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Home My WebLink AboutBLDP-21-005442 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK I i.- /= CITY YARMOUTH MA DATE 3/22/21 PERMIT# BLDP-21-005442 T JOBSITE ADDRESS 1 PINE REACH VILLAGE OWNER'S NAME anne girardi P OWNER ADDRESS 1 PINE REACH VILLAGE YARMOUTH PORT,MA 02675-1470 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:0 REPLACEMENT:0 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 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 0 OTHER TYPE OF INDEMNITY 0 BOND 0 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 at Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Stephen Winslow LICENSE t/2298 SIGNATURE MP 0 JP ❑ CORPORATION ❑# PARTNERSHIP 0# LLC ❑It COMPANY NAME STEPHEN A WINSLOW ADDRESS 8 REARDON CIR CITY S YARMOUTH STATE MA ZIP 1026641207 I TEL FAX 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 PERMIT ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK T.-1,---30---=--e. _.w ,I= >w CITY YARMOUTH MA DATE 3/19/21 1 PERMIT # b i- C Z -` ` ) JOBSITE ADDRESS 1 PINE REACH, YARMOUTHPORT OWNER'S NAME ANNE GIRARDI 1 p OWNER ADDRESS SA I TEL 7749948308 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL F.] EDUCATIONAL Ej RESIDENTIAL Ei I PRINT CLEARLY NEW: h i RENOVATION: ` REPLACEMENT: I PLANS SUBMITTED: YES {,:sj NOD ,40 FIXTURES Z FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE aB _ .. I_ IIIIIIBI �' Ma MI DEDICATED SPECIAL WASTE SYSTEM �, ;M�ai ;. . :: k DEDICATED GAS/OIL/SAND SYSTEM m _ � 1 N DEDICATED GREASE SYSTEM ......_,ans, gilatMarn 1 ' .. DEDICATED GRAY WATER SYSTEM -, min DEDICATED WATER RECYCLE SYSTEM 1r �, iiiiiIannim t� DISHWASHER _._ __ DRINKING FOUNTAINnsulin _ a iI _ x FOOD DISPOSER I I FLOOR /AREA DRAIN 111111111111.111111.1111 _ 1n11111-.. -- 0a.11a11/[MMRI auuur II IIIIII1 I=.N11111IS0MN1N1IMB1 IMM1111111II , INTERCEPTOR (INTERIOR) . W . ' M Ii KITCHEN SINK _ ..__��. '; LAVATORY = _.,.. _`: { ''. 1 W Cb ROOF DRAIN rII-I MI-I IIIIWIMMIIIIIIIII SHOWER STALL .. 11 . SERVICE / MOP SINK TOILET '� 1. URINAL IIINIMIIMIINIHIIIIMIMII 2 �' - WASHING MACHINE CONNECTION IIIIIINNMMMIINIIIIIIIIIIIIIIMIIIMIIIIIIRIHIIIIIIIIIIIIIIIIIIIIIIIIII WATER HEATER ALL TYPES IMMIIIMMIII a1 ! WATER PIPING 11111111111WIMIIIIIIIIIIIIIIIIIIIIIIIIIINIMIMMIMIIIIIIINSI OTHER 1 IIMIMIIINIMIIINMIIMIEIIIIIIIIIIIIUONII. . _ IMT%- a Igppg L1i__ :_IL_ ITI INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Le i NO .....,' IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _,I,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 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 ._. y LICENSE # [j2298 1 SIGNATURE MP Y1= JP D CORPORATION PI#13281C PARTNERSHIP[, #[ mm 1 LLC # COMPANY NAME E.F. WINSLOW PLUMBING & HEATING ADDRESS : 8 REARDON CIRCLE CITY SOUTH YARMOUTH 7 STATE FMA I ZIP 02664 TEL 508-394-7778 - FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM _ �. .