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Home My WebLink AboutBLDP&G-21-002983 L. - MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK s CITY j\RMOUTH MA DATE 11/25/20 PERMIT# BLDP-21-002983 5 -� -- JOBSITE PDDRESS 179 SEAVIEW AVE OWNER'S NAME MOYNIHAN JOHN J JR TRS P OWNER ADDRESS MOYNIHAN A M TRS&FOX R C JR 20 DORLANDO WAY DANVERS,MA 01923 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ 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 0 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. PLUMBERS NAME Stephen Winslow LICENSE W298 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME [TEPHEN A WINSLOW ADDRESS 8 REARDON CIR CITY S YARMOUTH STATE MA —I ZIP 026641207 TEL FAX CELL EMAIL inspections@efwinslow.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES 1 Yes No THIS APPLICATION SERVE AS THE PERMIT ❑ ❑ FEES$ PERMIT# PLAN REVIEW NOTES r-- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY d _ _ _ MA DATE II %�1 / I._ _ ..,_- PERMIT# &PAP/ •a i�1 JOBSITE ADDRESS 1`l lit'etod Sd� _ . . -_— -_ OWNER'S NAME_�a" '!it . ,, �� t aI _Y. OWNER ADDRESS 7irl r �� t. 1 ] °. _ 3�. .. �-_, FAX __. TYPE OR OCCUPANCY TYPE COMMERCIAL � '�=a�� .-�J PRINT EDUCATIONAL LiRESIDENTIAL ' CLEARLY NEW: LJ RENOVATION: ,j REPLACEMENT: [i PL ANS SUBMITTED: YES E NO ,.� 1 -� FIXTURES FLOOR--) BSM 1 2 3 4 5 6 7 BATHTUB 8 9 10 11 12 13 14 CROSS CONNECTION DEVICE NNW ,' IIIIIIIMMIIIIIIIIIIIIIIIIIMillit INN DEDICATED SPECIAL WASTE SYSTEMjulliollanni � DEDICATED GAS/OIL/SAND SYSTEMmin _ 'I i ; it- _ ,:_,LL DEDICATED GREASE SYSTEM � uimt �l !�� al DEDICATED GRAY WATER SYSTEM MMIln DEDICATED WATER RECYCLE SYSTEmeiimingsrmM 1 DISHWASHERmumilowswimet- muirm INI � ` I.. . __ ._' f _ 1 ,"Ili DRINKING FOUNTAIN FOOD DISPOSER F-Timutuntamn-ir 71 .FLOOR!AREA DRAIN _ �I ,�I � t INTERCEPTOR (INTERIOR) Ili 7 MI ______ 2i2MMI:r KITCHEN SINK �-- �� r—_— _ _ MI � LAVATORY C ROOF DRY MIIIIIM ` DRAIN r � � F I 11.111111111.11M `1 ► SHOWER STALL 1111111111111111,SERVICE /MOP SINK - 1' , i J ' ' a TOILET i �; M IMMainiallialliiMMUMMMINIMIUMMOMMIN URINAL WASHING MACHINE CONNECTION �I [ 11111 WATER HEATER ALL TYPES 1~IIIIIINITIMFMM W{� ��(MMWWW1.11I � MIIIIIIIIIIIIIIMMINVIIIIIMENIF— —111111 WATER PIPING __ -- M _ C C U-` OTHER 'I �- , . ,,n . q.. . f III I iiiiIl INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142, YES El NO 177 IF YOU CHECKED YES, 'LEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSLRANCE POLICY ki OTHER TYPE OF INDEMNITY >fl BOND 0 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 D 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,aada r to 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 co II wit II ertine pro1isio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME ETEPHEN WINSLOW j LICENSE # 12298 SIGNATURE ^ iJ MPZ JP Li CORPORATION LI#j281C PARTNERSHIPI# J LLC _-,;# W T r COMPANY NAME E.F. WINSLOW PLUMBING & HEATING J ADDRESS L8 REARDON CIRCLE r CITY[SOUTH YARMOUTH STATE J MA J ZIP 02664 TEL 508-394-7778 --- `J� FAX 508-394-8256 CELL N/A EMAIL INSPECTIONS@ EFWINSLOW.COM @EFWINSLOW.COM The Commonwealth of Massachusetts may_ Department of Industrial Accidents i cy = Office of Investigations 've�1H :l Lafayette City Center ti 2Avenue de Lafayette,Boston,MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses Applicant Information Please Print Let ibly Business/Organization Name:E.F.WINSLOW PLUMBING&HEATING CO,INC. Address:8 REARDON CIRCLE City/State/Zip:SOUTH YARMOUTH,MA 02664 Phone 0:508-394-7778 Are you an employer?Check the appropriate box: Business Type(required): 1.