Loading...
HomeMy WebLinkAboutBldp-22-001317 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4 / CITY YARMOUTH MA DATE 9/7/21 PERMIT# BLDP-22-001317 ` JOBSITE ADDRESS 51 WALTHAM CIR OWNER'S NAME BEARSE ARTHUR W P OWNER ADDRESS BEARSE DEBORAH J 51 WALTHAM CIR WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES • FLOORS-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE 1 DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND 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 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 El 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 tR298 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 El El FEES S PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE September 07,202 PERMIT# BLDG-22-001316 11_ JOBSITE ADDRESS 51 WALTHAM CIR OWNER'S NAME BEARSE ARTHUR W G OWNER ADDRESS BEARSE DEBORAH J 51 WALTHAM CIR WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 111 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED:YES ❑ NO❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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 CI 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 ❑ JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsna.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 `_.emu"— CITY YARMOUTH MA DATE 8/27/21....... PERMIT# 1-1 - l‘11 JOBSITE ADDRESS 51 WALTHAM CIRCLE,WEST YARMOUTH OWNER'S NAME ARTHUR BEARSE POWNER ADDRESS SAME 1 TEL 5083988305 FAX -- TYPE OR OCCUPANCY TYPE COMMERCIAL ID EDUCATIONAL ® RESIDENTIAL I PRINT CLEARLY NEW:0 RENOVATION:E REPLACEMENT:Q PLANS SUBMITTED: YES Q NOQ FIXTURES 1 FLOOR-, BSM 1 2 3 kr/ I 4 5 6 7 8 9 10 11 12 1 13 14 BATHTUB CROSS CONNECTION DEVICE 1 _ DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIUSAND SYSTEM .DEDICATED GREASE SYSTEM y DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM aiiiiiii iiMiiiiii lialliilliiMilMiii DISHWASHER _ _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK _ _. V� LAVATORY ROOF DRAIN MEM 6 SHOWER STALL um — SERVICE/MOP SINK TOILET — URINAL r 1 WASHING MACHINE CONNECTION n WATER HEATER ALL TYPES MN III MI 11.161111 IIIIIIIIII MIN NM 1111MIIIIIIIMM WATER PIPING OTHER 111101MINIMIr IIIIIIIIIIII 6. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Li 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 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 wit II ertine proyisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ? -• i,.- PLUMBER'S NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MPU JP Li CORPORATION# 3281CJPARTNERSHIPL # __1 LC Lj# 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 _ iI_i— J4 CITY !YARMOUTH _ MA DATE 08/27/21 PERMIT# JOBSITE ADDRESS'51 WALTHAM CIRCLE WEST YARMOUTH 'OWNER'S NAME ARTHUR BEARSE GOWNER ADDRESS SAME a TEL 5083988305 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL!--1J EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:L j RENOVATION:[j REPLACEMENT: PLANS SUBMITTED: YESLJ NOL APPLIANCES-1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER i 1e...n_ , ". :.,. i _... , ...x.. BOOSTER 1 , - ; t [ i t' CONVERSION BURNER t COOK STOVE ` . .. L 1t � I, „�. �, 1 rt. ' e ' Y!➢1 is li�l`C IpLVY]. >174`.. ]l wu DIRECT VENT HEATER r .._ ;: _ 1. ,. u_. , .. 1_ 1 La 0 DRYER FIREPLACE 1 r 4x FRYOLATOR ,� 1E� L . `_ s.,. '?r) FURNACE GENERATOR �'- ,. �. t a . . ,. :� _. .G n�_ -.. t. y, 4 ,�GRILLE �, INFRARED HEATER ...MICt \ , t rsn{,11 S I l t 8 1 M`I "* ! 01, d %K Ott c :1a) L t. LABORATORY COCKS 1 rn MAKEUP AIR UNIT , — I �� OVEN l ._� i a _ v �_ I Ln POOL HEATER ROOM/SPACE HEATER r II 7 r : ..... ,----1..........,—,St.. ...A h ,. ROOF TOP UNIT i i s TEST t' J i'z. 3-- UNIT HEATER 3" F " . ,r , UNVENTED ROOM HEATER �} s '�"WATER HEATER E --OTHER r ' i tl' 4 i ... .... ...... £ 1, :-: .. �. E . .... .. .. __l_.. .. I ii -1L F � 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 LE, OTHER TYPE INDEMNITY Lj BOND Lj 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 v,„,j AGENT ILL.', 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 P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` /./.....- PLUMBER-GASFITTER NAME!STEPHEN WINSLOW LICENSE#? 12298 I SIGNATURE MP! ' MGF', JP JGF`v LPGI CORPORATION „#a 3281C —1 PARTNERSHIP # LLC #I � — COMPANY NAME LE F_WINSLOW PLUMBING&HEATING I ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE'' MA ZIP 102664 TEL 508-394-7778 FAX 508 394 8256 __ CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM