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HomeMy WebLinkAboutBldp-22-001323 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • ; ,, CITY YARMOUTH MA DATE 9/7/21 PERMIT# BLDP-22-001323 f' @ JOBSITE ADDRESS 92 PHYLLIS DR OWNERS NAME FRANCO SUSAN HEALY TR P OWNER ADDRESS SUSAN HEALY FRANCO REV LIVING TRUST 92 PHYLLIS DR SOUTH TEL YARMOUTH,MA 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES ID NO El 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/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 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. PLUMBERS NAME Stephen Winslow LICENSE W298 SIGNATURE MP El 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 0 FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK „,' � CITY YARMOUTH MA DATE September 07,202 PERMIT# BLDP-22-001323 JOBSITE ADDRESS 92 PHYLLIS DR OWNERS NAME FRANCO SUSAN HEALY TR G OWNER ADDRESS SUSAN HEALY FRANCO REV LIVING TRUST 92 PHYLLIS DR SOUTH YARMOUTH MA TEL 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES ❑ NO❑ 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 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 1 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 0 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❑ JGF❑ LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections(d),efwinslow.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT El ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -- tiffy� CITY yarmouth MA DATE 08/26/2021 J PERMIT# 221— i3z3 JOBSITE ADDRESS 92 phyllis drive,south yarmouth OWNER'S NAME franco,susan P OWNER ADDRESS TEL 508.394.8567 :FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO0 FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM ' DEDICATED GAS/OIL/SAND SYSTEM j DEDICATED GREASE SYSTEM DEDICATED WATER RECYCLE SYSTEM DEDICATED GRAY WATER SYSTEM I DISHWASHER DRINKING FOUNTAIN 1 FOOD DISPOSER INTERCEPTOR(INTERIOR ,I I KITCHEN SINK 1 I I ROOF DRAIN lir II SHOWER STALL I , SERVICE/MOP SINK URINAL WASHING MACHINE CONNECTION riiirIIIIIIillIllIllB 111111111111111111111111111111.1111111111FWII11111111111111111 WATER HEATER ALL TYPES WATER PIPING OTHER w\o 562730$40.00 , INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ci 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 Li 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 [I 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 r e 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 wit II ertine proyisioryof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / Vw+ .......!_...- PLUMBER'S NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP JP® CORPORATION]# 3281C PARTNERSHIPQ# LLC®# 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 FOR A PERMIT TO PERFORM GAS FITTING WORK 'r >� AFf= CITY Yarmouth 1 MA DATE 08126/2021 PERMIT# JOBSITE ADDRESS j 92 Phyllis drive,south yarmouth OWNER'S NAME franco susan . GOWNER ADDRESS TEL 508.394.8567 IFAX I TYPEPRI OR OCCUPANCY TYPE COMMERCIAL, EDUCATIONAL [J RESIDENTIAL El CLEARLY NEW: ] RENOVATION: REPLACEMENT:D PLANS SUBMITTED: YES LI NO Ri APPLIANCES Z FLOORS—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER --- _. a — - _� BOOSTER , - _ _, I, i i i' CONVERSION BURNER ,I B„� I :, ..m .. , '! a, jL_. I,,,._ „, ....r_ J_ _�.� l COOK STOVE DIRECT VENT HEATER 1 1 1 f fi DRYER mowt s FIREPLACE l FRYOLATOR mil m -ry __ C i' ` FURNACE GENERATOR � U 9._. GRILLE r- ,1 4717:11 _ 1. l INFRARED HEATER i i LABORATORY COCKS MAKEUP AIR UNIT '` sionimiiiiiiiii OVEN I ILmum I POOL HEATER , , ROOM/SPACE HEATER i L 1� 1 ri s ROOF TOP UNIT g TEST : l i` , i UNIT HEATER IIIIIIIOIIIIMIIIMIIITIIIIIIIOIIIIOIIMIMIIIOOV . . . . _, I . .1111111111111 UNVENTED ROOM HEATER „,.1M1 .„. ____ r-_J.._ __ r 1 , a WATER HEATER OTHER 1 a III[Mom no IIIIIIIIIIIMIIIII i w\o 562730$40.00 .._... - imiimermitimainutamialummit INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES . NO L.. I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ,; OTHER TYPE INDEMNITY Li BOND LI 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 i...w AGENT 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 accurat to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc a YPptine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME STEPHEN WINSLOW_ � LICENSE# 2298 SIGNATURE MP,,, MGF D JP® JGF*1 LPGI0 CORPORATION LI#13281C 1 PARTNERSHIPS# LLC 0# �J COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING —I ADDRESS;8 REARDON CIRCLE i CITY SOUTH YARMOUTH STATE MA j ZIP I 02664 _mm TEL 508-394-7778 FAX108-394-8256 CELL[NIA ]EMAIL INSPECTIONS@EFWINSLOW.COM _