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HomeMy WebLinkAboutBLDP-22-006122 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK w 1, CITY YARMOUTH MA DATE 4/25/22 PERMIT# BLDP-22-006122 JOBSITE ADDRESS 63 SEAVIEW AVE OWNERS NAME ADAMS ALISON J • OWNER ADDRESS 63 SEAVIEW AVE SOUTH YARMOUTH,MA 02664 TEL P TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT ID CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:0 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 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 1 _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 0 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 I LICENSE'1a2298 SIGNATURE MP 0 JP ElCORPORATION ❑# I I PARTNERSHIP El# I I LLC ❑# I COMPANY NAME STEPHEN A WINSLOW ADDRESS 18 REARDON CIR CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections@efwinslow.com MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ss r -Zli=i= CITY cj,1C�1 �... _.. 1 MA DATE FS4/2. ari- PERMIT# tip''. 41 t.t JOBSITE ADDRESS (p3 Vie S. J pWN R'S NAME A y P OWNER ADDRESS $aIK^ TEL 6 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL ID RESIDENTIAL lj PRINT CLEARLY NEW:El RENOVATION:LI REPLACEMENT: PLANS SUBMITTED: YES 0 NO(J FIXTURES-I 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB FLOOR-) BSM 1 2 I 1;. _ ..1 I CROSS CONNECTION DEVICE 1111111111111111111111.111M MOM , DEDICATED SPECIAL WASTE SYSTEM 11111111111111111111111011111111111.1111111111111101111111111MINIIIMIKWINIS DEDICATED GAS/OILISAND SYSTEM _ i� DEDICATED GREASE SYSTEM ... _ I , �. � r„ , �;��., DEDICATED GRAY WATER SYSTEMf FOOD DISPOSER I .;I II 1 V ! - 1... _. FLOOR/AREA DRAIN j mmam 111.11.1.11111111111111111111111111111111111.1 INTERCEPTOR •- I KITCHEN SINK , LAVATORY 1 ROOF DRAIN 11111111111,1111111111111111111MMIN1111111111111111111111111111111111111 SHOWER STALL IMIIJIIIIIIIIIIIIMIIIIIIIIIIWIIIWIIIMIIIIIIIIIIIIIIIIEIIIIIIIIIIIIIIIIIIIIIIIIII yr TOILET i i I 1 URINAL I, I' -._.E,. . WASHING MACHINE CONNECTION , �; -m, mmm^ ^ WATER PIPING __, I ,. .. if _. ..11 oTHER 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 0 OTHER TYPE OF INDEMNITY 0 BOND f 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 Ej 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 nfiacialor 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 li wit II ertine proyisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. y "` As041,..- PLUMBER'S NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP JP J CORPORATION 0# 3281C `PARTNERSHIP # LLCO# COMPANY NAME E.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH .),STATE STATE MA ZIP 02664 TEL 508-394-7778 FAX 508-394-8256 1 CELL N/A EMAIL INSPECTIONS EFWINSLOW.COM