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Home My WebLink AboutBLDP-21-006147 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK - CITY YARMOUTH MA DATE 4/23/21 PERMIT# BLDP-21-006147 r,s= JOBSITE ADDRESS 25 HAZELMOOR RD OWNER'S NAME Joyce renzulli P OWNER ADDRESS 25 HAZLEMOOR RD SOUTH YARMOUTH,MA 02664-2926 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES El 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 WATER PIPING OTHER 1 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❑ OWNERS 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 PERMIT ❑ FEES$ PERMITS PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK.N.. ——, CITY 1 YARMOUTH MA DATE [4/20/21 I PERMIT # • _ , , , ____., JOBSITE ADDRESS '! 25 HAZELMOOR ROAD, SOUTH YARMOUti: OWNER'S NAME, JOYCE RENZULLI SS SSS%SSSS%S. ,....,..J OWNER ADDRESS 42 SHERMAN ROAD, DEDHAM MA 02026 J TEL! 617.538.7663 IFAXE TYPE OR OCCUPANCY TYPE COMMERCIAL I:7j r-1 EDUCATIONAL i,„,i RESIDENTIAL L.-' i .. PRINT CLEARLY NEW. 1 , • L„,,„„, RENOVATION: ri REPLACEMENT:Li PLANS SUBMITTED: YES El NOD FIXTURES 1 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 „,..,..........._,;L...7....,r_....._ir.....,....._1r__• .1 (i) BATHTUB k pS5I 1--- -- '1 ..."1 - ir E--- -'-' ro, CROSS CONNECTION DEVICE . ) rt \ DEDICATED SPECIAL WASTE SYSTEM ;' ; 117 1 11....... [..---1--- ' 1 11 DEDICATED GAS/OIL/SAND SYSTEM 1 i ,--4. ----4 inj--H- [---p -7 r------1 _,,,..,.. , . ,„=.......„.„, ..........,_.,„,..,,......„.,...„„:„.....:,....._ x„...x....,...?..,.......,„_.„.„._.......„ ....„,,.,,,.._,.,..:..., ,- ,.._, ....,„. , .,.._., ,_,... , , .„ tn DEDICATED GREASE SYSTEM , r1r ,r ......1f_.,,,,,___,r,„,„ .. .„, .r.,.._: r7fir:.,1:7,Li._ .1..,,,,_ ;71.1.7.7)„,.,, ,,,,,,‘. ,E7 ...j v) DEDICATED GRAY WATER SYSTEM , o ;; i _ _!,,,, _ ! _ ,,,,., DEDICATED WATER RECYCLE SYSTEM i ir , I I' ,:[ 1! q -1, -11- 1[1-17,11 , -!,..„=„:„„.„..„:::::,..,.:::...:„,„„..„.,„:„_, _:„.„.„:„.....,,..„:„.....„.......:,...„...„..,...........: .........„:„.:„ , , 1 , ,,, , . : DISHWASHER DRINKING FOUNTAIN II__, _ - „,,,, .,.._ . 1. ,1177-1, [ ._.._,..._ IF ...27-1_,' FT ,JL !FT, -.1 .. _..1----1_ i: _ ..„ . -,- , li ...71 rf,,, FOOD DISPOSER 1 it . ,, . 1: it , ,.I[ FLOOR /AREA DRAIN e sa.; 1, i , , , , 1 f --"1 INTERCEPTOR (INTERIOR) ,.. • ilL1 -: i J: IT.- -11:_11 , i1LTiLIiJ , ===== z........,„........... =:====';. . ........ .,.......... .........._ ......_1 KITCHEN SINK .:, LAVATORY .[ !s ...„. . 114' —,---11-4 — ' . 'r„42.str...=I I.t=t,:s.:.- — 1 1---- (‘ () ROOF DRAIN it, —' — :7-1111111111- li—i 1111111111111 i_ 1 : ---"" 1 — j IIIIIIIIIIW r , - ir— —j'i----- 1----"-- 1------i[:: jr"—lr-- \--:. SHOWER STALL I'm 1r ,., -----1 , SERVICE / MOP SINK i Jr- ;1.-- : : .. -4 1 ir .:.1 (--- 7 t --H 7: '''' ' ''''' '' .1 'w ! '''' 1,,,,L, : r— *II TOILET ::1 i 1 URINAL , . ' :1- ., i! : . . . WASHING MACHINE CONNECTION -1r* . ! T-11111WNIllat ' 1' - 1-"--'1 ": VVATER HEATER ALL TYPES , .> WATER PIPING r 1 ., ,, --I r , , ...,„.... OTHER .-...,N, 0 S a • /A ' .WIIMIM . .:„„.. .-.:. 'i •' 1 !r . — : , ,---ir-",- "-,, fr. I, ,. . , INSURANCE COVERAGE•. I have a current liability_insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO i j IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY :, i :: OTHER TYPE 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. 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 proisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r .06...4, .0011444, IliKesie0*" ... ........ '"''' " "'"'y PLUMBER'S NAME [-STEPHEN WINSLOW I 122981 LICENSE # SIGNATURE „,_______, r— MP- i JP I j CORPORATION rti-J#028ic IPARTNERSHIPLig i LLCL i# --1 7 COMPANY NAME E.F WINSLOW PLUMBING & HEATING i ADDRESS i 8 REARDON CIRCLE , . CITY! SOUTH YARMOUTH 1 STATE [ MA I ZIP [02664 TEL 1508-394-7778 , . _ --------- FAX 508-394-8256 CELL N/A 1 EMAIL I INSPECTIONS@EFWINSLOW.COM ---- „._.