Loading...
HomeMy WebLinkAboutBLDP8-005296 .\ L:7ASSPICI$tISETTS tIC31FOl"rQ i APPLICATION FOR A PERM TO PEnFORL2 PLIYLc7EING latOl:t`a gArt,t 8 CUY Ajavatik ,...,, . ... ..j MA DATE WEN , PERMIT# /a-f'- 2Fifl JOBSITE ADDRESS 1411.-SeelIOWNER'S NAMEL.AI S J OWNER ADDRESSl�L� .�Yt J (� 4 TELL_____JFAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL 0 RESIDENTIAL[ PRINT CLEARLY NEW:U RENOVATION:M REPLACEMENT:0 PLANS SUBMITTED: YES 0 NOE FIXTURES 2 FLOOR-. BSM 1 2 3 4 5 6 7 .8 9 10 11 12 13 14 BATHTUB I�r s� CROSS CONNECTION DEVICE __ DEDICATED SPECIAL WASTE SYSTEM S a Ilea DEDICATED GAS/OIIJSAND SYSTEM - Spry a— ins DEDICATED GREASE SYSTEM ajlete ganalS DEDICATED GRAY WATER SYSTEM MatSe DEDICATED WATER RECYCLE SYSTEM ,�R_ DISHWASHER,, DRINKING FOUNTAIN iiiitU%_ra_illtaiNIN-I ,� ��S FOOD DISPOSER _n�aSIss1t s J_ FLOOR/AREA DRAIN ' M - INTERCEPTOR INTERIOR Ma El nitliganirMISSMSSINOIS KITCHEN SINK LAVATORY rMIRTISZainSaillnali ROOFDRAIN 1=Stilla SHOWER STALL raltatIMMISSESEISKIMERVAIUMOINSIS SERVICE/MOP SINK r �^ TOILET � 1 1�V S r-_, URINAL ®i���� �� Ill a' MI MISIIM�;FIKIl1 a WASHING MACHINE CONNECTION j a; 'w,� ,� WATER HEATER ALL TYPES � r 1 WATER PIPINGagarmignili OTHER r ' _ I .__3 . . 1- _il....,.., . _ . . f-1 I.. INSURANCE COVERAGE: I have a currentliability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES j'NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 1 LIABILITY INSURANCE POLICY V OTHER TYPE OF INDEMNITY 0 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 SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER © AGENT hereby certify that all of the details and Information I have submitted or entered regarding this application are true and accu e best of my knowledge and that all plumbing work and installations performed under the permit Issued for this application will be In compliance al�•' a ( Ion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _se/ PLUMBER'S NAME Spencer Hallett I LICENSE#116224 C SIGNA RE MP0' JP® CORPORATION®#I iPARTNERSHIPt,.. #1 1LLC0# 1 COMPANY NAME Spencer Hallett Plumbing and Heating, Inc ADDRESS 382 Old Falmouth Rd Unit 36 I CITY Marstons Mills 1 STATE nrvicZIP 102648 I5 TEL 508-428.-6080 ` s. i FAX 508428-7991 , CELL 1 {EMAIL spencer@hallettRlumbigg.com i k t� rS.. r