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Home My WebLink AboutBLDP-22-004928 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �r� CITY YARMOUTH MA DATE 3l7/22 PERMIT# BLDP-22-004928 JOBSITE ADDRESS 54 CHICKADEE LN OWNER'S NAME WATERMAN PETER C Y/ P OWNER ADDRESS WATERMAN KAREN M 54 CHICKADEE LN WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:El RENOVATIONS.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 1 SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 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 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 1098 I SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME STEPHEN A WINSLOW ADDRESS 8 REARDON CIR CITY IS YARMOUTH I STATE MA ZIP '026641207 TEL I FAX I I CELL I I EMAIL (inspections@efwinslow.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1 ' MA DATE 311122 PERMIT # CITY YARMOUTH um JOBSITE ADDRESS J54 CHICKADEE LANE OWNER'S NAME! KAREN WATERMAN ............... .. ... OWNER ADDRESS F SAME TELf 5087756154 FAX r . _ .,„ 6 P �. . V) TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL ci RESIDENTIAL Ld PRINTt ---$ ` PLANS SUBMITTED: YES NO CLEARLY NEW: RENOVATION: I. ,€ REPLACEMENT FIXTURES -1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1 .... . :. .. _ . CROSS CONNECTION DEVICE --:- :.....__._._ ' I DEDICATED SPECIAL WASTE SYSTEM - - DEDICATED GAS/OIL/SAND SYSTEM _ _! �PJI _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I n DEDICATED WATER RECYCLE SYSTEM ' I I: r�_. .-- - _'` 0 DISHWASHER IIIIIIIIIIIIIINIIIIUMIIIIIIMIIIIIIIIIIIINIIIMMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIO DRINKING FOUNTAIN 11 _ _ 1.. IIIIIIINIIISWIIIIIIINIIIIIIIIIMINIIBIIIIIMMIIN . .. . _ it) FOOD DISPOSER1011011 I it 1 111111111111 Mt-__ . FLOOR /AREA DRAIN ' 7 11111----1- -�- INTERCEPTOR (INTERIOR) l _ EEEIIEIEIIINIIIIIIIIIINIIIMIMIIIIIIIMMIHMIII '1 ; 111111111 LAVATORY ROOF DRAIN '1 SHOWER STALL - _ _. ..._ . 1 111.1.—Meg ,-----. r--- - 117-3 ._ ri..71 SERVICE / MOP SINK ' r- r �� TOILET _. + _ L ._ 11 -:....... . ..::.:. .._.. _ URINAL �� WASHING MACHINE CONNECTION f-:m_— I M WATER HEATER ALL TYPES � ritiL _...__.-. . - -•-- WATER PIPING OTHER l I _ 11111=1111111•11111 _IMIIIMIIII4111111911.1,_ 111 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES i NO 11 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. 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 co lia with II ertine prO isio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r .«...9 r._.�- PLUMBER'S NAME [ -STEPHEN WINSLOW ,I LICENSE # 12298 SIGNATURE _ . r CORPORATION # 3281C 'PARTNERSHIP . # LLC 1# 11 COMPANY NAME E.F. WINSLOW PLUMBING & HEATING i ADDRESS i. 8 REARDON CIRCLE CITY SOUTH YARMOUTH I STATE I MA ZIP I 02664 TEL 1--5-0-8:394-7778 FAX 508-394-8256 CELL I N/A 1 EMAIL I INSPECTIONS@EFWINSLOW.COM _„ _..__ _ ._.__. ._ ..__