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Bldp-22-001526 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK of CITY YARMOUTH MA DATE 9/16/21 PERMIT# BLDP-22-001526 1111 JOBSITE ADDRESS 4 PINE REACH VILLAGE OWNER'S NAME COUGHLIN RICHARD P p OWNER ADDRESS COUGHLIN JOANNE MARTEL 4 PINE REACH YARMOUTH PORT,MA 02675-1470 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES❑ NO❑ FIXTURES 1 FLOORS-0 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❑ NO ❑ 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 1Q298 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 ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES r � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ik,,,.0 `' BLDP-22-001526 e CITY YARMOUTH MA DATE September 16,202 PERMIT# I s' JOBSITE ADDRESS 4 PINE REACH VILLAGE OWNER'S NAME COUGHLIN RICHARD P G OWNER ADDRESS COUGHLIN JOANNE MARTEL 4 PINE REACH YARMOUTH PORT MA 02675-1470 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© 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 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 0 LPG! ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsto7.efwinslow.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT O ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • �u�- _._ta-0' CITY YARMOUTH MA DATE 9/8/21 i PERMIT# - JOBSITE ADDRESS 4 PINE REACH,YARMOUTHPORT OWNER'S NAME RICHARD COUGHLIN POWNER ADDRESS SAME TEL 5088280855 FAX TYPE OR 1 OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL LI RESIDENTIAL PRINT CLEARLY NEW:0 RENOVATION:El REPLACEMENT:ID PLANS SUBMITTED: YES LI NOLJ rO FIXTURES-1 FLOOR-' I BSM 1 2 3 4 5 6_ t 7 r _8 1 9 10 Om11 12 13 j I 14 BATHTUB CROSS CONNECTION DEVICE , DEDICATED SPECIAL WASTE SYSTEM _ DEDICATED GAS/01USAND SYSTEM DEDICATED GREASE SYSTEM IF - ' AI »Wajtiik. j t , , - NI ] DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM %,., DISHWASHER 5 DRm\ INKING FOUNTAINNr s.. . FOOD DISPOSERr - NI , FLOOR/AREA DRAIN INTERCEPTOR INTERIOR) I Mt i , KITCHEN SINK LAVATORY ROOF DRAIN __. nili.. SHOWER STALL 11.11.1111111 MI I 00 SERVICE/MOP SINK MI O TOILET 11111r URINAL c r WASHING MACHINE CONNECTION Cl- WATER HEATER ALL TYPES ' 1 WATER PIPING NMI r OTHER IIIIIIMIIIPIIIIIIMIIFIIIIIFI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO ID IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L+ OTHER TYPE OF INDEMNITY Q 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 ® 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. ,........._— PLUMBER'S NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP Ej JP ID CORPORATIONS# 3281C PARTNERSHIP(# _JLLC[J#L 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 A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ?,m`;W '� CITY I YARMOUTH MA DATE 9/8/21 PERMIT# JOBSITE ADDRESS 4 PINE REACH,YARMOUTHPORT _1 OWNER'S NAME RICHARD COUGHLIN GOWNER ADDRESS SAME TEL 5088280855 JFAX TYPE PRINTR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL� RESIDENTIAL Lj CLEARLY NEW:Lj RENOVATION:Li REPLACEMENT:_d PLANS SUBMITTED: YES 0 N0 APPLIANCES 1 FLOORS-' BSM 1 2 3 4 5 6 1 7 8 9 10 11 12 13 14 BOILER '.. . BOOSTER CONVERSION BURNER IIM MN Nil I 6) COOK STOVE .� .. :111.1 .. t..-_ DIRECT VENT HEATER IIIIIIIWIMFIIIII 11111/111111111 M MC 1 DRYER FIREPLACE �. FRYOLATOR E �_ r I WINK MK r 17 a.. FURNACE GENERATOR �._,; � GRILLE 11 11 � I , INFRARED HEATER ; I j 1r) LABORATORY COCKS • MN MIR `� 4 MAKEUP AIR UNIT E — a n+ - OVEN f .. :. POOL HEATER s ' jilt _ Mr ROOM I SPACE HEATER ( 7' FT ' Inr ROOF TOP UNIT m�, . TEST T11111.1111111 � UNIT HEATER _ `. `.� �,� m.m. .. _ r UNVENTED ROOM HEATER I ,1 u WATER HEATER ' OTHER ` ;Slii l ' fir INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Li NO _-,. I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ei OTHER TYPE INDEMNITY rs 1 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 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 compliancnc aJYPprtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r ~-i1 • �G/.r- -w- PLUMBER-GASFITTER NAME LSTEPHEN WINSLOW _ LICENSE# 12298 SIGNATURE MP Ei MGF JP Li JGF 0 LPGI LI CORPORATION[ # 3281C PARTNERSHIP # j LLC Li#1 COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING ADDRESS=8 REARDON CIRCLE CITY SOUTH YARMOUTH —1 STATE MA ZIP 02664 [TEL 508-394-7778 FAX 508-394-8256 CELL[N/A EMAIL INSPECTIONS@EFWINSLOW.COM ji