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Home My WebLink AboutBLDP-22-006695 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 5/19/22 PERMIT# BLDP-22-006695 '_ JOBSITE ADDRESS 12 SYRITHAS WAY OWNER'S NAME HACKETT JAMES P III P OWNER ADDRESS HACKETT MARY SUE 301 MUSTERFIELD RD CONCORD,MA 01742 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURFS • 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 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 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 D 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. 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. PLUMBERS NAME Spencer Hallett LICENSE 16224 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME SPENCER HALLETT ADDRESS 381 Old Falmouth Rd Unit 36 CITY MARSTONS MLS STATE MA ZIP 026481372 TEL FAX CELL EMAIL office@hallettplumbing.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ ❑ FEES E PERMIT# PLAN REVIEW NOTES Ar=.AS3A� t USETTS UNIFORM APPLICATION FOR A PE Mi T TOPERFORM PL G tker - 72-51-,a7i CITY ,,y/e/Mentt) 77-1 ___ , , , , 1 MA i..,, DATE rPERMIT #0-- )40/,'Fe JOBSITE ADDRESSi___g <y77e4 OWNER'S NAMEL /--‘40,-/-, --//7- t„,/,/ - - f . ._, OWNER ADDRESS l ` &e. M66/ 7 FAX TYPE OR OCCUPAN, TYPE COMMERCIAL EI EDUCATIONAL ri RESIDENTIAL IVO PRINT CLEARLY NEW: 'F i. RENOVATION: H____I REPLACEMENT: rli PLANS SUBMITTED: YES ❑ NOD FIXTURES 1 FLOOR--4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB MI 11111:!Mr , . ...: Mill : ''MR MI MI 1.11. MI N 1611 NMI CROSS CONNECTION DEVICE SIM 111111 111111,11111 EMI MO MIN MN NMI 111111W1111111 INN MIR INK DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM _ . ..j DEDICATED GREASE SYSTEM �I� I II � DEDICATED GRAY WATER SYSTEM MI MI MK NUM IIIII IIIIIII INKMI NM 1111111M1111111 MS 111111a DEDICATED WATER RECYCLE SYSTEM I DISHWASHER 1 Poir!IIIIPIBP111.1 I DRINKING FOUNTAIN ;I' I FOOD DISPOSER MEI FLOOR I AREA DRAIN s�_.1 INTERCEPTOR (INTERIOR) 4 KITCHEN SINK LAVATORY ROOF DRAIN 71.111111111111,111111I� I I=I ISHOWER STALL I1I_III�II �I 'EN Imo SERVICEIMOPSINK III � 3 ,® � �!ff� TOILET i� i URINALpm"! WASHING MACHINE CONNECTION WATER HEATER ALL TYPES IIIIIIj !I'll' WATER PIPING OTHER i I� ___- IMILIIIIIIiIIIIIIIIMIIIIIIIM MiIIIIIIIIIIIIIIIIIIIIIIISIM NMI -_ :.. M I NIP I I_I _ M .; N►I=ICI _ 1111111110111111_l l l_ . _ € _ Mil la. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES El NO [l IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1 OTHER TYPE OF INDEMNITY j_ ] BOND El 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 F] AGENT El 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 accura : . ,'*` best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance w' - . I P:...,i: 0.? ovi 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ' i, 1 ,"fir. PLUMBER'S NAME Spencer Hallett_ LICENSE # 16224 I GNATS 'F MPE JP CORPORATIONE # 3834 _,w __TIPARTNERSHIPE # LLC # COMPANY NAME Spencer Hallett Plumbing & Heating I ADDRESS L381 Old Falmouth Rd, Unit #36 CITY Marstons Mills STATE MA ZIP 102648 ._r TEL r508-428-6080 __ �, FAX 508-428-7991 CELL EMAIL office@JTIlettplumbing.com ...W.. ri � �..