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Home My WebLink AboutBLDP&G-22-005040 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK a CITY YARMOUTH MA DATE [3/11/22 PERMIT# BLDP-22-005040 JOBSITE ADDRESS 225 BLUE ROCK RD OWNER'S NAME LOCKE ARTHUR J P OWNER ADDRESS LOCKE DOLORES H 225 BLUE ROCK RD SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO El FIXTURFS • 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 El 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 OWNERS 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 tU298 SIGNATURE MP El JP ❑ CORPORATION ❑# PARTNERSHIP ❑# L LLC ❑# COMPANY NAME STEPHEN A WINSLOW ADDRESS 8 REARDON CIR CITY S YARMOUTH STATE MA J 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 ❑ ❑ nrrtnevr FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK F.')-=Ki-iitti4: -.. ---- .-.. r jamr s CITY [YARMOUTH (SOUTH MA DATE ;03/07/2022 PERMIT # JOBSITE ADDRESS 225 BLUE ROCK RD, S. YARMOUTH, MA i OWNER'S NAME ROBERT TAVARES P .,... OWNER ADDRESS SAME TELt(774)392-2516 IFAXL______I TYPE OR OCCUPANCY TYPE COMMERCIAL EJ EDUCATIONAL l RESIDENTIAL r PRINT CLEARLY NEW: RENOVATION: Li REPLACEMENT: PLANS SUBMITTED: YES fl NO', FIXTURES Z FLOOR BSM 1 2 4 6 7 8 9 10 11 12 13 14 BATHTUB I iiimilimimmup i CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM I DEDICATED GAS/OIL/SAND SYSTEM i I L DEDICATED GREASE SYSTEM . . ' '' I; DEDICATED GRAY WATER SYSTEMn__ iiiiiMiliniiiiii DEDICATED WATER RECYCLE SYSTEM II 11 __ , « ! - DISHWASHER 111110111.WI AEI DRINKING FOUNTAIN _ FOOD DISPOSER - I ' _ I I III. FLOOR /AREA DRAIN -- ..._ I INTERCEPTOR (INTERIOR) - ,.. MIMI n------ , ..._ NM M NMI L_111110 MKITCHEN SINK I _ LAVATORY 111 ROOF DRAIN SHOWER STALL . . v:M_ SERVICE / MOP SINK 11.11iMaillial TOILET _ . URINAL 1111111111111111111111111 111111111111111111.1111111.1.01Mii WASHING MACHINE CONNECTION 3 I I I WATER HEATER ALL TYPES maitiiiiit 'MIIIINIMITMIIIIIIIHIIIMIIIIIIIIIIMIIIIINIIWIIIIIIIIMI WATER PIPING MI1 ICI _. III OTHER IIIRIIIIMIIIIIIIIIIIIITIIIIIIIOIEMTMIMIIIIIIIIIMIIIIINIIIINIFan � MIII �.... . ,. _ .- �:.,_ _,_ numais ' i ' ._ 'I { x + a ., 1 .. IIIIIIM INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Ei NO 11 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW ............... LIABILITY INSURANCE POLICY v 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. CHECK ONE ONLY: OWNER LI AGENT w;p _ 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 to 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 com lia with II ertine pro'(isio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. _. a._..� __ .«aw .�..P PLUMBER'S NAME 1 STEPHEN WINSLOW : LICENSE # 12298 SIGNATURE MP JP CORPORATION } - # 3281C PARTNERSHIP- '# LLC # COMPANY NAME I E.F. WINSLOW PLUMBING & HEATING ADDRESS [8 REARDON CIRCLE I CITY SOUTH YARMOUTH STATEFTA—I ZIP 02664TEL508 394 7778 __ . FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS EFWINSLOW.COM S MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH I MA DATE 'March 11,2022 IPERMITH BLDP-22-005040 JOBSITE ADDRESS 1225 BLUE ROCK RD OWNER'S NAME 'LOCKE ARTHUR J G OWNER ADDRESS LOCKE DOLORES H 225 BLUE ROCK RD SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS-s 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 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 El 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 A 12298 SIGNATURE MP El MGF 0 JP❑ JGF El LPG' ❑ CORPORATION❑A PARTNERSHIP ❑# LLC❑A COMPANY NAME: ISTEPHEN A WINSLOW I ADDRESS. 18 REARDON CIR, CITY IS YARMOUTH I STATE MA ZIP 026641207 TEL I FAX CELL EMAIL Iinspections(thefwinslow.com S310N M31A32:1 NVld #111M3d $ 33d ❑ 1IW213d 3Hl SV S3A2:13S NOI1V011ddV SIHI ON saA S31ON NO1103dSNI 1VNId AINO 3sn 10103dSNI 2IOd 30Vd SIH1 S31ON NO1103dSNI SVO H91108 . , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH (SOUTH) MA DATE 03/07/2022 1 PERMIT # .y JOBSITE ADDRESS 225 BLUE ROCK RD, S. YARMOUTH, MA OWNER'S NAME ARTHUR LOCKS OWNER ADDRESS `SAME [ TEL 5875 � - FAX � 650 483 TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL --1 RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NO, APPLIANCES -1 FLOORS-0 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 FRYOLATOK 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 . g _. ..w. m �.. » ,.. 