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HomeMy WebLinkAboutBldp-22-001765 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK • ` ei CITY YARMOUTH MA DATE 9/28/21 PERMIT# BLDP-22-001785 JOBSITE ADDRESS 1292 ROUTE 28 OWNER'S NAME CONDO MAIN P OWNER ADDRESS YARMOUTH PROFESSIONAL CONDOS 1292 ROUTE 28 SOUTH YARMOUTH,MA TEL 02664 TYPE OR OCCUPANCY TYPE COMMERCIAL m RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES -1 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 2 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 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 0 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. PLUMBER'S NAME Stephen Winslow LICENSE 1i2298 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 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Sul CITY YARMOUTH MA DATE 9/22/21 PERMIT# V`- (78 i tSk . 1OQ( O JOBSITE ADDRESS 1292 ROUTE 28,S.YARMOUTHtomitiv4i WNER'S NAME SOUTH YARMOUTH CONDO ASSOC POWNER ADDRESS SAME TEL 5082805114 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL 0 RESIDENTIAL LI • PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES LI NO0 FIXTURES Z FLOOR-0 BSM 1 il, 2 i 3 4 5 6 7 8 9 10 11 12 13 14 i/7 BATHTUB _ : .... . u do CROSS CONNECTION DEVICE -3- DEDICATED SPECIAL WASTE SYSTEM i ,9 DEDICATED GAS/OIL/SAND SYSTEM Willit' 1 31. 1 O DEDICATED GREASE SYSTEM MEE DEDICATED GRAY WATER SYSTEMmingimmunimmiutudiwww DEDICATED WATER RECYCLE SYSTEM 111111.0111 L 1--- I IN" I DISHWASHER I i lM • - I M C' DRINKING FOUNTAIN �.... ... . . ... .-M L.. .� . FOOD DISPOSER 1E-Er ‘ FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) [ all 4 1� __ (t KITCHEN SINK I a— LAVATORY 2 :. 1,. _ } l ROOF DRAIN ` .,m NEE SHOWER STALL SERVICE/MOP SINK TOILET 111.1 . _, ,,. ___ i, _ arie.„,,iwin a URINAL MB '' WASHING MACHINE CONNECTION . � MlliWillrllffII WATER HEATER ALL TYPES • WATER PIPING p OTHER ..... ._ mai INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES 0 NO I.... IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABII ITV INSURANCE POLICY E OTHER TYPE OF INDEMNITY 1-1 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 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 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 with II ertine proyisioof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / y -. ..ry ` �- PLUMBER'S NAME STEPHEN WINSLOW ]LICENSE# 12298 SIGNATURE MP El JP El CORPORATIONO# 3281C 1PARTNERSHIP U#r LLC U# _ 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