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HomeMy WebLinkAboutBLDP-21-004495 s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Ek. .1., CITY YARMOUTH MA DATE 2/8/21 PERMIT# BLDP-21-004495 I I JOBSITE ADDRESS 15 BAXTER AVE OWNER'S NAME JOSEPH PATRICIA ANN TRS r - P OWNER ADDRESS JOSEPH PIERRE TRS 181 LEBANON MOUNTAIN RD PITTSFIELD,MA 01201 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 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/OIUSAND 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 El 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 0 CORPORATION ❑# PARTNERSHIP 0# 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 r g MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK i�%,; CITY / / -Uc, g MA DATE /�/5��z/ PERMIT# _•// JOBSITE ADDRESS j 6',q x ? ' 'w 1 OWNER'S NAME /t 9-JZx 'xi Ireiree)// i POWNER ADDRESS( sl-- l3gnv7), I TEL1 `�i � /e FAX ! TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL tJ RESIDENTIAL ID PRINT CLEARLY NEW:El RENOVATION:DI REPLACEMENT:Iiir PLANS SUBMITTED: YES ID NOI FIXTURES Z FLOOR-+ BSM J 1 2 3 4 1_._, 5 6 I=7 8 9 10 11 12 13 14 BATHTUB f II 1 CROSS CONNECTION DEVICE ter —'i DEDICATED SPECIAL WASTE SYSTEM � s ,•LL F w r DEDICATED GAS/OIL/SAND SYSTEM 1' _, a '' " "' DEDICATED GREASE SYSTEM Mt _� _ DEDICATED GRAY WATER SYSTEM _ DEDICATED WATER RECYCLE SYSTEM i ;limUng DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER ` - FLOOR 1 AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY ROOF DRAIN MOW , 1111111 PIMP SHOWER STALL SERVICE/MOP SINK ,�u __ TOILETI1' 7 i- URINAL i .i ' IN Animmeaminiummem, ._:_-m WASHING MACHINE CONNECTION um, WATER HEATER ALL TYPES /f 1 WATER PIPING i Is, 14 OTHER01.1101. , - augmhim . 1111111111111.01111111MEWNIMMIIMINIMII 1101011111111010IONIMMIIIIIMPliiiiiiiiimming INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Eil 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 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 subm1ted or entered regarding this application are true=i A - 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 wit II ertine proyisly,of the ,. Massachusetts State Plumbing Code and Chapter 142 of the General Laws. R[. ,, !/,ti„... PLUMBER'S NAME STEPHEN WINSLOW LICENSE#112298 I SIGNATURE MPO JPD CORPORATION D#M3281C 'PARTNERSHIP DM ILLC®#I COMPANY NAME E.F.WINSLOW PLUMBING&HEATING ADDRESS l8 REARDON CIRCLE P. I. rN,f1 1 fir = . CITY(SOUTH YARMOUTH 'STATE MA ZIP 102664 I. TEL 508-394-777$ i fr B 0 42011 6 FAX 1508-394-8256 I CELL I NIA I EMAIL I INSPECTIONS@EFWINSLOW.COM 1 t pu,[Ail NA �,C.fsRl rJi`_i! a • PI The Commonwealth of Massachusetts • Department of Industrial Accidents Ia=p Office of Investigations * refi tl` t Lafayette City Center •= 2 Avenue de Lafayette,Boston,MA 02111-1750 �. e, 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#:508-3944778 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. 0 Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. 8. 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 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. 