No preview available
HomeMy WebLinkAboutBLDP&G-21-006075 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK , i,_ CITY YARMOUTH MA DATE 4/21/21 PERMIT# BLDP-21-006075 ;' JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 4B OWNER'S NAME dianne moore P OWNER ADDRESS 300 BUCK ISLAND RD UNIT 4B WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ 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 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❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D 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 12298 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 Yea No THIS APPLICATION SERVE AS THE PERMIT ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK l',. .0,,,:s) , e __I �` CITY YARMOUTH - _ _ MA DATE 04/15/2021 PERMIT # JOBSITE ADDRESS 300 BUCK ISLAND ROAD, UIT 4-B OWNER'S NAME] MOORE, DIANE j OWNER ADDRESS [WEST YARMOUTH 1 TEL 845.891.1408 IFAX j TYPE OR OCCUPANCY TYPE COMMERCIAL a EDUCATIONAL i RESIDENTIAL 71 PRINT _ CLEARLY NEW; j RENOVATION: _ : REPLACEMENT: [' PLANS SUBMITTED: YES NO FIXTURES Z FLOOR--+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB . . MIS MI IIIIIIII 11111111 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM W DEDICATED GREASE SYSTEM -�-" 4.--- H� __._ 1 . DEDICATED GRAY WATER SYSTEM .. - Tina .� r_.. r ... . ..: DEDICATED WATER RECYCLE SYSTEM ...._.. ._ _ _i ___ I . .. . .. V.µ 1 _ _,,alainilling DISHWASHER l 1�_ 11IIIIIII MI In 11111111111117--- . DRINKING FOUNTAIN 111.1111111.111111111111111111111111111111a I , - N I FOOD DISPOSER FLOOR I AREA DRAIN 3�" ;�-- `' INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY n I A ' ROOF DRAIN W—,1111.111111.11111111111111111111111111M1111111111MIIIIIII. - SHOWER STALL SERVICE I MOP SINK MIIIIIINNIIIIIIILIIIIIIHM1111111111111111111IIIINIIIIIIIIIIBIIIIIIIIIIIIIIII TOILET URINAL I w .. ' -� € , WASHING MACHINE CONNECTION _, - __� 'h - ._ lk E , WATER HEATER ALL TYPES WATER PIPING _. ____ ___ .,_ OTHER ,111111111111111.1 11111111111111111.111111111 , '111M.11.771 1 - . IIIMMIIM 'RIIMIIIIIIIIIIMIIIIMIIMIIIIIIN— alliWiliallilli.11111111111111 IIIIIIIIIMINIMIMIIIIIIMMBIIIMNMEMillIllIllIllMIMMMIIIIIIIIIillIllNM W10 550916 $40 00 I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES [T NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 j 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 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 corn lia with II ertine pro\isio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. .� r - - + �s ... ^ ,„..__ PLUMBER'S NAME STEPHEN WINSLOW I LICENSE # [T98 ] SIGNATURE MP w JP *jj CORPORATION u #f 3281C (PARTNERSHIP[1#L ..J LLC11# 1 COMPANY NAME E.F. WINSLOW PLUMBING&HEATING ADDRESS i8 REARDON CIRCLE 1 CITY SOUTH YARMOUTH i STATE MA ZIP 02664 TEL [ o894-777 8 FAX 1 508-394-8256 j CELL NIA EMAIL INSPECTIONS@EFWINSLOW COM mm w MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ifs; CITY YARMOUTH MA DATE April 21,2021 PERMIT# BLDP-21-006075 eyaL{y�i` JOBSITE ADDRESS 300 BUCK ISLAND RD UNIT 4B OWNER'S NAME dianne moore G OWNER ADDRESS 300 BUCK ISLAND RD UNIT 4B WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED: YES 0 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY 0 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 0 JGF❑ LPG! ❑ CORPORATION 0# 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 0 ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _: ;, ram " ' CITY YARMOUTH MA DATE 04/15/2021 PERMIT # JOBSITE ADDRESS 300 BUCK ISLAND ROAD, UNIT 4-B OWNER'S NAME MOORE, DIANE NE OWNER ADDRESS WEST YARMOUTH TEL 845 891 1408 FAX 7.. TYPE OR OCCUPANCY TYPE COMMERCIAL .. EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NO'' APPLIANCES Z FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER r DRYER FIREPLACE FRYOLATOR i FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN - 1----- POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER WIO 550916 $40.00 ,. :.. � 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 jj 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 dine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General laws. PLUMBER-GASFITTER NAME STEPHEN WINSLOW ' LICENSE # 12298 SIGNATURE MP v MGF JP JGF LPGI CORPORATION "�1# 3281C ' PARTNERSHIP # LLC # nm„ a COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE MA ZIP 02664 iTELF08-394-7778 FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM