HomeMy WebLinkAboutBLDP-18-002377 q-�, W1A t'/\Ctigi E i,r LfLIIPOL tlil A L`L I_.UCATIOL= HOR A l;'t'I�,1€.JI t TO A 11_.41t NIA PLUMBING WORK
ti CITY L kvoutv41 I MA DM td PERMIT#I 02
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JOIJSITE ADDRESS t`1 I 1 > ,,,,,,,1 5_d e(411 OWNER'S NAME!.,,,,Alga]g e ,.,._...._v.,,,,, „ ,
OWNER ADDRESS 0.'1 1-c,01'111v, a 5ti1 ��._if tilklt5TEL _...,......,� ,FAX ,_-.�._._ ___.g
TYPE OR OCCUPA Y TYPE COMMERCIAL(u' EDUCATIONAL ( i Vii
RESIDENTIAL
PRINT
CLEARLY NEW: , RENOVATION:[2 REPLACEMENT:Li PLANS SUBMITTED: YES , NO[..,„
FIXTURES 1 FLOOR-. BSM 2 3 4 5 6 7 Km 9 10 11 12 13 14
BATHTUB I — 1 - Yr ( . ( ., ( ( ,.,
CROSS CONNECTION DEVICE l -1,- 1 i i l I
DEDICATED SPECIAL WASTE SYSTEM ( '1 '{ I. j
DEDICATED GAS/OIIJSAND SYSTEM f i- ____ 11
c Ik , c I -
DEDICATED GREASE SYSTEM 11, f 1.1 1 ' . I
DEDICATED GRAY WATER SYSTEM 11 :1___ ,1 I 1 1 1 i i , (� r
DEDICATED WATER R RECYCLE SYSTEM i i [ ... ! +I,...w.- .._...is l_. ... (.._ L.._.- f)l. I.. . ,I__- ..ri r
DISHWASHER l` 11 i ,. 1 _ tr i.__
_.._.- .I 1(IA - _. -.. ,j
DRINKING FOUNTAIN ..-,.,.,(�..._. _r_.._,,. .. .;. - '.I —� -if- __I
FOOD DISPOSER �_ c _ _
FLOOR/AREA DRAIN r 1 I lr I ,I {.. ( 1
INTERCEPTOR(INTERIOR) --� w i I
KITCHEN SINK 3 ! (-- ,LAVATORY � _ I. L i( _
ROOF DRAIN !, =i .N I E C
SHOWER STALL . _ __.... [_ i .. k r - "
SERVICE!MOP SINK � _ gyp. I[- ii ;r
TOILET ,I �` I 11 '„ 11 - p _ _ ( -- -
URINAL l,- 1 i i —
WASHING MACHINE CONNECTION I _ ..i 1 t r '( 1 +
WATER HEATER ALL TYPES .1.,... 1 ....,t L.. . .'.! .1 . I .. .`{.....,` 'i l
WATER PIPING k (. .-1 1... . _... _.... ili_ . I ..-,._
OTHER 1.... :�
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'rn't ; ININIIIIIIII.XMUr ,, ,in
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of INGL 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 El BOND I,_;p
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 ,I AGENT L_,_'
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 a best of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance • all In `t".r ai ion of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Spencer Hallett = j LICENSE#ft6224 SIGNA RE
MP( ' JP[73 CORPORATIOND# PARTNERSHIP # LLCM;# _ .4
COMPANY NAME Spencer Hallett Piumbr'in and Heatin ,Inc 'ADDRESS I 382 Old Falmouth Rd Unit 36
CITY Marstons Mills 1 STATE Ma ZIP 0264$ TEL 608-428-6080 —�v
FAX 508-428 7991 �(CELL 3 EMAIL Is, hallett lumbincg,com _________ f
If