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HomeMy WebLinkAboutBLDP&G-23-001929 • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w_, CITY YARMOUTH MA DATE 10/12/22 PERMIT# BLDP-23-001929 ' II-J JOBSITE ADDRESS 173 ROUTE 6A OWNERS NAME BURBANK EMILY L TRS P OWNER ADDRESS BURBANK ROSLYN D TRS 364 ROUTE 6A YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS—, RSM 1 9 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❑ 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*224 SIGNATURE MP ❑ JP 0 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 El ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSA °R SE``TS UNIFORM APPLICATION N FOR A. PERMIT TO 'PERFORM PLUMBING WORK --- - --- I—rim, ii _g CITY Yol, 3 _ ?cc ._...�_. ... MA DATE [A0 15J�a"�s .. PERMIT # -2- -- tCi Zci �� /4 .:.:....wiser... ...x »n+.a+i,......r's.a-........ .wmn JOBSITE ADDRESS [ rl :5 MiekiNNSITao, . .... nF. .; I OWNER'S NAME Ligy ! y2wv \-V U � ttoe D_ OWNER ADDRESS tt ��.._ \► __.. /Upti\COW\ °� TELt {a - LD1 FAX r - 4obi'-ii TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL C RESIDENTIAL El PRINT � CLEARLY NEW: u RENOVATION: LJ CJ/REPLACEMENT: L� PLANS SUBMITTED: YES 11 NO FIXTURES -1 FLOOR-4 BSM 1 2 3 4 5 6 !IIII8 9 10 11 12 13 14 BATHTUB , J _ , ..__ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM t - - I DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I DEDICATED WATER RECYCLE SYSTEM j II I DISHWASHER g i DRINKING FOUNTAIN FOOD DISPOSER 1 1 FLOOR I AREA DRAIN I 1 i INTERCEPTOR (INTERIOR) I . KITCHEN SINK 1111111111,1111.LI MN MN nil _ MN NMI MI MINI LAVATORY ! I ROOF DRAIN II SHOWER STALL iI SERVICE I MOP SINK I I I i 1 TOILET ! l URINAL I 1 WASHING MACHINE CONNECTION j. i WATER HEATER ALL TYPES I WATER PIPING OTHER -- i � I 1 i MI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES T] NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY t.." I OTHER TYPE OF INDEMNITY El BOND E . 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 Ell AGENT F] 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 - • .'r 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': D.F. ovi 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. :0'../ /i ir PLUMBER'S NAME Spencer Hallett . J LICENSE # 16224 4 IGNATIRE MP El JP 0 CORPORATION F]# 3834 i PARTNERSHIP:1# LLCQ# COMPANY NAME I Spencer Hallett Plumbing & Heating ADDRESS r381 Old Falmouth Rd, Unit #36 CITY Marstons Mills i STATE FM—A-11 ZIP 02648 TEL 508-428 e6080 FAX 508-428-7991 CELL L EMAIL office a@hallettplumbiN.com ___ __ �. Y,_w _._ „__.�,_ . :. _ .w..__n _ __-, _ rJ • • 1 Please visit our web site at http:ilwww.mass.govidpl!boards/PL SPENCER HALLETT 18 EASTVIEW TER (PL) MARSTONS MLS,MA 02648-1372 Fold,Then Detach Along All Perforations CONTROL 4 ,a ,8 2 8 4 0 IMPORTANT If your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit our web site at mass.00v/dpi for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law. Keep this license on your person or posted as required by law and/or regulations. Fold,Then Detach Along All Perforations v . COMMONWEALTH OF MA SACHUSE S DIVISION OF OCCUPATIONAL LICENSURE BOARD OF PLUMBERS AND GASFITTERS ISSUES THE FOLLOWING LICENSE u,' MASTER PLUMBER SPENCER HALLETT H 18 EASTVIEW TER W' MARSTONS MLS,MA 02648-1372 U 16224 05/01/2024 217137 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK `w CITY YARMOUTH MA DATE October 12,2022 PERMIT# BLDP-23-001929 I I JOBSITE ADDRESS [173 ROUTE 6A OWNER'S NAME BURBANK EMILY L TRS G OWNER ADDRESS BURBANK ROSLYN D TRS 364 ROUTE 6A YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL J❑ RESIDENTIAL❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES❑ NO 0 FIXTURES FLOORS—, 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 LICENSE# 16224 SIGNATURE MP©MGF 0 JP 0 JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME: SPENCER HALLETT ADDRESS. 381 Old Falmouth Rd Unit 36, CITY MARSTONS MLS STATE MA ZIP 026481372 TEL FAX CELL EMAIL offcea(�,hallettplumbing.com , ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ 0 FEE: $ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY [ (gJjMA DATE ‘015 j aa PERMIT # 23— 19 27 JOBSITE ADDRESS`—] -, i ' Sc , (0 ,_._._.. OWNER'S NAME Li(e ..VAIN GOWNER ADDRESS 93\ u,) ,,\\044i Sviokt�Y 1 L�.�`�k g4 TEL -- FAX .. . q9 TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Li RESIDENTIAL El PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: Nic PLANS SUBMITTED: YES Li NO APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER i 1intimuni CONVERSION BURNER j 1 COOK STOVE 11111.1111.1111 limmen DIRECT VENT HEATER 11111 IN.111111WIMMEMO 1.1111111111111.1111111111 DRYERNis �; IIII � I Ememomiiiiiim.11.11miiiim GRILLE 11111111111111111111111111111111111111111111111111111111111111111111111111111111111r —111111111111111111111111 I .IILH ±i1LLk ± ICINE!Nip Noi TEST al I 111111111111 UNIT HEATER UNVENTED ROOM HEATER 1 WATER HEATER OTHER muminiumminutuffin IMO 11.1 MI NM NU MiiilM111111111 111,NE NM NMI NM EN NM NU 111111 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ' NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY i BOND r 1 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 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicationare true - • accurate • - - •estof my knowledge and that all plumbing work and installations performed under the permit issued for this application will be it corns 7 . .V�ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Spencer Hallett LICENSE # 16224 SIGNATURE MP Li MGF JP ® JGF LPGI Li CORPORATION # 3834 PARTNERSHIP®# LLC ®#, COMPANY NAME: Spencer Hallett Plumbing & Heating, Inc. ADDRESS 381 Old Falmouth rd, Suite 36 CITY Marstons Mills I STATE MA ZIP 02648 TEL 508-428-6080 I FAX 508-428-7991 —1 CELL EMAIL office@hallettplurnbing.com J