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HomeMy WebLinkAboutBLDP-22-006190 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/27/22 PERMIT# BLDP-22-006190 I JOBSITE ADDRESS 135 SOUTH SHORE DR UNIT 9 OWNER'S NAME Mr.Wolfe D OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:m PLANS SUBMITTED: YES NO El FIXTURFS • FLOORS—. RSM 1 2 3 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 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 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 El NO El 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 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 16224 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 ❑ ❑ FEES S PERMIT# PLAN REVIEW NOTES I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i m��t= CITY INar('(hc, �� - I MA DATE I[ 1 1PERMIT# 22— b(RU JOBSITE ADDRESS ,I:3 )}h S1cy'_`xc:L 1 OWNER'S NAME kipakc__— POWNER ADDRESS aa5 E (,alle ._IcorqA.eat_ A2? _._. TEL jOS Lopiuo IsiiFAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL P RESIDENTIAL PRINT CLEARLY NEW: [- RENOVATION:rT REPLACEMENT: PLANS SUBMITTED: YES n NOn FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB Ir 1,7li CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM IL j I DEDICATED GAS/OIL/SAND SYSTEM I DEDICATED GREASE SYSTEM ; , DEDICATED GRAY WATER SYSTEM ! DEDICATED WATER RECYCLE SYSTEM I I I i DISHWASHER ®®® ®® pi DRINKING FOUNTAIN I_II 1 'I ,II I = IIFOOD DISPOSER I lFLOOR/AREA DRAININTERCEPTOR(INTERIOR) I KITCHEN SINK LAVATORY anon 1 , ROOF DRAIN SHOWER STALL III 1111111 SERVICE/MOP SINK 7 1 1 iir II TOILET ;i D URINAL Il .WASHING MACHINE CONNECTION i � WATER HEATER ALL TYPES j WATER PIPING I OTHER 1 1 LuiN° DE-goa.:If II _ . 1INT I I I I II _ I i' Il INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES n NO ri IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY C BOND ri 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 Q AGENT Q 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 . I a ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Spencer Hallett 'LICENSE# 16224 I SIGNATURE MP n JP fl CORPORATION H#3834 'PARTNERSHIP # LLC # COMPANY NAME Spencer Hallett Plumbing&Heating, Inc I ADDRESS 381 Old Falmouth Rd, Unit#36 _ CITY Marstons Mills ISTATE MA ZIP 02648 ^J TEL 508-428-6080 FAX 508-428-7991 CELL EMAIL sue@hallettplumbing.com