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HomeMy WebLinkAboutBldp-22-001595 i t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK t. Lti CITY YARMOUTH MA DATE 9/20/21 PERMIT# BLDP-22-001595 JOBSITE ADDRESS 55 PHYLLIS DR OWNERS NAME GRAY KATHLEEN M P OWNER ADDRESS 55 PHYLLIS DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL m PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES -I 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/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 WATER PIPING OTHER 1 OTHER DESCRIPTION:outside shower INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ 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 Stephen Winslow LICENSE 12298 SIGNATURE MP © JP ❑ 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 0 ❑ FEES E PERMIT# PLAN REVIEW NOTES r i 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e CITY YARMOUTH MA DATE September 20,202 PERMIT# BLDG 22 001594 ti_ krt ,� JOBSITE ADDRESS 55 PHYLLIS DR OWNER'S NAME GRAY KATHLEEN M G OWNER ADDRESS 55 PHYLLIS DR SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL al PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO 0 FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE 1 FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER • LABORATORY COCKS • MAKEUP AIR UNIT OVEN • POOL HEATER • ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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-GASFITTER NAME Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF 0 JP 0 JGF 0 LPG! ❑ CORPORATION 0# PARTNERSHIP ❑# LLC 0# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsna.efwinslow.com S310N MJIA32!NYld #lU1A2i3d $:33d ❑ 1I11213d 3H1 SV S3A213S NOI1V3llddd SIH1 oN saA S310N NOI103dSNI 1VNId /LINO 3Sfl O103dSNI 2IOd 30`dd SIH1 S310N NOI103dSNI SVO HOflO H MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK „w= =:vt�n r' _'fii= CITY Yarmouth MA DATE 09/16/2021 PERMIT# '2 -is S JOBSITE ADDRESS 55phyllis drive,south yarmouth OWNER'S NAME gray POWNER ADDRESS e____a _u. .. ._ ', TEL 508.394.0171 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E} EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW:Q RENOVATION:LI REPLACEMENT:El PLANS SUBMITTED: YES LI NO ] FIXTURES 1 FLOORS i BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB l CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM nil DEDICATED GAS/OIL/SAND SYSTEM , I • • I I DEDICATED GRAY WATER SYSTEM , DEDICATED WATER RECYCLE SYSTEM j II DRINKING FOUNTAIN 1 FLOOR/AREA DRAIN iiiiiiiii INTERCEPTOR(INTERIOR) IRRiIRURUIIiI KITCHEN SINK ROOF DRAIN MI 1111111111 111111,111111 MI al INS AM II,LAVATORY 11KIIItillianiMilliMalliffillIFIEMIRIMIIIIIIINM MN MI MIIIIII NIB NSW SERVICE/MOP SINK • f huh_111111111 URINAL 1 I WASHING MACHINE CONNECTION Ij i_ I WATER HEATER ALL TYPES 1 i.._ _...__1 WATER PIPING 11 I, 1 1 1j OTHER I 1outside shower ill IIIII1 R*RRR*iI*R*RRIi* I w/o 560783$50.00 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ID NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY 0 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. CHECK ONE ONLY: OWNER 0 AGENT 0 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 r e to the t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co Ii wit II ertine proyisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP El JP El CORPORATION[Q# 3281C PARTNERSHIP(# LLCQ# COMPANY NAME E.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-394-7778 FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM • • ' MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM GAS FITTING WORK i�h CITY yarmouth MA DATE 09/1� 6/2021 PERMIT# 2.- is-pi 1 JOBSITE ADDRESS 55 phyllis drive,south yarmouth OWNER'S NAME bra r GOWNER ADDRESS TEL 508.394.0171 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Ij EDUCATIONAL 0 RESIDENTIAL LI PRINT CLEARLY NEW:[ RENOVATION:Li REPLACEMENT:Li PLANS SUBMITTED: YES Li NO APPLIANCES 7 FLOORS-' BSM 1 J 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER NM _.. ,, B „Fn BOOSTER I� :r P E I. ,.1Ini _ _,M_ CONVERSION BURNER OM onCOOK STOVE DIRECT VENT HEATER iiiiiimoim all 101111W1011 1111111111.1111.11111111110i DRYER MIIIIIIIII i FIREPLACE I FRYOLATOR �.. ._ ,innillnilliMINMOMMOINIMMIM� .. . Ilin FURNACE a ` i I 1 GENERATOR 1_- & ,I GRILLE INFRARED HEATER 1 � ' i I LABORATORY COCKS it MAKEUP AIR UNIT �111 r._._.__. I MilliilliMallialli OVEN . ' . , POOL HEATER _ ROOM I SPACE HEATER IIIIIIIIIII ROOF TOP UNIT I TEST � UNIT HEATER I t UNVENTED ROOM HEATER 1 'V WATER HEATER OTHER riminumillitimiallit iiiiiiiit �, 111.0.110.101111111111111111111MMIIIIII_ON1__5 _Mil.maLII*alltwIIIII ,, 560783 50.00 1,,. ( Ia �.imaiiii=imoiniialiffilligiliiiiiiiitaili sMI INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Pjl OTHER TYPE INDEMNITY I 1 BOND 0 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 Li 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 t of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianca all'PP rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (�/71 • // y " PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE#1 12298 € SIGNATURE MP MGF Li JP Ljj JGF LPGI[D CORPORATION 0# 3281C i PARTNERSHIP0# LLC Ei#1 - J COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH 1 STATE[MA 1 ZIP 02664 _.. 1TEL 508-394-7778 FAX 1508-394-8256 I CELL N/A !EMAIL INSPECTIONS@EFWINSLOW COM