1 WATER HEATER . . ... '. OTHER _ w �, , . _ INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ; v NO I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND rs 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 AGENT 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 i a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `0. / r ' !'''-.-"- PLUMBER-GASFITTER NAME LSTEPHEN WINSLOW LICENSE # 12298 SIGNATURE MP v MGF ,,,j JP JGF LPG' CORPORATION v # 3281C PARTNERSHIP # LLC # COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE1 MA ZIP 02664 TEL 508-394-7778 '" .l&£aw:�+m 't? .... ..........:._;ti,YAP.a:.a'aNz.. FAX 508 394 8256 CELL Ns EMAIL INSPECTIONS@EFWINSLOW COM ,,` The Commonwealth of Massachusetts Department of Industrial Accidents R. ='�' Office of Investigations 51 Lafayette City Center �'� `AFt. 2 Avenue de Lafayette, Boston, MA 02111-1750 `'M wwn.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: E.F. WINSLOW PLUMBING & HEATING CO, INC. Address: 8 REARDON CIRCLE City/State/Zip: SOUTH YARMOUTH, MA 02664 Phone #: 508-394-7778 Are you an employer? Check the appropriate box: Business Type (required): 1.❑■ I am a employer with 99 employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑ Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Insurer's Address: City/State/Zip: Policy#or Self-ins. Lic. #1964A Expiration Date:01/01/2023 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under § 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ten the ins and penalties of perjury that the information provided above is true and correct. Signature: i - /''-r Date: 12/01/2021 Phone#: 508-394-7778 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 1,❑Board of Health 2.0 Building Department 3.❑City/Town Clerk 4.11Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia tx`e, The Commonwealth of Massachusetts Department of Industrial Accidents �,` Office of Investigations ; Lafayette City Center \\ I l'r 2 Avenue de Lafayette, Boston, MA 02111-1750 ,M - 1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: E.F. WINSLOW PLUMBING & HEATING CO, INC. Address: 8 REARDON CIRCLE City/State/Zip: SOUTH YARMOUTH, MA 02664 Phone #: 508-394-7778 Are you an employer? Check the appropriate box: Business Type(required): 1.❑■ I am a employer with 99 employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑ Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.❑ Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:ARROW MUTUAL INSURANCE COMPANY Insurer's Address: City/State/Zip: Policy#or Self-ins. Lic. #1964A Expiration Date: 01/01/2023 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under § 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer the in- !and penalties of perjury that the information provided above is true and correct. Signature: 7' -'` ''�-'" Date: 12/01/2021 Phone#: 508-394-7778 Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority(check one): 1.1=1Board of Health 2.0 Building Department 3n City/Town Clerk 4.❑Licensing Board 5.111 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK �" • .�,�� _ _ z so .i '• 1= CITY YARMOUTH(SOUTH) MA DATE 03/07/2022 I PERMIT# JOBSITE ADDRESS1225 BLUE ROCK RD,S.YARMOUTH, MA 'OWNER'S NAME ARTHUR LOCKE GOWNER ADDRESS SAME TEL(50)483-5875 I FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ° PLANS SUBMITTED: YES NO' APPLIANCES 7 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 ___I 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES v NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY - OTHER TYPE 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. CHECK ONE ONLY: OWNER _J AGENT 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 I a YP rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (`� J1y / PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP[ MGF JP JGF LPG! CORPORATION - # 3281C PARTNERSHIP # LLC # 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 Y I