1 **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 ce ee the ins and penalties of perjury that the information provided above is true and correct. • Sig nature:�� 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): 1.0Board of Health 2.0 Building Department 30 City/Town Clerk 4.0Licensing Board • 5.0 Selectmen's Office 6.['Other Contact Person: Phone#: • a. E. S W Quote Number: 20033 Work Order Id: 517095. Date: 10/01/2020 Submitted By: DAVID SMITH Page: 1 of 3 Proposal To: Service Location: PATRICIA JOSEPH JOSEPH, PATRICIA 15 BAXTER AVENUE WEST 181 LEBANON MOUNTAIN ROAD 15 BAXTER AVENUE PITTSFIELD MA 01201 WEST YARMOUTH MA 02673 4132813101 THANK YOU VERY MUCH FOR GIVING US THE OPPORTUNITY TO GIVE YOU AN ESTIMATE. WE LOOK FORWARD TO WORKING WITH YOU AND TO BE ABLE TO SHOW YOU OUR PROFESSIONAL WORKMANSHIP. PLEASE DO NOT HESITATE TO LET ME KNOW IF YOU HAVE ANY QUESTIONS OR CONCERNS. PHONE AT 508-542-1148 OR EMAIL AT DAVIDSMITH@EFWINSLOW.COM Option# 1 WE WILL PROVIDE THE FOLLOWING SCOPE OF WORK: 20033 *WE WILL REMOVE THE EXISTING GAS BOILER &WATER HEATER IN THE MECH ROOM OFF THE BEDROOM FROM THE JOB SITE. TECHNICIANS TO PROTECT THE FINISHED FLOOR WITH TARPS. *TENANT TO REMOVE CLOTHES IN L/R CLOSET FOR ACCESS. *WE WILL SUPPLY& INSTALL A HIGH EFFICIENCY WALL MOUNT HTP 150,000 BTU MAX RATED ELITE COMBI BOILER, ELU-150WCN, OPERATING AT AN EFFICIENCY RATING OF 95%. ***THIS UNIT IS ELIGIBLE FOR A REBATE FROM GAS NETWORKS IN THE AMOUNT OF $2,400.00 (SUBJECT TO CHANGE, 2020 CHANGES MAY APPLY). *WARRANTY INCLUDES FIVE YEARS ON PARTS AND TWO ON LABOR & FIFTEEN (15)YEAR WARRANTY ON HEAT EXCHANGER. *** BOILER WILL BE MOUNTED ON THE BACK WALL OF ROOM AND WE WILL VENT THE BOILER USING SOLID PVC PIPING WITH CONTRASTING PRIMER TO EXTERIOR OF THE BUILDING. THIS WILL REQUIRE RUNNING THROUGH THE CLOSET BEHIND, IN LIVING ROOM TO GET BEYOND THE DECK. *WE WILL REPLACE THE SURROUNDING BOILER TRIM CONSISTING OF: EXPANSION TANK, FAST FEED VALVE, BACKFLOW PREVENTER, CIRCULATOR, TWO (2)ZONE VALVES AND AIR VENT. *PROPOSAL INCLUDES ALL NECESSARY GAS PIPING NEEDED. *PROPOSAL INCLUDES ALL NECESSARY ELECTRICAL WIRING. EXISTING THERMOSTATS TO REMAIN. *BOILER HAS A BUILT IN HIGH PRIORITY CONTROL AND MODULATING GAS VALVE FOR A MORE EFFICIENT WAY TO MAKE HEAT AND HOT WATER. BOILER PRODUCES APPROXIMATELY 3.8 GALLONS OF HOT WATER PER MINUTE AT A 77 DEGREE TEMPERATURE RISE. IDEAL FOR TWO BATH HOMES. THE ELITE ULTRA BOILER ALSO HAS A 10-1 TURN DOWN RATIO FOR MAXIMUM ENERGY SAVINGS. *INCLUDES GAS, ELECTRICAL AND PLUMBING PERMITS. *ESTIMATING DEPATRMENT WILL ASSIST HOME OWNER WITH REBATE APPLICATION, AS NEEDED. *NOTE: CEILINGS IN MECH ROOM AND CLOSET MAY NEED TO BE OPENED FOR REPIPINGAND VENT, CARPENTRY REPAIRS ARE NOT INCLUDED IN THIS PROPOSAL. THESE CAN BE DONE AT A CONTINUING TIME AND MATERIAL EXPENSE UPON REQUEST. Initial: Total '? $ fir , O ! s r744.v".t r3 — �-.'Z/—O o2.5t// E3 U r�,s G .Z/ �, y r /74 ,a, fig/ — j.s-yy, 8 Reardon Circle, South Yarmouth, MA 02664 • Phone 508-394-7778 • Fax 508-394-8256 www.efwinslow.com