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Home My WebLink AboutBLDP-16-006688 MAS c • au NF• - c •P C • • i FO- • • t • PRF• : P : . • t . w7� , 41 CIN ■11121 MIN MA DAA; 1147M47,121 PERMIT# C 7 : JOBSITEADDRESS leriti Jr, g Y inntrWNER'SNAME 41/In Ca P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL 0 RESIDENTIAL[I PRINT N. CLEARLY NEW:0 RENOVATION;❑ _ REPLACEMENT: PLANS SUBMITTED: YES 0 NO L FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 ® 13 14 pj N BATHTUB S —s,�S'M ■■ 5S5a■�[a:s 1 CROSS CONNECTION DEVICE NUN SS 110111111111IMO„Mil MR',MN,Mt;NINOat MSN .S DEDICATED SPECIAL WASTE SYSTEM a. OMR 5Mt Sal' ;S IS IS aS DEDICATED GAS/OIL/SAND SYSTEM 5mpg so a,a,a an a Imi,fIS II�Aw[I1�I�C Iw�t M�■wt DEDICATED GREASE SYSTEM Mal NM la 11111111S jSW 555—555 DEDICATED GRAY WATER SYSTEM 11111111111K Mal„'am,a_a55;; ngawn;s mpg a DEDICATED WATER RECYCLE SYSTEM 55 N MN a OMR,;0.111.01S....11 iw,;r mum DISHWASHER 55Mit 5_SIM MitMill_,ssa• s DRINKING FOUNTAINanitimiSillijoulmorManting �1. FOOD DISPOSER , � . FLOOR/AREA DRAIN aaMss_s [ , ,;ss,Mil INTERCEPTOR INTERIORa , `,�'„ KITCHEN SINKass�>Iaa Ia'MNMas LAVATORY MISS MI NS S111111.1111110011 ROOF DRAIN 1111111111a SSIIMIRS555,1555,5 SHOWER STALL s_intI_s__I r�! lsmO_ a SERVICE!MOP SINK Sall11110111111111111111111(MaS1111111111111111110SINIKINIS, TOILET 5.55 5aasIss. URINAL 555 �i��', 'i�. WASHING MACHINE CONNECTION Ma55 as;1111111laSsaj5 55 NM WATER HEATER ALL TYPES IagamtsiSsaaNM; „MI NMI NM WATER PIPING $11.111.11111111 Nil 11.111111111111111 ;ISM I , i , OTHER MN JIM MJSIMI IMO 1' ili , SINS MS ON OMR Mot 1111111111111(11111111a Ala Jentigli Ma Nat ON NIIIIIIIIIINIMI111111111111111111111111111111111111111(111.111111111110111111011111111.111SIMIIIIIIIMOMESISIIIIONIII MIIIIIIII11111111111111.111111.11111111111111111111/111111111.11110 NMI INN 1111111:1111111:IONS Mar migg Ma Sas ingi INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY 0 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 1 hereby certify that all of the details and information I have submitted or entered regarding this application are e 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 fiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /0,1 PLUMBER'S NAME STEPHEN A WINSLOW LICENSE# 12298„ SIGNATURE MP[] JP CORPORATION ED 3281C PARTNERSHIP E3# LLC❑# COMPANY NAME E.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE' CITY SOUTH YARMOUTH STATE MA ZIP 02664 ..!TEL 508.3944778 FAX 508-394-8256 CELL EMAIL ACCOUNTSPAYABLE@EFWINSLOW.COM ' 0 G t Ae The Commonwealth of Massachusetts w__ •Department of Itr»astkul Accidents �. lE_,NI=a Office of Investigations '' •Eta ! 741= 6 1 Congress Street, Suite 100 e dila= a0 Boston,MA 02114-2017 ' www mass.gov/dla - Workeis'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information • Please Print Legibly •Name (Business/oigeniiation/Itidividual): E. F. WINSLOW PLUMBING & HEATING CO. INC. Address:8 REARDON CRCLE City/State/Zip:SOUTH YARMOUTH, MA 02664 Phone#:508-394-7778 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 70 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* - have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees - These sub-contractors have 8. 0 Demolition .. working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance - comp. insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I ant a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑ Other employees. [No workers'. comp. insurance required.] *Any applicant alai checks box#1 must also fill out the section below showing theiirworkers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees..If the sub-contractors have employees,they must provide their workers'comp.policy number. , I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Policy#or Self-ins. Lic. #:1794 A Expiration Date:01/01/2016 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as-required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations oftA o •' uranc, co erage van' .tion. I do hereby cert un a ins and enalties r a erjury that the information provided above is true and correct. jw 2016 Signature: K —a- Date: 508-394-777. phone#: ,. Official use only. Do not write in this area,to be completed by city or town'official. ' 0 City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: phone#: •`''S . MM ACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e =an- 1 ,f` CITY I._ H✓maul h . . f .MA DATE ,./ PERMIT# I340P-74- oO 0 7 JOBSITE ADDRESS. 