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Home My WebLink AboutBLDP&G-21-005408 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u CITY YARMOUTH —I MA DATE 3/19/21 PERMIT# BLDP-21-005408 I1 �a,, ,;, JOBSITE ADDRESS 44 AVON RD OWNERS NAME GORMAN GREGORY M P OWNER ADDRESS 44 AVON RD YARMOUTH PCRT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES El 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 El OTHER TYPE OF INDEMNITY❑ 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 fo-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 f2298 SIGNATURE MP El JP El 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$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK clit=z---r- CITY L ._ Yhtme0A , , MA DATE 1,.3,0 ligf1 PERMIT # ......, JOBSITE ADDRESS LA.,co gj,,,,....y ,AdildEAD4 OWNERS NAMEI Ititi,i4, ... ..11....V.c_.k.i.r_t-a. el ..,.,,_,_,,, __ -I pOWNER ADDRESS 541.yu FAX TYPE OR OCCUPANCY TYPE COMMERCIAL IJ EDUCATIONAL [1] RESIDENTIAL PRINT - PRINT CLEARLY NEW: Li RENOVATION: Li REPLACEMENT: a-- PLANS SUBMITTED: YES IS NO FIXTURES -1 FLOOR—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB IIIIIIIIME: : . 1,____ 1 . ._._ _ ___ . . __ __ _ 7:1 CROSS CONNECTION DEVICE --,_ .- ' 2 ' ___,...J ..___ I ,.. I - I 1 -,. . . . ... . '-- . 1---- 1,,_., DEDICATED SPECIAL WASTE SYSTEM j., _ II .',._- J A 17: "ID F73 :171 - 1 , _JI .._,,,..i DEDICATED GAS/OIL/SAND SYSTEM ..,-L__...,J .__.„. .: ,__1(„.. .,, L, , ,ZII,_ ,_J ,.,_, g r.i,.., !L. __ .i1 i,.,_ ii . __ __• DEDICATED GREASE SYSTEM n n '' 1 t'. - l'! it I ''r-1_ ' 7. ' ....._ . ..,_, ' ____ ' •_________ ________ _______.• ___________ _ •• .___, _____ __._ _______ _____. L._ ......._,_ DEDICATED GRAY WATER SYSTEM _._. _______ -,L [-7---]- ,j_7_71.JT.----71.-= -----': —j-----t-T----- DEDICATED WATER RECYCLE SYSTEM I 1 :IL ii t ___1_ ___ IL L IL ___., ji f ._. 1 1 I ___T I .! DISHWASHER I ---- 1 . ---- - - DRINKING FOUNTAIN -17-72. ___ I __Jc_a_c______IL„.._ ftT. ______it__._...___TL____L, ,iF_I:_l FOOD DISPOSER 1.--r--"." A4 . 'L.------:i--- --J -4--tr--J -..7-- -F" 'Civ-A-irjj-2--- 11—‘ 1Lialj: - ----41i FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) 1J ilLJ __IL __,L___I_ _I __________ ..,E7:11___ __ n,__ li KITCHEN SINK ' ... : ._____._. i. : 1_ ____I_A_______Ii A LAVATORY Li-ff.:0, :'1 -_,... .:L___A-:,4,,_ 1 ` _ j . j ______.. _ , ROOF DRAIN H. , . _ : .._ . __ II_____.,_. • ....,..,____F __ It . ,r _ _ J:_______IL_____..1 _ .-_____J _____., iJ SHOWER STALL LL,J1 . IL . .' 11_1 _ ,:i_' __I_ IL_t___ .,____1_,J, . _: . I.L. SERVICE / MOP SINK - -lila . : .„.„.„.:E171„,_,,,i,__,,_,' __ [7,7j ___,,.,. ,._,,[7:1:1,,,,,,f71 ,__,_,,,, ! ___‘_,. 1,_ TOILET _ ___...)' _ ______:i" . i j. . ._ _____IL j; . ii , ,____ I ________,j. ___ it____i URINAL LJ ' _ _ ._•_' • L_ I _IL ' _L __J _ ZI 4 _ WASHING MACHINE CONNECTION 't _ ' (.1,___, ,._,JE__ , ,_ I,„ _,,_ .1__ ' . _ .1..... . WATER HEATER ALL TYPES paiminit am , __7....1 ,...„...21 Hi WATER PIPING . .. 111111111111111__ A ._,:_.i ___..11___,__JL____ . iL , ._ Al . _ II . .. i ___ __IL , _ ii OTHEILL,........„„___ , I Mil= _. ....i ____ _i__________I _ __ __ _ ______,,c _,. ____. I ____ __I I . . Ji .. .1. _ ________________,_ :,. ..