HomeMy WebLinkAboutBLDP-18-002467 IDEAZSACC-IIUSE I; S UNDFORIfi APPLllCiZTi IOt'4 FOR A FE EHT TO PEG FORE?, PLUGLMMO WORK
=jlWAta-1 CITY a MA DATE Li PERMIT#ltG./op Jf-aOofl967
t. JOBSITE ADDRESS y (n� . . �"& y. 1 Q .w= OWNER'S NAME!
OWNER ADDRESS L.-:3-.LA.thilte"...AO.S.,___ '. TEL 'FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL J RESIDENTIAL r
PRINT
CLE t.RLY NEW:0 RENOVATION:l REPLACEMENT:in PLANS SUBMITTED: YES N01�
FIXTURES 1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I 1. 1[--- -_.. _ _ - __
2
pains
CROSS CONNECTION DEVICE I.,,___:,,___ f ;r ,
DEDICATED SPECIAL WASTE SYSTEM -1; MI3
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DEDICATED GAS/OIL/SAND SYSTEM -y
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM _._._. _.._... L_ _ :!- L _ -v- , ___ _ __'
DEDICATED WATER RECYCLE SYSTEM 11:-. iI_._ _`.1 _ 1.__._.. r..._... L_...-.-_:I..__ -. ' (__..
DISHWASHER -I -- _ .L.._ I
_ ��... {! I1. ! ...V , 7
DRINKING FOUNTAIN IIIII. )�^1,_. .. ! T. . . . 1711 `.L- .i . _ _ ._. . . -I ;I.
FOOD DISPOSER l, ,I .IL I' 'r-'I--..I I ___ r ....- ! I ''
FLOOR/AREA DRAIN —': .. -- _._.7I - I . .. _ 1 ,i_ ,_.. i.... ._ '.__. . !. t . I
INTERCEPTOR(INTERIOR) I _.._,I I ......J _..__..._' . ....4!_.. _..,� 17T(---...-_._. . ..........``I. ._ 'jr- _ ! .....I
KITCHEN SINK ... .._. __ .._. . ...._. __ ,ti �_...-..__1 L__.... l __ . _...:i + ._.._...� _. _._._..
LAVATORY L... ,[- i� ___. - _. -,-.. _.__ (Ti ^� Ii _. _. I._
ROOF DRAIN I. ! I -t- ; --,i---Ii - I {`- ti, ....._._, _s
SHOWER STALL ,L .__.ia_ __,`I . _. `•.. _ _,1. ` ,._. ._ ![- 'L_ . _IF '
SERVICE/MOP SINK ? ...'! ...._ 1 ._. :.:i (-. _. rr- � .I! _(__...._ 1-- 1 ,(_-
TOILET 1. j. I- _ r • IL. i.._ I i - I :
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URINAL �.. _..._sl.. . ..11._�... .I I:. _ : (_�( I� II I �
WASHING MACHINE CONNECTION ,;i ..r'r- :_.IIL_ ,__. .. F:_ 771 !,.__..._'7 r!.._t , .__._'I,....:. l I
WATER HEATER ALL TYPES I . ._- ____—,I .? - -
WATER PIPING I ' I ' ! , _ ;
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OTHER �,._:,..,.._,.�.,. ... -.��. �: �_ �'�®( _...._p.,I I[-
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Yc NO Li
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY L OTHER TYPE OF INDEMNITY 1L 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 ! .( 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 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.
II
PLUMBER'S NAME Spencer Hallett 11 LICENSE# 16224 - SIGNA RE
MP 11,,,,, JP 17 CORPORATION I___.s#j ;PARTNERSHIP #I •I LLC[J# 1
COMPANY NAME Spencer Hallett Plumbin and d Heating, Inc I ADDRESS L382 Old Falmouth Rd Unit 36 _ _ __ _ ,
CITY-MarstonsMills ^ ;STATE Lkla li ZIP [02648 f TEL508-4286080 _
FAX 1508-428-7991 [1 CELL .EMAIL 1s enter hallettplumbing_com - —_
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