7 4j l�f I.s� ��/nfioit1J/Jn NER S NAME ! /111))96/1 f GOWNER ADDRESS 1_ TEL' 7Y .............Tiis / / TYPE OR OCCUPANCY TYPE COMMERCIAL LI - __ .EDUCATIONAL 1._1 RESIDENTIAL Y CLEARLY - NEW.I I RENOVATION:!) REPLACEMENT:iyPLANS SUBMITTED: YES' ) N APPLIANCES 7 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 133 14 BOILER1" F BOOSTER a _ I J..,» _wmJ 1 J _J( . ( _J J J I _____I) 1✓) CONVERSION BURNER _.J J _ I _.,. .J __ I _1 _ I __.,._l ,,1 ...,..J I, _ „_.1,___ J COOK STOVE __I J F J I ( ___ I. I J I DIRECT VENT HEATERI - i i _1J J J -_ 1J J I J I DRYER ' __J ____1 _._J _._1 _ I f J t _J, I_—J �1 - I FIREPLACE I-_ I _.J 1___J ,1,�J 1 I.___II . I 1 .. 1 FRYOLATOR ______J _____I__J 1 I 1 I .__J .__._.J I _ , I �. I ___I I _—I FURNACE -.-J I T A J -r-1 ,Q I J , I__J__.._...J , I ,,.,_.J.__J i _ I GENERATOR ._J I ____1._._-J __J..__I _I 1 1_1-J I, I T}_,- I IZ GRILLE _ I t._.__J I__JI I I I I I I I I ' O INFRARED HEATER 1 I I 1 _ 1 I 1 1 I I _____..I J 1 y„ LABORATORY COCKS _I_ 1 .. .,,.___1 _1 _._J ._.__1' _._l, 1 ._I ..__....1_. 1 __. ..I __..,1I D. MAKEUP AIR UNIT 1 __ 1 . _ ___ J__—1 _,..J —1 __--1 -_-1 _- 1 ___---I ___J ____I _ _..J ____I OVEN POOL HEATER ..1 I _- I _J_J I __1 -._J —.J _J ._J___J !__J ROOM I SPACE HEATER ___ 1 __J_r.JI , I'___I __._J ., 1 ___I _1 1_ ,l _ 1 J , ROOF TOP UNIT .__ I -_-J __I__J _,.1 __I _,I _V I .J I____J . I__J __I__1 TEST t____I J I __J . 1_..1 ._ _I___!L 1_, 1 _.z.J - —_.I . I UNIT HEATER t 1' _ _ ; I' 1 �I .-. I 1 rJ _ 1 1 _ -.� �1J UNVENTED ROOM HEATER i J :_'' _ _J yw._J ___.I I 1_ I I, , I _, 1._ __J __.,._I 1 �I _1 WATER HEATER __J :__I ..__I _` _ I _ _ 1 ___J -. ._. _ J - _J 1 I OTHER ., . . 1 __J I ._! _.._.._I 1 .,_.._._J 1 .. J_ _ i J ,I _-.I I I._.,.J .......... ___�___ =__1 _._-_l ___1 ._, _1 . _ .' .___I ___1 .,. ._I'_..._J, _..l _.f __ _1__I_ .,-1 1' 1 , t J J _._._..J .,1.>__ I _. ..J...,.,..J __J__.,J INSURANCE COVERAGE I have a current Jiability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 14 NO '_,I I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY .4 OTHER TYPE INDEMNITY BOND L.__J 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 '„ f 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 compli��9PPPccce with all Pertinent provisiblr of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. {'.�} , PLUMBER-GASFITTER NAME STEPHEN A WINSLOW__..,.,,_,,._ 1 LICENSE#JngR SIGNATURE MP',�,JXMGF'.J JP J JGF J LPG!J CORPORATION J#'3281C1 PARTNERSHIP ._..,'# 1 LLC J# COMPANY NAME E.F.WINSLOW PLUMBING d HEATING J ADDRESS,8 REARDON CIRCLE CITY SOUTH YARMOUTH I STATE MA I ZIP 02664 .��TEL 508-394-7778 FAX 508.394.8256 J CELL, I EMAIL ACCOUNTSPAYABLEaIEFWINSLOW.COM 76 .4-.R It The Commonwealth of Massachusetts i�=w== DepartmentlfIndustrialAccidents —, '=o_,'Mli_=Ct Office of Investigations ,. =lint- a 1 Congress Street, Suite 100 '• ``t:- 14 Boston,MA 02114-2017 • Y"'' `°' www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly • Name(Business/Organization/Individual): E. F. WINSLOW PLUMBING & HEATING CO.,INC. Address:8 REARDON CRCLE City/State/Zip:SOUTH YARMOUTH, MA 02664 Phone#:508-394-7778 . Are you an employer? Check the appropriate box: Type of project(required): 1.El I am a employer with 70 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 Buildingaddition [No workers' comp. insurance comp. insurance.: ❑ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3:❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] • . 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Policy#or Self-ins.Lic.#: 1794 A Expiration Date:01/01/2016 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised t tat a copy of this statement may be forwarded to the Office of Investigations of o ' uranc• co erage veil tion. I do herebycert�un a ins and ,enaltles r ,erjury that the information provided above is true and correct. Signature: K Date: 2016 Phone#: 508-394-777 Official use only. Do not write in this area;to be completed by city or town official. - � • �' City or Town: Permit/License# Issuing Authority(circle one): y1+1 1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector k 6.Other Contact Person: ^ '"Phone#: