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Home My WebLink AboutBLDP&G-21-003922 MASSACHUSETTS UNIFC^ivr APeLICATION FOR A PERMIT TO PERFORM PLUMBING WORK °, r; CITY YARMOUTH MA DATE 1/15/21 PERMIT# BLDP-21-003922 • � JOBSITE ADDRESS 24 CLINTON DR OWNER'S NAME PIVIROTTO ANTHONY P n OWNER ADDRESS PIVIROTTO ELIZABETH J 2 APPLE VALLEY DR REHOBOTH,MA 02769 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: El RENOVATION:❑ REPLACEMENT:El 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 El OTHER TYPE OF INDEMNITY El 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. PLUMBERS NAME Stephen Winslow LICENSE VQ298 SIGNATURE MP ❑ JP El 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 PERMIT ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES S. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ‘;reau� .i� CITY YARMOUTH ] MA DATE 01/04/2021 I PERMIT # BLi 21 `al2-, JOBSITE ADDRESS 24 CLINTON DRIVE, YARMOUTHPORT OWNER'S NAME PIVIROTTO, ANTHONY POWNER ADDRESS I TELE 401.524.2623 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL I1 RESIDENTIAL L71,3 PRINT CLEARLY NEW: 1 RENOVATION: __ REPLACEMENT: _PLANS SUBMITTED: YES � NO FIXTURES Z FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB M1 CROSS CONNECTION DEVICE 111.11 DEDICATED SPECIAL WASTE SYSTEM ._ , _, 'r - i DEDICATED GAS/OIL/SAND SYSTEM ;; 4 i, r A DEDICATED GREASE SYSTEMi III! DEDICATED GRAY WATER SYSTEMIRII ,- iF DEDICATED WATER RECYCLE SYSTEM _ r DISHWASHER l i _ DRINKING FOUNTAIN I r111M.111111!lia ' ' _ FOOD DISPOSER I -----, 'Ili,. ' FLOOR / AREA DRAIN _ INTERCEPTOR (INTERIOR) — ' 11111111111119111AIIIIIII l ill KITCHEN SINK LAVATORY 111111 l ___ ROOF DRAIN ant Fa SHOWER MMIIIIM SERVICE 1 MOP SINK .� . } ,I iiiiiini al ____2!Ill"Ella no.-12j, TOILET URINAL !IIIIIIIIIIirIli�_V; _ ; WASHING MACHINE CONNECTION i WATER HEATER ALL TYPES '- _ . on, !i -1.1i WATER PIPING IIIIIM...sr- OTHER E 1-M UR MNl I1 - 1 ' — — 11111111 111.11 :; i in Riallai, W/O 542601 $40.00 I I I II I f [fir:11"r:RNA WINE INSURANCE COVERAGE: .� .I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL C ' 14 . YES NO ._" IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW JAN 13 202 ) j i i LIABILITY INSURANCE POLICY I OTHER TYPE OF INDEMNITY '� BOND _,___ r . . ; BUILDING DEPARTMENT I OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required • ' - -• o ----- Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER L.: AGENT Li 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 # ; 12298 SIGNATURE MPi JP CORPORATION # 3281C— ]PARTNERSHIP #�� LLC # 1 r COMPANY NAME E.F. WINSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE _ _ _ _ CITY SOUTH YARMOUTH STATE MA ZIP 02664 TEL 508-394-7778 FAX 508-394-8256 CELL N/A ' EMAIL INSPECTIONS@EFWINSLOW.COM _ :z7N, The Commonwealth of Massachusetts Department of Industrial Accidents flW Office of Investigations Lafayette City Center 2Avenue de Lafayette, Boston, MA 02111-1750 `1M = www.rnass.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.E I am a employer with 90 employees (full and/ 5. ❑ Retail or part-time).* 6. ❑ Restaurant/Bar/Eating Establishment 2.❑ lam 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]** 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#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 • � the "in✓s��d penalties of perjury that the information provided above is true and correct. Signature: Y 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): 1FJBoard of Health 2.0 Building Department 3.1=I City/Town Clerk 4.❑Licensing Board 5❑Selectmen's Office 6.['Other Contact Person: Phone#: www.mass.gov/dia MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY 'YARMOUTH • MA DATE January 15,2021 PERMIT# BLDP-21-003922 JOBSITE ADDRESS 24 CLINTON DR OWNER'S NAME PIVIROTTO ANTHONY P G OWNER ADDRESS PIVIROTTO ELIZABETH J 2 APPLE VALLEY DR REHOBOTH MA 02769 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL El PRINT CLEARLY NEW: 0 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❑ 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 Stale Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Stephen Winslow LICENSE# 12298 SIGNATURE MP 0 MOP❑JP❑ JGF❑ LPGI ❑ CORPORATION 0# PARTNERSHIP ❑# LLC❑# COMPANY NAME 'STEPHEN A WINSLOW ADDRESS. 18 REARDON CIR, CITY IS YARMOUTH I STATE MA ZIP 026641207 TEL FAX I I CELL EMAIL inspections(a)efwinslow.cam . 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 t MASSACHUSETTS UNIV3RMVI APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK yn ®• CITY YARMOUTH MA DATE 01/04/2021 PERMIT # l� �P"Z `" - 39 Z� JOBSITE ADDRESS 24 CLINTON DRIVE, YARMOUTHPORT OWNER'S NAME PIVIROTTO, ANTHONY 1 GOWNER ADDRESS TEL 401.524.2623 FAX! TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL i RESIDENTIAL , PRINT CLEARLY NEW: RENOVATION: L.. REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS-I BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER r COOK STOVE DIRECT VENT HEATER DRYER . FIREPLACE -_ _ FRYOLATOR FURNACE GENERATOR .__.._ . — GRILLE INFRARED HEATER LABORATORY COCKS — MAKEUP AIR UNIT _.._ OVEN POOL HEATER ROOM / SPACE HEATER I ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 1 OTHER R IF- C E ! 1:440' TT- W/O 542601 $40.00 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. h. 42 YES VNOiJi r I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW BUILDING UEFgRTtvl..L, LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY Y 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 Frtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME STEPHEN WINSLOW j LICENSE #' 12298 SIGNATURE MP i MGF JP «I JGF 0 LPGI El CORPORATION i # 3281C PARTNERSHIP LJ# LLC #.......... COMPANY NAME E.F. WINSLOW PLUMBING & HEATING I ADDRESS 8 REARDON CIRCLE CITY SOUTH YARMOUTH I STATE ! MA IZIP102-664 TEL 508-398-7778 FAX[508-394-8256 CELL N/A ,EMAILINSPECTIONS@EFWINSLOW.COM The Commonwealth of Massachusetts Department of Industrial Accidents 9 Office of Investigations i\ Lafayette City Center 1 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. 0 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]** 11.❑ 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#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. Signature: Y �` A-- 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): 1.DBoard of Health 2.❑Building Department 3.❑City/Town Clerk 4.❑Licensing Board 5.0 Selectmen's Office 6.['Other Contact Person: Phone#: www.mass.gov/dia