HomeMy WebLinkAboutBLDP-22-005308 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY YARMOUTH MA DATE 3/23/22 PERMIT# BLDP-22-005308
`ter, JOBSITE ADDRESS 5 CHERRY LN OWNER'S NAME KENNEALLY KEVIN T
P OWNER ADDRESS KENNEALLY RACHAEL M 5 CHERRY LANE WEST YARMOUTH,MA 02673 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑
PRINT
CLEARLY NEW:❑ RENOVATION:D REPLACEMENT:❑ PLANS SUBMITTED: YES❑ 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
LAVATORY1
•
ROOF DRAIN _
SHOWER STALL _ 1
SERVICE/MOP SINK
TOILET 1
URINAL
WASHING MACHINE CONNECTION
WATER HEATER
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❑ OTHER TYPE OF INDEMNITY❑ BOND❑
OWNERS 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 LICENSE 16224 SIGNATURE
MP ❑ JP El 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 spencer@hallettplumbing.com
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE El El
FEES$ PERMIT#
PLAN REVIEW NOTES
1--- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
F-:
o1 IV d CITY i` ,�T a -2- 2 — So (
:. mL _ ar m Du ; MA DATE -� PERMIT #
JOBSITE ADDRESS 5 Cher/Li Lc rw. 1 OWNER'S NAME ken)/ ea 1
P OWNER ADDRESS
SSA +rA . .. . .. . .. TEL _ _ . FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Li RESIDENTIAL .71
PRINT
CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES [l NO '' I
FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUBil 1 11111111111filn.
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM 1 . I i
DEDICATED GAS/OIUSAND SYSTEM I
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM 11 j ' i
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN
_ a
FOOD DISPOSER I III
FLOOR /AREA DRAIN
INTERCEPTOR (INTERIOR) 111111111111111111111111111111111111111111
_KITCHEN SINK u
LAVATORY I , I i ._ II 11
ROOF DRAIN I 1^ 1
SHOWER STALL I i i ; j ;! t-----�C-__�
SERVICE / MOP SINK II I ii 1 II
TOILET 1 I, i
URINAL l l
WASHING MACHINE CONNECTION 1I _ iiL 11 II
WATER HEATER ALL TYPES ll I ( ll L I 1,
WATER PIPING �. I II
OTHER 1 11 I
ll h ti I 11
}� i
INSURANCE COVERAGE: _
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES n NO --
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY I ". 1 OTHER TYPE OF INDEMNITY BOND ri
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 lil
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 . ',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 corn. '100; V a ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Spencer Hallett JLICENSE # 16224 1 SIGNATURE
MP i JP n CORPORATION El# 3834 'PARTNERSHIP . _'# LLC . #
COMPANY NAME Spencer Hallett Plumbing & Heating, Inc I ADDRESS 381 Old Falmouth Rd, Unit#36
CITY Marstons Mills STATE MA I ZIP 02648 J TEL 508-428-6080
FAX 508-428-7991 CELL EMAIL sue hallettplumbingcom �