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HomeMy WebLinkAboutBldp-22-001318 t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ‘1/4., CITY YARMOUTH MA DATE 9/7/21 PERMIT# BLDP-22-001318 JOBSITE ADDRESS 233 WEST GREAT WESTERN RD OWNERS NAME RICHTER PAMELA A P OWNER ADDRESS 233 WEST GREAT WESTERN RD YARMOUTH PORT,MA 02675 J TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES El NO Cl 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/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 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El 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. 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 12298 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC El# 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 . 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK . ,' e CITY YARMOUTH MA DATE September 07,202 PERMIT# BLDP-22-001318 I;r- JOBSITE ADDRESS 233 WEST GREAT WESTERN RD OWNERS NAME RICHTER PAMELA A G OWNER ADDRESS 233 WEST GREAT WESTERN RD YARMOUTH PORT MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL III PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El 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 0 NO❑ 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 ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# Lc ❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections(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 •r , , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4 t' XS:1 ,Q CITY_yarmouth MA DATE PERMIT# ZZ " i 3 19 JOBSITE ADDRESS 233 west great western rd,yarmouthport OWNER'S NAMELitcher,pamela POWNER ADDRESS TEL 603.475.3295 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL LI EDUCATIONAL El RESIDENTIAL Ej PRINT CLEARLY NEW:LI RENOVATION:El REPLACEMENT:0 PLANS SUBMITTED: YES® N0LI FIXTURES 7 FLOOR-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 1 -1 I_ l i__ .:1 1 CROSS CONNECTION DEVICE �� DEDICATED SPECIAL WASTE SYSTEM ( II DEDICATED GAS/01USAND SYSTEM I 1 _n RRRURRRRRR DEDICATED GREASE SYSTEM ,i 1 DEDICATED GRAY WATER SYSTEM I'! I l I DEDICATED WATER RECYCLE SYSTEM , I _ II I DISHWASHER I . ';NM 11111111,111111111111111 MO DRINKING FOUNTAIN I w mrwmotiour FOOD DISPOSER n 1 I,__ .... .. II FLOOR/AREA DRAIN 1,. INTERCEPTOR(INTERIOR) I i I KITCHEN SINK 111111111111111111111111111111111111111111� LAVATORY Ni i f _ R ROOFDRAIN I RN_ SHOWER STALL ism II- I min 1I SERVICE/MOP SINK I I'_ niiiiiii TOILET ----I___.__11111111111. n[MIMI MIIII OM 1 . URINAL IOW liIllillIllHIIIMIIIIIFIIIIIIFWIIIIIIIIUIIIIFWIIIIIIIWWIIIIIIIIIIIIIIII WASHING MACHINE CONNECTION RIIIIIIIIIIIIIIINMIIIIINIIIIIIFIIIIIIFIIIIIIIIIIIIIIIIIIIIIIIEIIIMIIIIIMIIVIIIIIIIIIIIOIIIIIFIIIIIIF WATER HEATER ALL TYPES IllalleillliliMN IIIIMOMI 1-1MOMUM IIIIIIIIII MO OMM WATER PIPING , .ry OTHER ._ 1 i_:. Mill1111111111111111111111111101.1 illOOMIIIIIIMINi 561702$40.00_ i - I I I i' INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO LI 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 LI AGENT El 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 nd cur a 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 proxisioryof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 f/ "` ,.....•"...- PLUMBER'S NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP ID JPQ CORPORATION El# 3281C PARTNERSHIP Q#L ILLCE1# .. 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 5 =_1 CITY [yarmouth J MA DATE L0812612021 _I PERMIT#f z� - r r8 JOBSITE ADDRESS[233 west great western rdarmouthport OWNER'S NAME ntcheramela GOWNER ADDRESS TEL 603.475.3295 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL U EDUCATIONAL i RESIDENTIAL EJ PRINT CLEARLY NEW:[ RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NOLi APPLIANCES 7 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER C""_ n... .._. ._, I u n Ant MI MOM 111111 OM BOOSTER I 1E ? r CONVERSION BURNER i 1 ------ mg mum an COOK STOVE ,. w ��� _ „ -_.. r e ... , t DIRECT VENT HEATER E. ,.uw_-` .... .,r 1g =' �. .a�, �. liW NMI DRYER � � 1 a � I .. �. 4. .39 FIREPLACE i t. �'_ , FRYOLATOR , i $� 1 t FURNACE = ,` � - I I' GENERATOR GRILLE _e r ----1 _. INFRARED HEATER �� .ti- 41 LABORATORY COCKS _ E .a _ �' , _ _„ '.r MAKEUP AIR UNIT ____ I OVEN - E 71 POOL HEATER 111011.1111111111111111110M1.111111W 3 11 ROOM I SPACE HEATER ROOF TOP UNIT �, TEST 1 1 ,---11 UNIT HEATER e > UNVENTED ROOM HEATER ''WATER HEATER ,- H. i OTHER � � :.� M w/o 561702$40.00 .-_. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO !,:r M I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY , BOND 1 4 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 ID AGENT 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 complianca a(l�Pprtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 71 • y -• ...I-- :,_PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE#1122-98 1 SIGNATURE MP LI MGF u JP , JGF 1 LPGI 0 CORPORATION Li# 3281 C PARTNERSHIP LJ# LLC[]# . COMPANY NAME:[E.F.WINSLOW PLUMBING&HEATING J ADDRESS 8 REARDON CIRCLE —_ � j CITY [SOUTH YARMOUTH 1 STATE I MA_�ZIP 02664 JTEL 1508-394-7778 ,i FAX 508-394-8256 CELL NIA JEMAIL — , ry INSPECTIONS@EFWINSLOW.COM --