® I am a employer with 90 employees(full and/ 5. 0 Retail or part-time).* 6. 0 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. g, 0 Non-profit [No workers'comp.insurance required] 3.❑ We are a corporation and its officers have exercised 9. 0 Entertainment their right 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 area 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 theirworkers'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 it I. 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 car e1 the ins penalties of perjury that the information provided above is true and correct. Signature: %�-'e 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❑Board of Health 2.❑Building Department 3.0 City/Town Clerk 4.0Licensing Board 50 Selectmen's Office 6.['Other Contact Person: Phone#: MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ERMOUTH MA DATE November 25, 202( PERMIT# BLDP-21-002983 JOBSITE ADDRESS 179 SEAVIEW AVE OWNER'S NAME MOYNIHAN JOHN J JR TRS Cjr OWNER ADDRESS MOYNIHAN A M TRS & FOX R C JR 20 DORLANDO WAY DANVERS MA 01923 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ 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 El NO El IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER OF INDEMNITY El 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 ar d 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 Q MGF El JP ❑ JGF ❑ LPGI ❑ CORPORATION ❑ # PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME: EEPHEN A WINSLOW ADDRESS. 8 REARDON CIR, CITY S YARMOUTH STATE MA ZIP 026641207 TEL FAX ] CELL EMAIL inspections(a,efwinslow.com ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No ti THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES . '\. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK T.,.....7.....zir.... / fi ..-alromLeya 7.s _________.......,__....._ __ .._iatikrair—=• * CITY [7:... idt2t)t_b, .,_,____ ] MA DATE 11111.72O 1 PERMIT # 4P- .P-i -sgo;-*-----3 _...._ .,!..,. .4 owl •••••••••••••••••••••01•1.4y111...., ..... ..'. .•..,1 JOB SITE ADDRESSED/14 r .7773 ''' 64 ' OWNER'S NAME LA.0,1f ....--Y-!...-- - ..—Vt--- :.-4.414z - -2 G OWNER ADDRESS 12_o 1 ,(14,0 1,- ,1 TYPE OR PRINT ---1 OCCUPANCY TYPE COMMERCIAL LA EDUCATIONAL r RESIDENTIAL pt--- : I CLEARLY NEW:Il,:l RENOVATION: [1] REPLACEMENT: r, ;-- 1 PLANS SUBMITTED: YES[] NO1- I APPLIANCES 1 FLOORS-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER . . ___ __ . : _ ., _ BOOSTER . . 1 ;1 d III :il ! I I ' CONVERSION BURNER f--- ..-ii- .: 17 -A" !1 -.. i - 71 -- 4--- :il : ; !I ,1 H I I COOK STOVE r -7-. I - - 1-- - e -- .- 1-- - - 1 .----d ' ---1 .-- --__ .; I - l' - - i -.....,.-? I . 1-- 0: ____ I- -- '4 .L.....-...,. -_ DIRECT VENT HEATER ! ,_r- 1------r- ----ir--!_i-Tir--- -TIT--- FIREPDRYER I . ---._ _.: 11._--, , -I ' -_it .---1 ii 1 i 1- "4-"..-":1 Ill 1:11-77 1;!" A ,• 1___--- _-11:-, LACE 1----- -----7. --- - --1 --- --11- - 1 --Thr-------r----i I-------,:1------ 1------7i. -_-----, 1- -7- - FRYOLATOR . J-- . . 3- .,, 4, ,, _ , _,:i _ ._,,,1 3.