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Home My WebLink AboutBLDP-23-004120 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .y 10 ',e: CITY YARMOUTH MA DATE 1/25/23 PERMIT# BLDP-23-004120 JOBSITE ADDRESS 193 WHITES PATH OWNERS NAME MID CAPE RACQUET CLUB INC P OWNER ADDRESS C/O MAJEWSKI ASSOC INC 13200 OAKMONT DR FORT MYERS,FL 33907-8030 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ FIXTURFS I 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 1 FOOD DISPOSER FLOOR/AREA DRAIN 2 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 4 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 4 URINAL 2 WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 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 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 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 12298 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME STEPHEN A WINSLOW ADDRESS 8 REARDON CIR 8 REARDON CIR CITY S YARMOUTH STATE MA ZIP 02664 TEL 5083947778 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 0 ❑ FEES; PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,►� CITY 1 YARMOUTH MA DATE i 12-16-2022 = PERMIT # L:s — 1/4-1 t 42 7intow ; JOBSITE ADDRESS I 193 WHITES PATH OWNER'S NAME[ ROBERT MAJEWSKI P OWNER ADDRESS ' 1 TEL _.. ._. : L 508 394 3511 F TYPE OR OCCUPANCY TYPE COMMERCIAL E EDUCATIONAL El RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: [ REPLACEMENT: Eti PLANS SUBMITTED: YES 0 NOI '.I FIXTURES 7 FLOOR-0 BSM III , 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB i -� - I �------_ -. ji I �t mm__ i am 1 CROSS CONNECTION DEVICEum DEDICATED SPECIAL WASTE SYSTEM ,1 ___ _ .. .. MillialliMilillial DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM _ .._:. DEDICATED GRAY WATER SYSTEM I IM _ I ... I I DEDICATED WATER RECYCLE SYSTEM IIIIIIIIIIIIMMILMIIIMS DISHWASHER MINN MOM FONIMMIIIIIIIMMIIIIIIMMIIIIMMISO DRINKING FOUNTAIN _. II._ FOOD DISPOSER _ NMIMTIMMIIIIIIIIIIIIIIIIUINIIOIIMIIIIIIIMMIIMIII FLOOR /AREA DRAIN IMIIIIIIIRIIININMIWRMIIIIIIIIIMIIIMINIIIMMIIIINMMMIIIINIIINIIIII INTERCEPTOR (INTERIOR) 1.01.01111111. . KITCHEN SINK I a_ LAVATORY Millar 4 _ ROOF DRAIN FINEM111.1 0111111.1111111.111111.11111111111.11111111.1111.111111111111.11 SHOWER STALL IMIIIIIIIIIIIIIIIMIIIIIIIIIIFMIMIINIIMIIIIIMIIMNIIMIIIMIIIIINFMIIIIS SERVICE 1 MOP SINK INIF IIIIIIMMAII11.1111111MMOMOMICIMIIMIEN TOILET 11111111111,-4 '4 IM URINAL �� II_ MM WASHING MACHINE CONNECTION MilliMn WATER HEATER ALL TYPES .. .. ... ........ L. . ii ini WATER PIPING I . OTHER x _ =Milli Mil.._ __ ME 111111101111M.111M111 '11.111111111 . 1111.11 — IIIIMIIIIUINIIIIIIIIIIMIIIMI in:l : ;IIMI� I I . , r 3 111111NEM NMI 1 IL I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES [J NO I 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 Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT m_. 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 . a 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 proYisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r --+ ........ '`-,..- PLUMBER'S NAME STEPHEN WINSLOW ;LICENSE # 11.229811] SIGNATURE MP i JP ~ .[ CORPORATION # 3281C PARTNERSHIP i# LLC # COMPANY NAME E,F WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE _-___] L. v CITY SOUTH YARMOUTH STATE MA,rr ZIP 02664 TEL r5o39778 FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@EFWINSLOW.COM