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Home My WebLink AboutBLDP&G-21-001156 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY 'YARMOUTH I MA DATE 9/3/20 PERMIT# BLDP-21-001156 ;- JOBSITE ADDRESS 17 EBB RD OWNER'S NAME GASKELL SCOTT P OWNER ADDRESS GASKELL ELLENMARIE 132 WASHINGTON ST TOPSFIELD,MA 01983 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL D RESIDENTIAL ❑ PRINT CLEARLY NEW ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURES FLOORS-4 _ 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 D OTHER TYPE OF INDEMNITY D BOND D 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. PLUMBERS NAME Stephen Winslow LICENSE 132298 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# [ PARTNERSHIP ❑# LLC ❑# COMPANY NAME ETEPHEN A WINSLOW ADDRESS 8 REARDON CIR CITY S YARMOUTH STATE IMA I ZIP 026641207 TEL FAX 7 CELL 7 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 '44,74.1,1 CITY YARMOUTH MA DATE 108/28/20. 1 PERMIT # 3L ) P �\ —OO 1l . t6 JOBSITE ADDRESS 17 EBB ROAD, YARMOUTHPORT OWNER'S NAME GASKELL, HEATHER pOWNER ADDRESS , TEL 978.595.8833. , ._ _Ye 1FAX "__"_. _ ..._..."_ TYPE OR OCCUPANCY TYPE COMMERCIAL 1 EDUCATIONAL I I RESIDENTIAL 0 PRINT CLEARLY NEW: _ __i RENOVATION: ___ REPLACEMENT: _Li PLANS SUBMITTED: YES LI NOE FIXTURES Z FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 111111111111111MMI®1 IMMUNE MIMI IOW Imm CROSS CONNECTION DEVICE MI '..1111.11/1111111 IiIMO '. Mil DEDICATED SPECIAL WASTE SYSTEM IMO j III I1 II I— allilillillilit011110101 M DEDICATED GAS/OIUSAND SYSTEM Imo mom mum um ofm [ III atium an no DEDICATED GREASE SYSTEM I IG I I I i i ': ! i DEDICATED GRAY WATER SYSTEM m� ,� a n � I I M ' 'IF 11� � DEDICATED WATER RECYCLE SYSTEM i DISHWASHER IIIIIFIIIMIIIINAIIIIIIIMMIINIMMIIIIIIIIIIIIMIIIIIMIIIFMIMIIIII DRINKING FOUNTAIN IICM 111111111111111 IIIIIIIMMIIIIIII I III FOOD DISPOSER 1II M�..�. I I EMI 11111111111111111111 FLOOR/AREA DRAIN 11111111111111MIMMIEM111111111.1111M : M, INTERCEPTOR (INTERIOR) M_ 1111111=11111111 KITCHEN SINK I'IIIIIM MN 11111-0111.• LAVATORY MIMI IIIIII II1I 'I ' ROOF DRAIN SHOWER STALL rill11.111111111111111111111111 •11111111111111 SERVICE / MOP SINK 111.11MMMIEWIMMERIEMILWIIIIMEMMI TOILET Miil10111M0011N11M111.mamus am lestamiumIElm 11111111111110 �1 URINAL fII II I■r IIIII iI IIIw I WASHING MACHINE CONNECTION ��m � I m imio al WATER HEATER ALL TYPES MIIII .111111111 h WATER PIPING usaliMmulallialitimi OTHER I IIIIMMINIMI1110111111111111111111111,i I 1 INN IMI r No ranniiiiiiiiiiiimmen um man= r MO 535509 $40.00 1 I 11 s ._ _,- l S INSURANCE COVERAGE: I have a current Iiabili�insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES Li NO i i IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY H OTHER TYPE OF INDEMNITY I BOND I~__ 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 Li 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 Ii with II ertine prgisio of the Massachusetts State Pirumbing Code and Chapter 142 of the General Laws. ---. ...q,.../L-- - - -- --- -- - --, PLUMBER'S NAME STEPHEN WINSLOW LICENSE # 12298 I SIGNATURE MP • ? JP CORPORATION [# 3281C jPARTNERSHIPil#1 I LLC # 1 COMPANY NAME E.F. WINSLOW PLUMBING & HEATING ADDRESS i 8 REARDON CIRCLE CITY! SOUTH YARMOUTH ' STATE MA ZIP [02664 t TEL 508-394-7778 FAX 508-394-8256 1 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM ISEP - 1 ZD2C I V( q0 BUILDING DEF,=,iRi ;Y;; ,, By. --- - The Commonwealth of Massachusetts Department of Industrial Accidents l Office of Investigations F MIN Lafayette City Center 2Avenue de Lafayette,Boston MA 02111-1750 , 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): 1.111 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 tight 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.❑ 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 41. 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.#1909A Expiration Date:01/01/2021 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' /7 the ins and penalties of perjury that the information provided above is true and correct Signature: Date:01/02/2020 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): I.❑Board of Health 2.0 Building Department 30 City/Town Clerk 4.❑Licensing Board 50 Selectmen's Office 6.DOther Contact Person: Phone#: www.mass.gov/dia MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK :r' CITY YARMOUTH MA DATE September 03, 202 PERMIT# BLDP-21-001156 JOBSITE ADDRESS 17 EBB RD OWNER'S NAME GASKELL SCOTT G OWNER ADDRESS GASKELL ELLENMARIE 132 WASHINGTON ST TOPSFIELD MA 01983 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS ---i 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 I 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 ❑ OTHER OF INDEMNITY❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have :he 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 aid 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 0 MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: E.EPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX ! CELL EMAIL inspectionsRefwinslow.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 CITY YARMOUTH MA DATE 08/28/20 PERMIT # p - tjo 51) JOBSITE ADDRESS 17 EBB ROAD, YARMOUTHPORT : OWNER'S NAME GASKELL, HEATHER OWNER ADDRESS TEL 978.595.8833 IFAX , van, TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: L . REPLACEMENT: PLANS SUBMITTED: YES NO � APPLIANCES -1 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 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER MO 535509 $40.00 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 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. PLUMBER-GASFITTE.R NAME1 STEPHEN WINSLOW LICENSE # 12298 SIGNATURE MP MGF LI JP f JGF LPGI , CORPORATION # 3281C PARTNERSHIP '#_ LLC # COMPANY NAME: E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE ._ ,. CITY SOUTH YARMOUTH I STATE MA ZIP 02664 ;TEL 508-398-7778 FAX 508-394-8256 CELL] N/A EMAIL INSPECTIONS@EFWINSLOW.COM u (.4� C The Commonwealth of Massachusetts b_ Department oflndustrialAccidents `—. _ . Office of Investigations _.101' '=;1 "` Lafayette City Center � _7.,e 2 Avenue de Lafayette, Boston, MA 02111-1750 'M 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. ❑ 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]** 4.❑ We are a non-profit organization, staffed by volunteers, 11.0 Health Care with no employees. [No workers' comp. insurance req.] 12.E 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. Lic. #1909A Expiration Date: 01/01/2021 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 ins and penalties of perjury that the information provided above is true and correct. ' / 01/02/2020 Signature: r 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.❑Board of Health 2.0 Building Department 30 City/Town Clerk 4.❑Licensing Board 5.1=1 Selectmen's Office 6.❑Other Contact Person: Phone#: www.mass.gov/dia