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HomeMy WebLinkAboutBLDP&G-22-003119 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 11/30/21 PERMIT# BLDP-22-003119 I JOBSITE ADDRESS 19 HOSKING LN OWNERS NAME MARTIN JAMES A P OWNER ADDRESS MARTIN MARILYN G 19 HOSKING LANE SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NO❑ FIXTIIRFS FLOORS—, RAM 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❑ 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. SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are We 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 1Q298 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 ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK — CITY YARMOUTH SOUTH MA DATE 11/10/2021 j PERMIT # JOBSITE ADDRESS 19 HOSKING LANE , OWNER'S NAME JAMES MARTIN POWNER ADDRESS 1 SAME .�_ ._.,. . . _._ . .__ TEL 508-394G9387 ....._,FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 6 1 EDUCATIONAL 0 RESIDENTIAL ED PRINT CLEARLY NEW: __. . RENOVATION: , . _ REPLACEMENT: H PLANS SUBMITTED: YES EI NO, .-.. FIXTURES Z FLOOR-• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB n 7,011, �__ NW An CROSS CONNECTION DEVICE I X i ,m, W ,, 4,' DEDICATED SPECIAL WASTE SYSTEM ,.. ..... . .. N! . - „ j DEDICATED GAS/OILJ$AND SYSTEM •111111147-... c I DEDICATED GREASE SYSTEM _ ': �. i . k DEDICATED GRAY WATER SYSTEM 11111110111111111111111.1 DEDICATED ED WATER RECYCLE CLE SYSTEM STEM 11-3. l MIH DISHWASHER -.: .. . E . i QM DRINKING FOUNTAIN . W,,:, ..: _It y ._.__ • ' . -11 ( 17 3 FOOD DISPOSER f.....:.. ! .... ! _ FLOOR 1 AREA DRAIN mi INTERCEPTOR (INTERIOR) €m � IIIRIIIIIMMNIPI MMMIIE ::. :_:_.�. ' - F__ KITCHEN SINK :.MINIW..._�W..- I l LAVATORY piir-=''"--- ; ,,, - -- ROOF DRAIN SHOWER STALL -y 11.111.I iII . SERVICE ! MOP SINK _ ITIOW 1 _ .111111110111.1 MIMI ,,,,_,.! _ _ : _, , TOILET _ URINAL 4.., „ WASHING MACHINE CONNECTION I �I' WATER HEATER ALL TYPES p t X :' WATER PIPING i � . INN OTHER __ MOB mor !_._ ...... -'l6' ..Yf *It Xw'•'1151` yf, ........ _ e milIMIN:E�.. E'.,�......... _ ...__ ._ _........ ... ... r.. "'"' ti _ .., ., ., v., IN • 1 ni _ 1 i,..." : p BIS .0-- INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES [L NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW .............:: LIABILITY INSURANCE POLICY 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 a 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 Ii with II ertine proYisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME STEPHEN WINSLOW J LICENSE # 112298 I SIGNATURE MP i / JP ill CORPORATION171# 3281C PARTNERSHIP , . #I I LLC # COMPANY NAME E.F. WINSLOW PLUMBING & HEATING I ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH STATE [—MA • ZIP 02664 TEL [508-394-7778 FAX 508-394-8256 J CELL N/A I EMAIL INSPECTIONS@EFWINSLOW.COM pc ;is b 1 --tom MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK e . CITY YARMOUTH MA DATE (November 30,202I PERMIT# BLDP-22-003119 JOBSITE ADDRESS 19 HOSKING LN OWNER'S NAME MARTIN JAMES A G OWNER ADDRESS MARTIN MARILYN G 19 HOSKING LANE SOUTH YARMOUTH MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:© PLANS SUBMITTED:YES 0 NO❑ 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 0 NO❑ IF YOU CHECKED YES.PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER OF INDEMNITY 0 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-GASFITTER NAME Stephen Winslow LICENSE# 12298 SIGNATURE MP©MGF 0 JP 0 JGF 0 LPG( ❑ CORPORATION❑# PARTNERSHIP ❑# LLC 0# COMPANY NAME STEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX CELL EMAIL inspectionsanefwinslow.com er"" 1. S31ON M3U1321 NVId #.VIH d $ : 3d El 0 111A1213d 3111 SV S2A J3S NOI!VOIlddV SIHJ oN Sa), S310N NO1103dSNI 1VNl3 AlNO 3Sfl allO3dSNI HOd 3OVd SIHl S31ON NO1103dSNI SVO HO1102J MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK f=�` 1 i CITY YARMOUTH (SOUTH) „� � MA DATE! 11/10/21 PERMIT # 2 1 i 1 ? JOBSITE ADDRESS 19 HOSKING LANE OWNER'S NAME ` JOSEPH MARTIN ___ OWNER ADDRESS SAME TE 508-394-9387 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL Li RESIDENTIAL PRINT CLEARLY NEW:I ' RENOVATION: REPLACEMENT: 1 PLANS SUBMITTED: YES` NO APPLIANCES 1 FLOORS-0 BSM 1 2 4 5 6 7 8 9 10 11 12 13 14 BOILER x BOOSTER CONVERSION BURNER M COOK STOVE �.l xnc�an. �,I DIRECT VENT HEATER DRYER FIREPLACE ' FRYOLA i OR Lc FURNACE GENERATOR GRILLE INFRARED HEATER fp LABORATORY COCKS "' MAKEUP AIR UNIT ' OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT __ TEST __ .. .. UNIT HEATER UNVENTED ROOM HEATER WATER HEATER __ -. OTHER \ INSURANCE COVERAGE 6,),.) I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 121,. NO L c) I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i 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(;— 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 ssued for this application will be in complianc a P rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 7,,, -..... ...K....4-- PLUMBER-GASFITTE.R NAME STEPHEN WINSLOW i LICENSE # 12298 SIGNATURE MP v MGF JP JGF LPG! CORPORATION ri 1# I 3281C 1 PARTNERSHIP #...3 LLC z �# COMPANY NAME: E F. WINSLOW PLUMBING & HEATING I ADDRESS 8 REARDON CIRCLE i CITY SOUTH YARMOUTH STATE MA i ZIP 02664 TEL 508-394-7778 ....... .... . . FAX; 508-394-8256 CELL N/A JEMAILINSPECTIONS@EFWINSLOW COM