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Home My WebLink AboutBLDP-21-005990 L-, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 4/15/21 PERMIT# BLDP-21-005990 JOBSITE ADDRESS 35 GARDINER LN OWNERS NAME judith badiali P OWNER ADDRESS T MA 02155 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW: ❑ RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO El 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 1 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 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 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'S NAME Stephen Winslow LICENSE f2298 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 PERMIT EI FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r:4, CITY YARMOUTH MA DATE 04/12/2021 PERMIT# •ram JOBSITE ADDRESS 35 GARDINER LANE,SOUTH YARMOUTH OWNER'S NAME[ ADIALI,MATTHEW OWNER ADDRESS TEL 857.203.1998 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL) PRINT CLEARLY NEW:Ej RENOVATION:LI REPLACEMENT:0 PLANS SUBMITTED: YES LI NOI FIXTURES Z FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 11. _•J CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM e __. I _ I 1 DEDICATED GAS/OIL/SAND SYSTEM 1, 4 . .,... ] . f, DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM __ .. III l DISHWASHER � 1 `! _. t DRINKING FOUNTAIN If .J II- I FOOD DISPOSER _FLOOR/AREA DRAIN ; � � 1 INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY �._ _ 0 II ROOF DRAIN SHOWER STALL I L 0 1. I SERVICE/MOP SINK TOILET URINAL U I WASHING MACHINE CONNECTION I 9(f ]I H Y Y- [ Y"iI"�' <.L1 VA &.\.CAW "1 A A V_ "• C + -P W.,ly.... ,H� \ 1.. ", . WATER HEATER ALL TYPES ID WATER PIPING f. . . II .. -- I(_ . I OTHER iiIl .. _ _k _ W\O 548673 50.00 11 11 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES n NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY[J OTHER TYPE OF INDEMNITY [3 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 0 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�pd,r+ur a 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 proyisioryof the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. / PLUMBER'S NAME[ -EPHEN WINSLOW LICENSE# 12298 SIGNATURE MP Q JP Q CORPORATION El# 3281C PARTNERSHIP[]# LLC LI# 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