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HomeMy WebLinkAboutBldp-22-001319 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/7/21 PERMIT# BLDP-22-001319 JOBSITE ADDRESS 17 POINSETTIA DR OWNERS NAME CIGANIK GEORGIA C P OWNER ADDRESS BONGIOVANNI S&ROZEWSKI D 101 SUMMIT ST NEWINGTON,CT 06111 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES NO❑ FIXTURES • 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. PLUMBERS NAME Stephen Winslow LICENSE W298 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP 0# 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 S PERMIT# PLAN REVIEW NOTES k MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK "' n� CITY YARMOUTH MA DATE September 07,202 PERMIT# BLDP-22-001319 .. w JOBSITE ADDRESS 17 POINSETTIA DR OWNER'S NAME CIGANIK GEORGIA C G OWNER ADDRESS BONGIOVANNI S&ROZEWSKI D 101 SUMMIT ST NEWINGTON CT 06111 TEL 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 i GRILLE . INFRARED HEATER , LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I 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❑ LPGI 0 CORPORATION 0# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 18 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL I FAX CELL EMAIL Iinspections(a,efwinslow.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ;l• illir CITY Yarmouth i MA DATE 08/18/2021 PERMIT# 22— 1 3 1 ci JOBSITE ADDRESS 17 polntsetta drive,south yarmouth I OWNER'S NAME giganik,georgia OWNER ADDRESS TEL TEL 508.398.3275 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL` EDUCATIONAL El RESIDENTIAL ID PRINT __ CLEARLY NEW: RENOVATION:= REPLACEMENT. PLANS SUBMITTED: YES El N0ID FIXTURES 1 FLOOR BSM ,i 1 2 3 4 5 6 UUUIIIU I®! 11141 BATHTUB �' ' CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM 1.11111111111111111111r - ii W DEDICATED GAS/OIUSAND SYSTEM IIIIIIIIMPIMIIIIIIIINIIIMIIIIIIIIIIIFIIIIIIIIIIIIIIIIIIIIIllIltIIIIIIIIIIIIIIIIIIIII DEDICATED GREASE SYSTEM i DEDICATED GRAY WATER SYSTEM 11.111.1=111111111111 DEDICATED WATER RECYCLE SYSTEM EI ; - DISHWASHER DRINKING FOUNTAIN I IIIIIIIIIIf I it. IIIIIIIIII FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) 1111111' KITCHEN SINK �i LAVATORY ROOF DRAIN L. _j _ SHOWER STALL it 1 SERVICE/MOP SINK 1 I TOILET I II 11 WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES IiII1iII WATER PIPING ___ ___s ._ #__ �..�_ OTHER --=,I--___., i 111111111111111111111111111 w\o 561665$40.00 I _ � it 1 � INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El 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 Li 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 Lj AGENT L3 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 li with I eertine proyisiL he Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME j STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MPl JPLI CORPORATION =':# 3281C !PARTNERSHIP Q# LLC Ej# COMPANY NAME I E.F.WINSLOW PLUMBING&HEATING 'ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 1508-394-7778 I FAX 508-394-8256 CELL r N/A i EMAIL INSPECTIONS@EFWINSLOW.COM • - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK S � _ - _ ,'' am CITY yarmouth MA DATE 08/18/2021 4 PERMIT# 22— i 3 I JOBSITE ADDRESS 17 pointsetta drive,south yarmouth OWNER'S NAME 1 ciganik georgla G OWNER ADDRESS 'TEU 508.398 3275 _jFAX— 1. . - TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ` RESIDENTIAL.11 PRINT' CLEARLY NEW: RENOVATION: REPLACEMENT: " PLANS SUBMITTED: YES!q„ ITI APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - :./11111111.11.101.01Millaat ----_1 BOOSTER r t CONVERSION BURNER COOK STOVE r ,.._ . DIRECT VENT HEATER „' r_.. Mill DRYER rr_ FIREPLACE a, . . W :, w PM : .. m. �m FRYOLATOR � FURNACE �-GENERATOR GRILLE 1111M1111111 _ 'r INFRARED HEATER t, i LABORATORY COCKS MAKEUP AIR UNIT OVEN [ 'i te[ r, POOL HEATER ROOM I SPACE HEATER ��„ ROOF TOP UNIT - — T TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 1,.- I OTHER - t ; t, Mt)561665$40.00 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY - OTHER TYPE INDEMNITY BOND i_is 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 4444,4 AGENT j_ ...L 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 t a Pprtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws ,......1—. • !/ r �-- PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP � _ MGF JP JGF LPG! CORPORATION �# 3281C PARTNERSHIPS #, LLC M #' 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