-i' -._i _. ___________.. 1_ ,.._.1:- I______.i .____ __I.__ --2.,-......_ _E___ 7q :__________________. 1 . . .. . 1) _..;fj__ - IL_JI_ L._11,. IL_____1._______1_ _-_—__ ___-...._-____ — !' _:j1 iL _,,,, _ J...__11._._._J_._JJ:L_._I._ JLj INSURANCE COVERAGE: I have a current liability_insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Ld NO ._..: IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Li j OTHER TYPE OF INDEMNITY BOND 0 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 ri AGENT 0 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 best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in co li with rertine proyisio,of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ? 4". .4.44,40/"....0.• e=1 (..-. PLUMBER'S NAME [ TEPHEN WINSLOW LICENSE # 112298 SIGNATURE MPD JP17.1 CORPORATION 0# 3281C PARTNERSHIP FP LC Lk ._i • i 0.-- ' COMPANY NAME E.F. WINSLOW PLUMBING & HEATING ADDRESS r8 REARDON CIRCLE er- r-- , --. CITY SOUTH YARMOUTH STATE F. MA 1 ZIP 102664 1 TEL 1508-394-7778 'Zi- '-'- • '-'.- FAX 508-394-8256 CELL 1-N/A -I EMAIL INSPECTIONS@EFWINSLOW.COM - ---.1 1.)-b- ,.., lb The Commonwealth of Massachusetts Department of Industrial Accidents z,' Office of Investigations =��— Lafayette City Center =•= 2Avenue de Lafayette, Boston,MA 02111-1750 4^ s} 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 90 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.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.0 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. Lie. #1964A Expiration Date: 01/01/2022 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 . e the plzins and penalties of perjury that the information provided above is true and correct. / 01/02/2021 Signature: I' "` -..-�!^--- 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): 1.11]Board of Health 2.0 Building Department 3.0 City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia • MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e =:alio 1'414=S. CITY dw► 1 MA DATE 31111 1 Z 1 PERMIT# JOBSITE ADDRESS iLi6a1Ja-tLa,R llailg=OWNER'S NAME rdtlln 6citt ayl _ . 1 GOWNER ADDRESS 5kriC I TE yQ "5 FAXL TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Li RESIDENTIAL[ PRINT CLEARLY NEW:U RENOVATION:( REPLACEMENT:1. PLANS SUBMITTED: YES J NOD APPLIANCES Z FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER .-- _____. _. _..' _.`._'(..,_.' " I � 1� {1 ---- { BOOSTER — _ __ -. CONVERSION BURNER C._�,i I_ 1-- i• I1. 1.-=-71- -I - [ 1 ....--_-1--71 ITIJ : --1_-_ !. COOK STOVE '.1. ,:.....- [.,_ .....' .. - '1_._.._:1__.. ..-.1, _----.1----! DIRECT VENT HEATER .�-._-..i1.-.----1�--. __417.-21 JI_- L__-7L._.. 1.__ I__—!r__ ETI____.dr— �_,,T,_ DRYER (- '`r- r _h L�__IJ=1,.___f I .. I L_-J r______1 L LJ_ .I L_..-_1(�-�..Ii[~. FIREPLACE ., ,.1'I. ,,..11. _1`l. _11_.... -1 7 . 1..... .'1. 1L1_ 1'----_)E 11 . _.__.I----.7 FRYOLATOR L�._�r I____11771 ..7.3:__,.J . J 1 E F-_-----_A.,_-__G---_A___--!"1-- -f'----! --:L_.._._I. FURNACE [ 1I_,_�...,}r : !.r..--�1- f- I17.771 I. i'I- .-!:1._----'1-- -1 .__ II`� I"l GENERATOR _11.__ '--J I 1]_._..._!1-7 �111W-�1_____-II.