---_ 1 , - 1 ____ ___, , _ _ ! FURNACE - -- 7--------- ------Ti--if-----11-- --- I - ---11---d--- ---71----, 1— I.- -- _ _ __ _......_ ,..,,,..._--.....e.GENERATOR I- ' I . 'I 4 -7-Tir-.-- 1 Ti 7--1-Tr—i-- GRILLE 1 ---.--! [----'117--1=7IT: --1:: -----r I-7:1-.7_ ._1'1 '11_ _ 1 INFRARED HEATER 771--7, 1-71-7. ----. •.rj- J1----- --- H--- ET iE F- , _._. LABORATORY COCKS I !!I T .I .rr ' I P 1 ---7 n-- i I T I------ - 1-1-..----:1--- -- MAKEUP AIR UNIT I tr- T- 1 id ill---. , ill- - -' r .,, i,, If- OVEN 0 -1:1---i 1----71- -_-- . 1- ----1 ' .----._-11' " _ _ i'l---"-" ! -.11 7_1 ;!.1Tif _--:r ---1(-- I POOL HEATER 1 -----:li--- i--, I------1-- I, -.---_ -'1-2- 11_-_----1.1 _1-TII:_. 171. -7,:l 71.-_ - :17..._ ROOM / SPACE HEATER _ _.‘ Irlr_ .., i __ _ . . . _ ROOF TOP UNIT IT:- LL 1--- L_„_.' r•-• i I - '1-- 1 -41 1_ _ II TEST 1- --1 I-- ' - ,r ---1,7-71 ----7 - -'f--- -1 ''l I( 1 , 1 i, _ ! I UNIT HEATER I----.. --- 1------- I-_--• '-- - - 0r-_- --•--- :r-- ir-- -4 - ----ir-Tii- - -.!ii----- yi-------7,1 --- : ,r-- UNVENTED ROOM HEATER I -- i I-----.1- - 71.----7 -----71 --- --T-71 -'---, r-- -7. _-__ _ ' IT ii :.1-- _ I I- - WATER HEATER I-1- 1---M1-4-- 1--- 1.- lr-1___ 1 _ 1 ,i- -- -:1 ----II- ,I.--- - , i- r 1 1 ___......, OTHER i I _ F r _ 1 i IT_ , 1 - i; ; I .1 . i _ If 1 _ 1 1 ,, -I- I i 1 I ., . r---'--- er ! -- ---- i- , - -----, i----- ;- ---1-- -- ---!! - ---7 i--1111-------, 1——1---- I-7r— - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL jhJ42 YES f#N0 k. .,:,_,el I IF YOU CHECKED YES, PLEASE INDICATE T b_HE TvPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW k 'I— ',..." ,: 1"-- LI I71 ,ABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 1 : •, BID Ititi 1 8 2fi2il 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. BUILDING DEPP.P — CHECK ONE ONLY: OWNER EzTAGENT I. SIGNATURE OF OWNER OR AGENT r--- - 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 a Ptrtine provision of the D Massachusetts State Plumbing Code and Chapter 142 of the General Laws,k.r-1 #1- .......1 r „ 1-------------- -'--1 PLUMBER-GASFITTER NAME 1 STEPHEN WINSLOW j LICENSE #[122981-11 SIGNATURE MP f.,:_._/J, MGF 121 JP [1:: JGF 171 LPGI [7] CORPORATION Fil#1-32-8-1-C--1 PARTNERSHIP[TA#[------] LLC 0#1,, ._ ---- - (N' ,*-........, — k5e, COMPANY NAME E,F. WNSLOW PLUMBING & HEATING ADDRESS 8 REARDON CIRCLE 1 _____.....,.._ s•\--% CITY SOUTH YARMOUTH i STATE l-fA-IZIPF02664 TEL 508-394-7778 1 ._______I c..., FAX[508-394-8256 .1 CELL N/A EMAIL1 INSPECTIONS@EFWINSLOW.COM i 'irsCr.-.17MIresamaaw-weomr..a........ ,. .,..y...,.... Q.e. t4 g lb The Commonwealth of Massachusetts _= Department oflndustrialAccidents _ ll Office of Investigations =:q.a =I Lafayette City Center ZAvenue 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.® 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 10.0 Manufacturing no employees.[No workers'comp.insurance required]** 11.0Health 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.Lie.#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 ce of the insand penalties of perjury that the information provided above is true and correct Signature:��/Y,f/" - '-- 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): 10Board of Health 2.0 Building Department 30 City/Town Clerk 4.❑Licensing Board 50 Selectmen's Office 6.❑Other Contact Person: Phone#: www'mac nnv/din