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HomeMy WebLinkAboutBLDP&G-22-001883 . . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK lk,mn BLDP-22-001883 �_- CITY YARMOUTH MA DATE October04,2021 PERMIT# JOBSITE ADDRESS 635 WILLOW ST OWNER'S NAME CMSIX PROPERTIES LLC G OWNER ADDRESS C/O MOY FONG 63 LAWTON ST BROOKLINE MA 02446 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES 0 NO El FIXTURES 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/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 El NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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 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© MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME: STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspections(a,efwinslow.com S31ON MIA NVlld #.IV H d $ 33d ❑ ❑ 111Alaad 3H1 SV S3A 13S NOI1V3IlddV SIH1 oN SaA S310N NO1103dSNI IVNIJ AlNO 3Sfl H0133dSNI NO 30Vd SIHI S3ION NO1103dSNI SVJ HOfOa MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK mm�1= ` CITY , YARMOUTH MA DATE 9I30/21 PERMIT # __ `� `.:.d\NR„di NWOU .iw`f:(tt ,`toKiR.3.Cc%fokex(Sd,A�\Co.SeW,�KQaa\ . \::P.` 'R�...1 : \dWN'S\WdS h"S4Ett<N\,Y.ti�Ad NW —_- i ,� JOBSITE ADDRESS 635 WILLOW STREET OWNER'S NAME CM SIX PROPERTIES am...., :exx. z«¢e:.wm axw,wuuauwixew0 OWNER.--...J G ._..., ADDRESS 63 LAWTON STREET, BROOKLINE MA TEL 6177944789 JFAX ,. : ':>:.: ... .,...:::«...,...,.,,w..„...,.. ,.......«mw,via.c.«a..w..*aawa.. TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL i EDUCATIONAL 1 RESIDENTIAL[N ' CLEARLY NEW: RENOVATION: REPLACEMENT: v PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS--* BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER 1" CONVERSION BURNER if -."--. COOK STOVE p DIRECT VENT HEATER DRYER j-- FIREPLACE OFRYOLA,TOR N) FURNACE , GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS ,. MAKEUP AIR UNIT i p ......, _.... OVEN :, 1 POOL HEATER , ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER GAS PIPING ::,,Ya.L :.w::S:?Sa�:.ri' :D.+iit.,,.:5 .9RYtH<uYY.x➢uef+!`aR:a� (.: INSURANCE COVERAGE I have a current Iiabilil:Yinsurance 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 I,F 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 b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complianc a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 0 /644,...41J......." PLUMBER-GASFITTER NAME STEPHEN WINSLOW LICENSE #[12298 . SIGNATURE MP MGF I . ,,P JGFt LPGI '3 CORPORATION # I3281C PARTNERSHIP # : LLC El# COMPANY NAME E.F. WINSLOW PLUMBING & HEATING - ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH j STATE MA :ZIP; 02664 ;TEL 508-394 7778 .„___________„„„..„_,„„__..._ ,„.....,....____ FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �;t"llh• CITY YARMOUTH MA DATE 9I30121 ! PERMIT# Z 9 .,4 JOBSITE ADDRESS I 635 WILLOW STREET 1 OWNER'S NAME1 CM SIX PROPERTIES P OWNER ADDRESS 63 LAWTON STREET BROOKLINE MA TELF6177944789 _— FAX I TYPE OR OCCUPANCY TYPE COMMERCIAL`'[J EDUCATIONAL II RESIDENTIAL PRINT CLEARLY NEW:Li RENOVATION:Li REPLACEMENT:0 PLANS SUBMITTED: YES IJ NOD FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ? CROSS CONNECTION DEVICE �' r---„ DEDICATED SPECIAL WASTE SYSTEM 1 DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM Jo DEDICATED GRAY WATER SYSTEM T DEDICATED WATER RECYCLE SYSTEM 1 DISHWASHER ~ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY r ROOF DRAIN � SHOWER STALL SERVICE/MOP SINK TOILET . . URINAL r O WASHING MACHINE CONNECTION WATER HEATER ALL TYPES 1 WATER PIPING „ OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES i NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY tv 1 OTHER TYPE OF INDEMNITY i t BOND L J 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 Ei 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 li with II ertine pro'isioryof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. `/ PLUMBER'S NAME i STEPHEN WINSLOW 1LICENSE#1 12298 SIGNATURE MPH JP Li CORPORATION[!.]#13281C PARTNERSHIPS #_. 1LLC #1 J COMPANY NAME FE F.WINSLOW PLUMBING&HEATING ADDRESS 8 REARDON CIRCLE CITY[SOUTH YARMOUTH STATE MA ZIP r 02664 TEL 508-394-7778 FAX 508-394-8256 1 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM