' , T '�`--- E--11-----1,--� !_ . FLOOR IAREA DRAIN �'- - q - 'I 1 - FOOD DISPOSER f INTERCEPTOR(INTERIOR) � i I r KITCHEN SINK 1''-_ ry LAVATORY ��' ! 1-1 _ c L . ROOF DRAIN r ;E I I r - SHOWER STALL _ .., , 1 .i fir_- 1 r - f� I SERVICE/MOP SINK ( 7 ? ; v- - ;, r --! TOILET I - I s _ [ - -r URINAL _ .t .1 r , 1 I-7 tl_ ��r_-, WASHING MACHINE CONNECTION I 7 �'-" now ipppi i l--I 4 "; WATER HEATER ALL TYPES - OTHER WATER PIPING _ _ 1,... � ---H ...(r f , I til- ';_ ---`. -_ .- • 1 ,r INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142. YES a NO ip IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 BOND o . 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. L 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 accu . , =best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In compliance • a0 • 4.1'• • ' Ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. //i, PLUMBERS NAME Spencer Hallett I LICENSE# 16224 I SIGNA RE MPD JP 0 CORPORATION 0# 3PARTNERSHIPD#� 1LLCD# COMPANY NAME Spencer Hallett Plumbing and Healing,Inc I ADDRESS 382 Old Falmouth Rd Unit 36 CITY Marstons Mills 6 STATE mZIP 02648 F TEL 508428-6080 1 FAX 508-428-7991 CELL EMAIL spencer©hallettplumbing.com ...____,1 , Z'6?(I dy-1 27 /2 71/( 2 0 •10/ -rni2d -)ia 9