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HomeMy WebLinkAboutBLDP&G-001586 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK VICITY YARMOUTH MA DATE September 20,202 PERMIT# BLDP-22-001586 JOBSITE ADDRESS 222 BUCK ISLAND RD UNIT 35 OWNER'S NAME IGROSS GARY G OWNER ADDRESS 222 BUCK ISLAND RD UNIT 35 WEST YARMOUTH MA 02673 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 ❑ 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 State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Stephen Winslow LICENSE# 12298 SIGNATURE MP© MGF ❑ JP 0 JGF❑ LPG! 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: STEPHEN 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 THIS APPLICATION SERVES AS THE PERMIT ❑ FEE:$ PERMIT# PLAN REVIEW NOTES r_ � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I, -1. -- � - 112shi CITY [yarmouth _ MA DATE 09/1312021 PERMIT# JOBSITE ADDRESS!222 buck island road,3-5,west yarmouth I OWNER'S NAME gross,gaG ry OWNER ADDRESS TEI 508.280.5187 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL fl . RESIDENTIAL PRINT CLEARLY NEW:Ej RENOVATION:Li REPLACEMENT:Ili PLANS SUBMITTED: YES„, NO APPLIANCES-1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER MI Wit OM MI OS Ma 111111 MIMI IIIIIIII MI COOK STOVE DIRECT FIREPLACE FRYOLATOR E .-_ .. j FURNACE i . GENERATOR t ¢ i li i - GRILLESt LABORATORY COCKS ' , MAKEUP AIR UNIT �.- .- - POOL ROOM I SPACE HEATER saiiiiminsinisimiamosainiallillillintilliiitillil ROOF TOP UNIT TEST UUNVENTED - fini, na 1w111111, - can li- • 000001:-.0:1111111-1111.:00.1111:111111:11111101111111111111111111: _ i Mc)563506$40.00 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO [ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY L OTHER TYPE INDEMNITY r 1 BOND 11-17 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 Lj 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 and accuratg 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 rtine provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. C ' !/ y ..--- PLUMBER-GASFITTER NAME STEPHEN WINSLOW i LICENSE#1 12298 SIGNATURE MP LJ MGF Li JP L, I JGF Li LPG'vJ CORPORATION J#13281C PARTNERSHIP #! LLC F #'! COMPANY NAME: E.F.WINSLOW PLUMBING&HEATING 1ADDRESS 8 REARDON CIRCLE 1 CITY [SOUTH YARMOUTH i STATE MA ZIP 02664 ITEL[508-394-7778 FAX 508-394-8256 1 CELL NIA IEMAIL INSPECTIONS@EFWINSLOW.COM MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK .im C. 1f * CITY yarmouth MA DATE 09/13/2021 PERMIT# 7,1 i r� JOBSITE ADDRESS 222 buck island road,3-5,west yarmouth OWNER'S NAME ross, a P OWNER ADDRESS TEL 508.280.5187 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL D EDUCATIONAL ED RESIDENTIAL ED PRINT CLEARLY NEW:® RENOVATION:LI REPLACEMENT:0 PLANS SUBMITTED: YES Q NOLj FIXTURES Z FLOOR—• BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 11 - .. , CROSS CONNECTION DEVICE DEDICATEDDEDICATED SPECIAL WASTE SYSTEM . , I I , 1 I I I GREASE SYSTEM I DEDICATED •. I' I i DEDICATED WATER RECYCLE SYSTEM 1 DRINKING I FOUNTAIN i! I I I I I i FOOD DISPOSER 1 I FLOOR/AREA DRAIN I INTERCEPTOR(INTERIOR) , KITCHEN SINK , LAVATORY 1 ILd1 SHOWER STALL III II SERVICE/MOP SINK a�� i, ! I TOILET lin lin URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES NG111111111 OTHER 1 w\o 563506$40.00 I f INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES ID NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY 0 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 0 AGENT 0 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 li wit II ertine proyisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. r46, ,..,.. .......- PLUMBER'S NAME STEPHEN WINSLOW LICENSE# 12298 SIGNATURE MP 0 JP ID CORPORATION El# 3281 C PARTNERSHIP©# J LLC Q# 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