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HomeMy WebLinkAboutBLDP&G-21-000181 .m. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • CITY YARMOUTH MA DATE 7/14/20 PERMIT# BLDP-21-000181 ' JOBSITE ADDRESS 6 AVON RD OWNER'S NAME HAZEL GOLD P OWNER ADDRESS GOLD HAZEL TRS 524 CALIBRE WOODS RD ATLANTIC TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El FIXTURES z FLOORS—) BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND 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 m 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 El BOND El 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 Stephen Winslow LICENSE 12298 SIGNATURE MP © JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME STEPHEN A WINSLOW ADDRESS 8 REARDON CIR CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections@efwinslow.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES$ PERMIT# PLAN REVIEW NOTES - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ."ig CITY Y1V6901 '. _., _ I MA DATE L1 b _W �_JPERMIT# ,LZ,' a/' OG°/Il JOBSITE ADDRESS (Avp ii AV i /�tav/'j,Oa,1- OWNERS NAME Hn 7/ ,t / P OWNER ADDRESS �Z y �a.1 r��pY� Wt5, , �� A�14t? bit ' TEL SDI�i�Za_�.-6 I FAX TYPE OR OCCUPA CY TYPE COMMERCIAL D EDUCATIONAL D RESIDENTIAL D--- - PRINT CLEARLY NEW:D RENOVATION:U REPLACEMENT:al-------- PLANS SUBMITTED: YES ID NOD FIXTURES 1 FLOOR--4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ' >.ILJI.... I . I CROSS CONNECTION DEVICE i f 11-11.. _ ' 7 :,DEDICATED SPECIAL WASTE SYSTEM ro [1—, ...F.--1 r-1( a, .„a DEDICATED GAS/OIL/SAND SYSTEM �I �1, , x__i . ,JL, .. . L... �I[ ;I L DEDICATED GREASE SYSTEM '__ ) _1 1 _ II d I ai _ ___- DEDICATED GRAY WATER SYSTEM I__ , L.... I_ L_,_ L _ ' �' DEDICATED WATER RECYCLE SYSTEM MI DISHWASHER _v DRINKING FOUNTAIN ' I {L_ I a FOOD DISPOSER Mai 1 t FLOOR/AREA DRAIN I I. EEEIEIIEIEE 1 1, NE KITCHEN SINK -- _ - I L LAVATORY 4__._, 11111111.111111 i ROOF DRAIN R$RRRRRRR$ SHOWER STALL ,,,, SERirliMillilliriMff Olt TOILET /MOP SINK Untw on I 11111111111111111111111111.111111111111111111111101111111 1111111 OM URINAL 111101111111N1111110ff, 'W' WINIffIM WASHING WATERHEATERINE ALLTYPESCTION � ', —.111111.111111 ill' MI WATER PIPING I � ... 1�■�..' � i f l r I ' ' I OTHER � �._ i _- � � I, - =...- . -. P; ,.., -3. j 1 H' I : f � . ,..� _.. =I®, „_, ' ,._, C INSURANCE COVERAGE� I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES LLi NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW i LIABILITY INSURANCE POLICY Li OTHER TYPE OF INDEMNITY © BOND D 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,4nd that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER Li 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 it a to the b t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co Ii with II ertine proyisioryof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / IYN y .•., 0`.�- ? PLUMBER'S NAME LTEPHEN WINSLOW — LICENSE# 12298 SIGNATURE t Imo- MP JP CORPORATION# 3281C PARTNERSHIP®# ILLC(TI# 0 4 Ig:' COMPANY NAME E.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE rJ CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-394-7778 FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM