HomeMy WebLinkAboutBLDP&G-18-001290 MASSACfrIUSE $ UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
R �=11X, ¢ CITY 1 AA._ 7 ' ;1 MA DATE t_o PERMIT# r 1-'/8-"o O
JOBSITE ADDRESS (Q.._.. -N _+ OWNER'S NAMES i.c-'e —
OWNERADDRESS .-�P.... .fP.�2N.. �-_._.._ ` TELL _ y3WAX!
TYPE OR OCCUPANCY TYPE COMMERCIAL! EDUCATIONAL RESIDENTIAL
PRINT �;-�-�
CLEARLY NEW: RENOVATION:L REPLACEMENT:* PLANS SUBMITTED: YES ES NOi
FIXTURES 1 FLOOR—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 •Li 3i _ 17 '` , [ li ilr I r-77-71
CROSS CONNECTION DEVICE —'
DEDICATED SPECIAL WASTE SYSTEM ^-.
1 [_ -�1_ 1.. I
DEDICATED GAS/OIL/SAND SYSTEM iJ . 1._ +P .,k,,..f r_ i
DEDICATED GREASE SYSTEM ,r I W_J ., c r -- 1 I
DEDICATED GRAY WATER SYSTEM 1— ;,lj - 1 T i
DEDICATED WATER RECYCLE SYSTEM { . 73. ... L IC
DISHWASHER 1 1 1I: I. _ (-,. 't 3 . ._ , _
DRINKING FOUNTAIN 1...,..�.ii1 . .__.(�_ . I Ti.. l- -^J _ r . __ I. -i ;i_
FOOD DISPOSER I I fi 'I _ -._.' _7177.1 1 I, u 9! I 1,-
FLOOR/AREA DRAIN I ;i I.__ 1 tI __'_ . __ ._ _. sir - . F. T;-----,
INTERCEPTOR(INTERIOR) 11. . ._; Li... if!..._.... TT_ Ir _.a . L_ ... ..-..1. _ PT
KITCHEN SINK .. ;I _ ; -.�r 2 �_ ,
LAVATORY `[_- °... i - r'-----.r I- 11. e!A �i ..._ -y l ',i 7
ROOF DRAIN -
r-I 11-: iC .r r r b
SHOWER STALL -
SERVICE/MOP SINK
TOILET — — — _.--_ —__,
...1 ..._I,. _:i i. - ;r J '
URINAL � �._ ,. .. .��.� � '
WASHING MACHINE CONNECTION (- ,l _ !-. I___ _ _
�4 �[— ':I.. it —lf-
WATER HEATER ALL TYPES { _ 1 I.__ 1 _.1h _ 'I _ r .. .ice _!.
WATER PIPING '. ..-. -Ai__ TI 1[ 1- .. .f{ r. _....:1 -�i 'r
OTHER I i ,I 'i i
r yr. i� 1- .4 � �i
,
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0--NO L.I
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY V, OTHER TYPE OF INDEMNITY [ BOND L..
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 iLi AGENT [_
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 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 ' all r ' ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAMES enter Hallett __ — _J LICENSE# 16224 r, SIGNA RE
MP[e, JP , CORPORATION!__..,1#�L i PARTNERSHIP "# `'LLC[J# i
COMPANY NAME Spencer Hallett Plumbing and Heating, Inc I ADDRESS L382 Old Falmouth Rd Unit 36 __ __ ___.__-___...w.._._
CITY Marstons Mills i STATE I, Ma 1; ZIP 02648 1 TEL 508-428-6080
FAX 1508-428-7991 j CELL 4 - 1 EMAIL Lspencer@hallettplumbing_com k
. illitilii);4‘0:Liii-11-T
it 003)AV I
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY 744OL4 !M MA DATE f ti 7 PERMIT#j,-0I1 J2 oc/o2 i
JOBSITE ADDRESS /1, £✓er feQIvJ Sr OWNER'S NAME FofSGtg,Z—
OWNER ADDRESS E,7? 2 7re.>oN 5 TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION:E REPLACEMENT:rlEi PLANS SUBMITTED: YES` NO
APPLIANCES Z 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 I SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER _,..
OTHER
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 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.
CHECK ONE ONLY: OWNER rj AGENT ID
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 est of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit e • vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME'fencer Hallett LICENSE#116224 IGNA E
MP El MGF JP -al JGF LPGI CORPORATION I# 3834 -PARTNERSHIP #L LLC #
COMPANY NAME:Spencer Hallett Plumbing and Heating,Inc. ADDRESS 381 Old Falmouth Rd Unit 36
CITY IMarstons Mills STATE Ma [ZIP102648 ItT1'
FAX 508-428-7991 I CELL EMAIL:spencer@hallettplumbing.com
BUILDING DEPARTMENT
BY