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Home My WebLink AboutBLDP-22-002300 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Y, CITY YARMOUTH MA DATE 10/21/21 PERMIT# BLDP-22-002300 JOBSITE ADDRESS 12 WEDGEMERE RD OWNERS NAME Samantha canney P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS 1 FLOORS RSM 1 2 3 4 5 6 7 8 9 10 11 12 13 I 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 0 NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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. PLUMBER'S NAME Spencer Hallett LICENSE t8224 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC ❑# COMPANY NAME SPENCER HALLETT ADDRESS 381 Old Falmouth Rd Unit 36 CITY MARSTONS MLS STATE MA ZIP 026481372 TEL FAX CELL 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 •: ,\ '' I- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORKI ' CITY [\4CuJ ! IPERM!T # 2t - 2 °Uf m a ca?�-1�-> MA DATE ! C��l �2,1 — JOBSITE ADDRESS 1 a W edcjJ.e ry‘..124.-P Y2. I OWNER'S NAME Z.I. Lo d-K.f p OWNER ADDRESS Say-c _ _ . _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL RESIDENTIAL Q PRINT CLEARLY NEW: T RENOVATION: REPLACEMENT: (r PLANS SUBMITTED: YES NO . . FIXTURES 1 FLOOR—► BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ! CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM I I ! 1 El DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM I DEDICATED GRAY WATER SYSTEM I , I II DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN ! , FOOD DISPOSER i j rtillill FLOOR /AREA DRAIN l INTERCEPTOR (INTERIOR) I j KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL , i EL 1 SERVICE / MOP SINK 1 TOILET I I 1 I URINAL 1 1 ' i WASHING MACHINE CONNECTION _ WATER HEATER ALL TYPES 1 t I i I ` WATER PIPING I I L . OTHER I , .i. 11 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. CHECK ONE ONLY: OWNER Li 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 to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in corn. if. I a " ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME pencer Hallett ILICENSE # 16224 I . SIGNATURE MP v JP 1 CORPORATION .i # 3834 'PARTNERSHIP ' # i LLCF# COMPANY NAME Spencer Hallett Plumbing & Heating, Inc ADDRESS 381 Old Falmouth Rd, Unit#36 CITY Marstons Mills 1 STATE MA f ZIP 02648 J TEL 508-428-6080 -I . FAX 508-428-7991 1 CELL EMAIL sue@hallettaymbing.com ......"...,...___.......1 cic tL 7010