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Home My WebLink AboutBLDP-22-00169 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 9/21/21 PERMIT# BLDP-22-001629 JOBSITE ADDRESS 162 THACHER SHORE RD OWNERS NAME CLARK BRADFORD BARRETT P OWNER ADDRESS CLARK PATRICIA 1 HEWLETT PL GLEN HEAD,NY 11545-1612 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ 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 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 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 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 112298 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 Yes No THIS APPLICATION SERVE AS THE FEES$ PERMIT PLAN REVIEW NOTES A MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I 2-V,.. CITY YARMOUTH MA DATE 9/16/21 PERMIT # _w JOBSITE ADDRESS [162 THATCHER SHORE ROAD ' OWNER'S NAME BRADFORD CLARK 1 t� P OWNER ADDRESS 1 HEWLETT PLACE, GLEN HEAD, NY 11545 TELI 5163062467 ;FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL i_::I RESIDENTIAL 2 PRINT CLEARLY NEW: , l RENOVATION: L,.,,.- REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES Z FLOOR--I BSM 1 2 3 4 I 5 6 7 8 9 10 11 12 13 14 BATHTUB _ �.... 1 CROSS CONNECTION DEViCE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM ,Y\ DEDICATED GRAY WATER SYSTEM _..3 DEDICATED WATER RECYCLE SYSTEM ` DISHWASHER DRINKING FOUNTAIN -- _., ,,, m ,... FOOD DISPOSER I _....._ :::- FLOOR /AREA DRAIN -INTERCEPTOR (INTERIOR) - w r_._ ; KITCHEN SINK f . LAVATORY 1 — ROOF DRAIN SHOWER STALL f SERVICE / MOP SINK ( M. _ W J CIS TOILET r ..-_ 1 1, U URINAL 1 ......... WASHING MACHINE CONNECTION a.....,:zz-Ar . et, ,7..- =.._.' ..)_ WATER HEATER ALL TYPES WATER PIPING 1 OTHER I li INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO ____]I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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 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 e 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 prgisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I STEPHEN WINSLOW LICENSE # 12298 SIGNATURE MP JP CORPORATION � '#s 3281C PARTNERSHIP # ILLC[.... # COMPANY NAME E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH 1 STATE MA J ZIP j 02664 TEL 508-394-7778 FAX 508-394-8256 i CELL N/A j EMAIL INSPECTIONS@EFWINSLOW COM