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Home My WebLink AboutBLDG-22-003648 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I CITY 'YARMOUTH 'MA DATE 'December 30,20211 PERMIT# BLDG-22-003648 ...,.F. JOBSITE ADDRESS 82 SOUTH ST OWNERS NAME TRAINOR JOSEPH P G OWNER ADDRESS TRAINOR IRENE L 82 SOUTH ST SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED:YES❑ NO❑ FIXTURES FLOORS—u 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 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST 1 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 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY El BOND ❑ 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 la 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 0 LPG' ❑ CORPORATION❑# PARTNERSHIP ❑# LLC❑# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsnaefwinslow.com S310N M9IA32d Nbld #±IW2:13d $ :33d LI 1H3d 3H1 SV SaA2i3S NOIlV011ddb SIN' oNSA S310N N01103dSNl 1VNId AlN0 3Sf H0103dSNI 2IOd 39Vd SIHJ S310N N01103dSN1 SVO HOflOH MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '; •1��k CITY YARMOUTH ` SOUTH Av „ t MA DATE'12/13/2021 PERMIT # . L -. 6 t1 ti t JOBSITE ADDRESS 182 SOUTH ST, S. YARMOUTH, MA 02664 OWNER'S NAME PAUL PETELL G OWNER ADDRESS `SAME TEL 413 781-0559 IFAX I .-.y TYPE OR OCCUPANCY TYPE COMMERCIAL I - EDUCATIONAL . RESIDENTIAL PRINT CLEARLY NEW: RENOVATION REPLACEMENT: Lu PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER mxa. , If a a._ r it BOOSTER _ £ CONVERSION BURNER _1.5*.kj Leri I =r i . ,r----- r i: µi :1 ,;Z=."'ne: —— .::'..= 6,„, ,,,g,„„..---<;.`,,malrm...«.,i,," COOK STOVE _ firms%�Sx J.dJ 'l:sd� xus cromrwsu,.x,xyw s¢'otaiv`>e°6` W. + »"iutts3 ..sEkN'.Ys;Sw3ff(WS dPK9t-rt/�p.,uttJ»siA..,..:e�..., y..bMf.,':'^DIRECT VENT HEATER ^ _..'. .._� i1 5.._ ._.�� µ m,.. .��µpp �.� w�;f, . .mx, w, ,,,s,w, . ,;,„ , ,,. : , _, l_ Nr ,.yx....: �a i.1, s�fi,urfi ' Ems. „ .ti DRYER .n_ wa_.�. ,. a m a _ ,� tea . f �, .. ,.�u. „'„.---,..,.:m...r -.,,:.,aa. m ...... ..................,. g,...n ......-----,-,., ............ i i, ---1: ,,.e..,.......,.., .-A .,,.,,_.,,,,_........0 1-- .e., ..$r. ....,... 5... .........._.., y e...,..e., ,s.... FIREPLACE FRYOLATOR r z � r- g �� , m • .ar, .. .,»,,,I i�.H..,,,..x,,%r%mmi ri—„..... i.. ..g ,r •,Antv. ...,-.., %i,,,,,n j Lrem,= 1, kit.,,. ..n: ,, L,;,� "�, =J FURNACE ,. _ „',a.:...„ 'raSF'Av:':»».:sssx» x�r�,.�^" is:•,,,sa%•,xs%a - r9»vt - �£ .. Losxnm» ,,�anrra3 �d -amuii,�cNSPAM< a%»m "w6w,wssng s Kv£tlf".atiA:4,�' b GENERATOR f;;f�; .. » »11 . 4.,; :;n., . . ;>. ._._ .45u;t.. r��ir r. �. r__._.,jr,__3r_ ,_ I?. GRILLE INFRARED HEATER r 1 ' ____in LABORATORY COCKS , e m MAKEUP AIR UNIT . a, ry,_" � .�. I �%a, , ,,,,:f �.,�i� :: ,..4.,. .., ,:Solo= , , i, � . �, OVEN �£ , � ^ �� -1��...,' POOL HEATER � ? , , j i f , t ROOM 1 SPACE HEATER m �_ , ' � y y W cw�LOb?aa tl' P'sfshKY' '�£IL Ax9b5,rWJTW MTk".�a L.M.�kS�::r,Y2 #$s' 34F� ,'� �' 31„;,3,h Ems' &>;tti�r. O'tslsl'3'S i3i3 w..L.z„YsS' ,',h'Xti%#dClai`.2�'3.L:r.^}S� ROOF TOP UNIT i i tm >sx x az L, bx'a - ..„.>sa-,�r:n;Hs mu..rsbs,xmusxaresvwme�rs- :se, a .. . .,,,ntnaren.> ,.... ,,..., ............._'s", 'xssu:,,,, x 'swan,. µ. .wr ems'_.:„':;.....^ srrna.,an i«sv;, a»w.awxu: M: .. isut mm ; �s £ TEST 1 ,, _;JL1. , i, .x ' ..« . ; %%.m,:, ;;; rn,J _ _. g UNIT HEATER , � = m 1— ;` 8�.a � 's , . %� „� .. f47 23 „2;-2zS2.,_ � ii ,.' u433, 0;x x i;i 4 54iStL482444JEJ .. :;s .:. Jam, ,, i , UNVENTED ROOM HEATER k �, . ws«rw ..A 3m. ap...,, ir:'-''sxsc'au vicnrzh< ; .:agpr, AauaHn.uiw»sea •- ..:a%es,.or»aw, fa:=:,z. z 6w ,xrWATER HEATER [ £ 3 .aawxuwn_....wxavwwa'wuwwwo'axwwuua .--. .. w�3 .,,.r iRvw' E.,x..,,, x ks.YiR �e LOttbYdiffixfrU&'N�&2 SSRYF£rAxGx> a-+smf£:+F r s*43'Y�Mu i¢4£ ••� .. " 'aa33 >1+:XA".,..,..... „xaw.waxaowwa >m'.. ... ... .. ronmwmwi'y rs r «erne mavu«awmumv- ,... y,., C OTHER . 1 , >m ww "t�........ _.. .tea £ .... ..m .... ... .;`! ... .. .:.A-. Ro.>/ � xe, r.,....y ro. s. MwN,........ ..... a... ..:.. .: .. s mrriirr mrr.»n.,r, uva�r� ymmy,uwm,mv, i, rm ewurrmxm i ��'�rsrc � .... .._. .,, 11... . . ,4 -',as 14 �. . .. n ...s....<. - 3 wiias�ema ----.w ,$sus,'of ...a:m,:, •us 4 ;,_, INSURANCE COVERAGE I have a current liability insurance policyor its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ElNO q q ; I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE—POLICY _- — 'r#>eR TYPE-INDEMNITY Li BOND 1.3. . 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 Lj 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. �\ .>. ,.<r: :w,:, a:. {*F:, v�,.,F�<: �.,.,, x,.,4. ,3H.%a.,a<u,a,5. .'2**2. ...a_,:::::,:.,,..2m:.:,, ` �' "` .••-P��--^p- PLUMBER—GASFITTER NAME STEPHEN WINSLOW LICENSE # 12298 SIGNATURE MP Ej MGF s JP JGF LPGI CORPORATION 0# 13281C PARTNERSHIP �� # LLC '` # COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY ,SOUTH YARMOUTH STATE = MA ZIP 02664 TEL 508-394-7778 ,a<- FAX 508-394-8256 CELL NIA ,EMAIL INSPECTIONS@@ p m.,. EFWINSLOW.COM The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 9 AV= _ Lafayette City Center = 2Avenue de Lafayette,Boston,MA 02111-1750 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 10.0 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.] 12.0 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 /ef the Akins andan penalties of perjury that the information provided above is true and correct \ 7/f/• �{/ !/ 12/01/2021 Signature: Y Date: 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 3.0 City/Town Clerk 4.0Licensing Board 5,0 Selectmen's Office 6.00ther Contact Person: Phone#: www.mass.gov/dia