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HomeMy WebLinkAboutBLDP&G-22-004523 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK yA �/ CITY YARMOUTH MA DATE 2/14/22 PERMIT# BLDP-22-004523 'nar JOBSITE ADDRESS 53 PROSPECT AVE OWNER'S NAME TRACY WILLIAM D P OWNER ADDRESS 53 PROSPECT AVENUE WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES • Fl OORS-. BSM 1 2 9 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 at 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 R6224 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME 'SPENCER HALLETT ADDRESS 1381 Old Falmouth Rd Unit 36 CITY IMARSTONS MLS I STATE 'MA ZIP 1026481372 ' TEL ' FAX 1 I CELL I 1 EMAIL spencer@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 r '' I _— MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK mu CITY I MA DATE I Of. Fa.• PERMIT # 22+ L+ 523 JOBSITE ADDRESS 133 ,per- Aho OWNER'S NAME Tcc c'1 • POWNER ADDRESS 5Ci..YY _. TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL . EDUCATIONAL J RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: P REPLACEMENT: R PLANS SUBMITTED: YES NO[ FIXTURES Z FLOOR-i BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ' CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM j i i DEDICATED GAS/OIL/SAND SYSTEM � � i DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER . ; 1111 I I FLOOR /AREA DRAIN ' INTERCEPTOR (INTERIOR) ;KITCHEN SINK jLAVATORYROOF DRAIN SHOWER STALL , I iSERVICE / MOP SINK TOILET i URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES I ! I WATER PIPING . OTHER j1 l _ 1 11 L I ... I _ ..._ I I ll ll INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES PI NO [] IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY J OTHER TYPE OF INDEMNITY U 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 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 com• '. ' I, a ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. , PLUMBER'S NAME Spencer Hallett LICENSE # 16224 1 SIGNATURE MP i JPr1 CORPORATION[ i 1# 3834 PARTNERSHIP .# LLC . # COMPANY NAME Spencer Hallett Plumbing & Heating, Inc I ADDRESS 381 Old Falmouth Rd, Unit#36 CITY 1Marstons Mills STATE I MA I ZIP 02648 J TEL 508-428-6080 - '._._..______J ,. FAX t508428-7991 CELL I 1 EMAIL sue@hallettplumbing.com ,_.._ __._...._.__ ,_ ____ � 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE February 14,2022 I PERMIT# BLDP-22-004523 JOBSITE ADDRESS 53 PROSPECT AVE OWNER'S NAME TRACY WILLIAM D G OWNER ADDRESS 53 PROSPECT AVENUE WEST YARMOUTH MA 02673 TEL I TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL Q PRINT CLEARLY NEW 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES❑ NO❑ 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 I 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 0 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 I LICENSE# 16224 SIGNATURE MP©MGF❑JP 0 JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: 'SPENCER HALLETT I ADDRESS. 1381 Old Falmouth Rd Unit 36, CITY IMARSTONS MLS I STATE MA ZIP 026481372 TEL I FAX I CELL I I EMAIL IspenceranhallettDlumbino.com S310N M3IAal Ndld #.IWH3d $:33d ❑ ❑ 11Wd3d 3H1 SV S3A2l3S N011V011ddv SIHI ON SaA S310N NO1103dSNI 1VNId KINO 3Sfl NO103dSNI NOd 39Vd SIHI S310N NOI103dSNI SVO HOf108 •-. L' , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 =El o'°>T�F CITY - l�_-C�.0 C w I MA DATE I r` ( / --- PERMIT # J 4 _ JOBSITE ADDRESS S3 Pctrvec4---14. OWNER'S NAME tra GOWNER ADDRESS Sa TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL pi EDUCATIONAL J RESIDENTIAL ---ii,r . PRINT CLEARLY NEW: 1 RENOVATION: [ REPLACEMENT: vi PLANS SUBMITTED: YES ED NO APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 _ -, .._n ( BOOSTER a CONVERSION BURNER R ,_ COOK STOVE DIRECT VENT HEATER DRYER ._..m-_ . . 1--.,. FIREPLACE . E. , . ,t. _ ... . it , , .., , _i_ _I .. _II. _ .„_ , • . : , . rin.. , . . _ , _,,,,r7:71 FRYOLATOR FURNACE GENERATOR __ _ GRILLE ---1,--1-----:, . '__ _ ._ _ __, __ __ INFRARED HEATER -_ ,,._ ; _ _ ____ . ,I .._._____ . LABORATORY COCKS , r.MAKEUP AIR UNIT OVEN .±..... _ _ POOL HEATER ROOM / SPACE HEATER _.. ! ... -._- (_� ,, ., ,.-h_.. _ .,-- �.... _ ._._..._. .___ ,... ROOF TOP UNIT TEST I UNIT HEATER UNVENTED ROOM HEATER _ .. WATER HEATER --------- — --- OTHER i . _. 1 ___ . .. NM INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES A NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [71 OTHER TYPE INDEMNITY 11 BOND 171 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 ( d AGENT I , 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 •_ best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in comp 'f► .- i''ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Spencer Hallett LICENSE # 16224 SIGNATURE . MP 1..�..I MGF 0 JP ID JGF Li LPGI _,.. I CORPORATION [ # 3834 PARTNERSHIP _ I# LLC (j# COMPANY NAME: Spencer Hallett Plumbing & Heating, Inc. I ADDRESS 381 Old Falmouth rd, Suite 36 I STATE MA ZIP[02648 ITEL 508-428-6080 CITY [Marstons Mills _ -. 91 CE EMAIL a@ haIIettpIumbing.com I FAX�508-428 79 I LL�-._�.,.-. ._ �_.,,, ._..�„ ..� ,sue