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HomeMy WebLinkAboutBLDP&G-21-006640 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK „N CITY YARMOUTH MA DATE 5/17/21 PERMIT# BLDP-21-006640 1F4 JOBSITE ADDRESS 65 NEARMEADOWS RD OWNER'S NAME KELLEY STEPHEN S n OWNER ADDRESS KELLEY ANNA S 225 SOUTH VERMILLION AVE BROWNSVILLE,TX 78521 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES❑ NO El 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 El OTHER TYPE OF INDEMNITY El BOND El 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#2298 SIGNATURE MP El 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 PERMIT FEES$ PERMITS PLAN REVIEW NOTES d\ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK -... ,,,,..,,,,,r_iii , CITY [YARMOUTH 1 MA DATE 05/11/202,1 IPERMIT # JOBSITE ADDRESS L65 NEAR MEADOWS RD, W.YARMOUTH OWNER'S NAME KELLEY, STEPHEN POWNER ADDRESS _.. _. TEL 703.559.4950 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ED EDUCATIONAL 0 RESIDENTIAL P.1 PRINT CLEARLY NEW: RENOVATION: I REPLACEMENT: [�'J PLANS SUBMITTED: YES El NO0 i FIXTURES Z FLOOR--+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB -- ffi W�h. _- .: . I 1 _. _.... CROSS CONNECTION DEVICE iI_-_ 11...."..���4. it v_ � � DEDICATED SPECIAL WASTE SYSTEM _ __. , II i I DEDICATED GAS/OIL/SAND SYSTEM u y , DEDICATED GREASE SYSTEM I,, I DEDICATED GRAY WATER SYSTEM NM .,i I 1 DEDICATED WATER RECYCLE SYSTEM _._ __._... = I � �'.z - _ — 11 ;1 .. _a__ n� a.wm_ _ DISHWASHER 'I [—I -I I DRINKING FOUNTAIN111111 FOOD DISPOSER 1i. ._ . .. um I ... f .�. Aim - w i -- _.- FLOOR J AREA DRAIN MI MOW INTERCEPTOR (INTERIOR) 1 jr i-. ._ ...._- iP r .1 . I ...: 1._a. . ... KITCHEN SINK _ i I I_. _ . 1 !I il -II- W~ II ... LAVATORY —' ,„, .....,.. -________---1, 7 _._ ROOF DRAIN ir- 1 . — _ - i_. in. . : i _ - _,'_. ___. _„.______,__-: Ci SHOWER STALL i 1 i SERVICE / MOP SINK _ , ______ ___ �_ .. -__ , M TOILET I tF � i a �� _ , i 3 y I URINAL =I I ,[ -- WASHING MACHINE CONNECTION . _ �� ��� ii _ JE_ i WATER HEATER ALL TYPES 1 i WATER PIPING [ ' 11 =i OTHER I I � , ._.... 1 ij 77 s. � a)3, $ i .e ... :: I FM r+— 7{j[ W/O 551949 40.00 q r m�m ` , ,,.. _ . ., _.__,,- ,m . A.....«,...,......,... ,,,.:,..„ J INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES rIT1 NOµ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 1 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 n 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 co lia with II ertine pro'isio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME STEPHEN WINSLOW j LICENSE # 12298 »_..._ j R SIGNATURE MP v i JP LI CORPORATION #r3281C 'PARTNERSHIP # ma LLC„ # COMPANY NAME E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH , STATE MA ZIP [02664 mm.,a TEL 508-394-7778 FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK --,i,_--- --_ �Ys 6 CITY YARMOUTH MA DATE May 17,2021 PERMIT# BLDP-21-006640 JOBSITE ADDRESS 65 NEARMEADOWS RD OWNER'S NAME KELLEY STEPHEN S _ j G OWNER ADDRESS KELLEY ANNA S 225 SOUTH VERMILLION AVE BROWNSVILLE TX 78521 TEL j TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL EI PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO CI 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 El OTHER OF INDEMNITY El 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 El JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# I] COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsefwinslow.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK r. frt CITY YARMOUTH MA DATE 05/11/2021 PERMIT # JOBSITE ADDRESS 65 NEAR MEADOWS RD, W YARMOUTH OWNER'S NAME KELLEY, STEPHEN OWNER ADDRESS TEL 703.559.4950 'FAX M. . . . TYPE OR OCCUPANCY TYPE COMMERCIAL;.:) EDUCATIONAL RESIDENTIAL v PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z 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 I OTHER W10 551949 $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 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 ' 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"-• ,... �.. PLUMBER-GASFITTER NAME STEPHEN WINSLOW = LICENSE # 12298 SIGNATURE MP MGF JP , j JGF LPGI rcr CORPORATION $ # 3281 C I PARTNERSHIP # LLC 0#� COMPANY NAME ' E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH —I STATE MA ZIP 02664 TEL 508-394-7778 FAX 508-394-8256 CELLI NIA EMAIL INSPECTIONS©EFWINSLOW.COM