__ I --'A__'--J.I.----I L 11 'I---1 ----I GRILLE 1 zJ 1-------I I IIIiIi L_---!.(-.1 i 1-- -" -3 I --7�1_ I_--GI-__I: INFRARED HEATER ...,..:,._..,a L..---`I------ Er__1' --' ----1 ET rL--..'•'L___._;I1__-_..,..,I'I hT ____J Iir LABORATORY COCKS L:�_,.. 11.--._IL_,___.3.1 _ _i I—_J I_.___-_11._____.' _.T -._-`:i-._.-`I______I I------- I___! I MAKEUP AIR UNIT ( .xil-. ..-_.!1..__.. : !;i._ f1.... ...Ir-_ 11.__.._1 .isr, -IIL--_---�L- ' - I____ . OVEN L._.,:, i 1-•------' .,.__.-,.,,I=j_7 - 1...._...--I-I---t-1 _____11__.._,_J I:I 11 ___ill-_i L IT 1 POOL HEATER (� �� ..._ rr- ,I:--J__ . �.[ _I i 1I ___'1 _It__J;--;-_ 1_ 1I_�!1 ROOM/SPACE HEATER _...I r .-1• r, _7.r ll-_ 111--- I f ----1 I- f 1--. _J:_n f C _t_..-.--:Cf--J' _i` ROOF TOP UNIT L._ m ,!1 i -r_J ____A_�_'_-.J:IT__I:L`1:J-__._ _____-`I=____..(,___J:1 I'I,�_1---- TEST • �_ ..J1.:,._ -,IL _. !i1_ -.II�.-11--._ _I'_._-._,.II.._.._.'r. .-il.___.? -J1_-- -ii..----1 i I UNIT HEATER L.. G1 'l— 1__. C-..i'I L �:1 1I______r1=1=1 f l_-_.-II-_ I1_ UNVENTED ROOM HEATER [.TJ1_-____[ ,_iil_ .__11: 1:1-----1. .177:71_-!;I..__ _jiI_ __JL:____ L____t 1 :f WATER HEATER_ .- ,L.L _I 1. ._ i -------I!.-_ `1_ L-_H - I I -____^i_ I__ OTHER r 1 , I � I _��l__ I .�fl-Z,117175E717 1 7_ _I 11._JL.l_ ,- 4 ^LI1 -? ---'--tl•'I:I, I`u71--_._S l_---- L--_II I--- 11=-71.=71=20_. .7 .j L—i L=- J7:__C_ 1 ..._-J -9____.7'-__7 I(T1 ------J=_---i 1I ._....r[___ J-lr:__1 f_:__I'( _I . 1'1�.:TT r'1 ! ...___. I---11_.__.r : INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES D NO Q I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Ell OTHER TYPE INDEMNITY ,.__'I 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 0 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 accuratg 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 compliant ajF'Pirtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. y "` --- LR PLUMBER-GASFITTER NAME LSTEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP[Z MGF L JP FA JGF ElLPGI I II CORPORATION} # 3281C __I PARTNERSHIP D#L LLC DI# -_ - - o COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE .4. p1% CITY I SOUTH YARMOUTH STATE I MA JZIPL02664 , ITEL L508-394-7778 N FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM _ _- — -_--j (sir 6 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette,Boston,MA 02111-1750 "6 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): 1.0 I am a employer with 90 employees (full and/ 5. 0 Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.0 I am a sole proprietor or partnership and have no 7. 0 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]** 11.0 Health Care 4.0 We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other *My 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: 01/01/2022 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• , the tinsd penalties of perjury that the information provided above is true and correct. /� 01/02/2021 Signature: r 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.OBoard of Health 2.0 Building Department 3.0 City/Town Clerk 4.OLicen sin g Board 5.0 Selectmen's Office 6.00ther Contact Person: Phone#: www.mass.gov/dia