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HomeMy WebLinkAboutBLDP-23-003835 r-., MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK !II _( CITY 'YARMOUTH I MA DATE I1/16/23 I PERMIT# BLDP-23-003835 , JOBSITE ADDRESS 1356 GREAT ISLAND RD i OWNER'S NAME ITAICLET JAMES D JR P OWNER ADDRESS ITAICLET CAROL D 5 COLGATE RD WELLESLEY,MA 02482 (TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL 0 PRINT RESIDENTIAL 0 CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO El FIXTURES 1 FLOORS BSM 1 2 3 4 5 6 , 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING OTHER OTHER DESCRIPTION: 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 El 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. 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 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 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME (Spencer Hallett I LICENS Massachusetts SIGNATURE MP ❑ JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# LLC ❑# COMPANY NAME Spencer Hallett Plumbing&Heating, ADDRESS 381 Old Falmouth Rd Unit#36 CITY Marstons Mills m" mmmmi �� ZIP 026481372 TEL 5084286080 FAX CELL EMAIL 1" MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH MA DATE 'January 16,2023 PERMIT# BLDP-23-003835 JOBSITE ADDRESS 1356 GREAT ISLAND RD OWNER'S NAME ITAICLET JAMES D JR G OWNER ADDRESS TAICLET CAROL D 5 COLGATE RD WELLESLEY MA 02482 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL PRINT ❑ RESIDENTIAL El CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO El FIXTURES FLOORS—4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER OTHER DESCRIPTION: 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 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. 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 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 Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 'Spencer Hallett I LICENSE# 'Massachusetts I SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPGI ❑ CORPORATION 0#I I PARTNERSHIP ❑#' ILLC ❑#I J COMPANY NAME: 'Spencer Hallett Plumbing&Heating,Inc I ADDRESS. 1381 Old Falmouth Rd Unit#36, CITY 'Marstons Mills I STATE IMA I ZIP 1026481372 I TEL 15084286080 FAX I I CELL ' 'EMAIL 1