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HomeMy WebLinkAboutBldp-22-000863 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK y r CITY YARMOUTH MA DATE 8/16/21 PERMIT# BLDP-22-000863 l'`` JOBSITE ADDRESS 17 NARROWS LN OWNERS NAME KING DENISE P P OWNER ADDRESS 7 COLELLA FARM RD HOPKINTON,MA 01748 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES • 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/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 WATER PIPING OTHER 1 OTHER DESCRIPTION:irrigation backflow INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO 0 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. PLUMBERS NAME Stephen Winslow LICENSE 142298 SIGNATURE MP © JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME STEPHEN A WINSLOW I ADDRESS 8 REARDON CIR CITY IS YARMOUTH STATE MA ZIP 026641207 TEL FAX I I CELL EMAIL inspections@efwinslow.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 4 J 1. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 0. - et - S.; 4 CITY`yarmouth MA DATE 08/11/2021 PERMIT# 2 Z — g(03 JOBSITE ADDRESS 17 narrows lane,sL 1 Via. »uth OWNER'S NAME king,denise POWNER ADDRESS TEL 508.345.1461 FAX a TYPE OR OCCUPANCY TYPE C01\.', IICI EDUCATIONAL ri RESIDENTIAL D PRINT CLEARLY NEW:I°! RENOVATION:; lei- ;C-".i NT: _A PLANS SUBMITTED: YES 0 NOQ FIXTURES 1 FLOOR 13SM 1 i 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 ---1 III CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 111111M11111111111111111A11Will1111111111111 DEDICATED GAS/OIL/SAND SYSTEM 9 --I1 �� DEDICATED GREASE SYSTEM i! DEDICATED GRAY WATER SYSTEM 1 , II l i DEDICATED WATER RECYCLE SYSTEM DRINKING FOUNTAIN — ! II _._._, FOOD DISPOSER > FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR)_ -.--T1 -1! .! LAVATORY :,__ all KITCHEN SINK I t it . ROOF DRAIN 1 � ' SHOWER STALL — — ! , .__ 11 MIall MI SERVICE/MOP SINK r . mg TOILET i 'i i I i ? l URINAL , WASHING MACHINE CONNECTION f I I I WATER HEATER ALL TYPES i WATER PIPING OTHER i I II_ i_ irrigation back flow i w\o 561859$50.00 . I IN[Si.1RANCE COVERAGE: I have a current liability insurance policy or its s ustant; ;.:;v-dent which meets the requirements of MGL Ch.142. YES 0 NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE 1 Pi CO'1 ' is r E.I;ECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY , Cl' '')' ' .:Jr ;N!)EMNITY BOND I I 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 0 AGENT 0 SIGNATURE OF OWNER OR IGi ,IT I hereby certify that all of the details and inforp r r, ,o rr ucred regarding this application are true r a to the b t of my knowledge and that all plumbing work and installations N , ', n :r . .r ed for this application will be in co li wit II ertine proyisio of the 9 Massachusetts State Plumbing Code and Ci-iiipior 1,, of the n I i,vis r PLUMBER'S NAME STEPHEN WINSLOW LICENSE# 112298 1 SIGNATURE MP JP El ;C ^Rl. 3281C PARTNERSHIP-1# LLC0# COMPANY NAME E.F.WINSLOW PI-UML,[I!.; :r,, €?I SS 8 REARDON CIRCLE CITY SOUTH YARMOUTH S i;,;L 1,\ r' 02664 1 TEL 508-394-7778 FAX 508-394-8256 J CELL LNIA i- 1ILL I r-C i ONS(cp,EFWINSLOW COM