BLDP-16-003856 RECEIVED
MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM °L Mpp)(IIOR i
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AM 8 CITY 161,ycwA 7f✓1/" MA DATE /2)30/ir 1 PERMIT# _*--20.7-49:-A)LYR3g O
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JOBSITE ADDRESSj ant. C,waf*t (--p OWNER'S NAME GiNe `" 71Q --- -
POWNER ADDRESS J'9'✓✓LG_ TEL 6Jq'-7,h 0 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 2g
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT f PLANS SUBMITTED: YES❑ NOD
FIXTURES 1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB - - T- 1
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CROSS CONNECTION DEVICE iii ,
DEDICATED SPECIAL WASTE SYSTEM IMsJ—I•,a!s(aI '.�MI's 5 IM
DEDICATED GAS/OIUSAND SYSTEM
DEDICATED GREASE SYSTEM �1e�a ants
DEDICATED GRAY WATER SYSTEM MIMEL 1=1 MI a M a Ia la M—,a
DEDICATED WATER RECYCLE SYSTEM NMSMEM.: 1al,_1_a a NM
DISHWASHER lla, 1111111111111-1M==m
FLOOR II AREA DRAIN I�IMMI=��=�l�i 51.1111
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DRINKING FOUNTAIN ���_�
FOOD DSPOSER 15
INTERCEPTOR INTERIOR IO(a(s(a!a MEN 1—Isla I_Mir r Is
KITCHEN SINK
LAVATORY 1.111.1111.111111111.111111411
ROOF DRAIN It�;�i�_�I—�i�il�l-1fl
SHOWER STALL NUMMI 1=1 a(atM1a a:sIa a a
SERVICE I MOP SINK i—iai—r a m 5I , a I,=la is a
TOILET ' IIMM11.111. —7-7,I111111I
URINAL iiiiienialmaI=MN(a a a—IaImam
WATER GMHEAACRNE ONNE I V_ .1 'Ma
WASHING MACHINE CONNECTION I����� I��ll J
WATER PIPING ---_ _ 1
OTHER r t 1 __: __ II I
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO ❑
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY ❑ BOND❑
OWNER'S INSURANCE WAIVER:lam 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 accurate to the be.{: my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Perti � '•.vision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R Peter Checkoway LICENSE# 13417 SIG tie•E
Or
MPD JP CORPORATION❑# PARTNERSHIP❑#— LLCD#
COMPANY NAME Checkoway Enterprises ADDRESS 11 Scargo Hill Road
CITY Dennis STATE 1 MA I ZIP 02638 TEL 508-385-1911 '
FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@comcast.net
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• Q^ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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-"hIt_ • CITY s. y/9/1/VjQ�j' MA DATE/L/&i/),f /PERMIT#O/�(,1-// 'V/az, -
JOBSITEAD/DRESS 30 Cori• E}waffice 20 OWNERS NAME 6/11917 9 j ii
GOWNER ADDRESS(gine TEtj6//-77 7 e3 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIALEt
PRINT �{
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:�y PLANS SUBMITTED: YES NOD
.
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER ---- I Si —1-1-_--„C
BOOSTER , ,
CONVERSION BURNER -2----1,11111,1 � , �ij: Ll, MILL 11 1
COOK STOVE I, II I__ _ I�,7 lI _�
DIRECT VENT HEATER i 1 ,- — _--LT_
DRYER
FIREPLACE i. r 1 _ _ -_z_ I____ ---
FURNACE
j ,
GENERATOR � Is I � 1 � _..-lr-- �� -�- 1i -- —1 -17a7,
GRILLE i_ �
1
INFRARED HEATER 11 11 r 1,7 T 1 1, r
LABORATORY COCKS , -
-
MAKEUP AIR UNIT i li � r 1r 1 _ I�
OVEN o —11 �I
POOL HEATER ' I 1- -'
ROOM 1 SPACE HEATER ��I 10 1 i s-1
' I i
ROOF TOP UNIT r
I I
TEST
MT II
f
; LUNIT HEATER I I 1 i i i
UNVENTED ROOM HEATER I _ II-
WATER
WATER HEATER Y
OTHER 1 -1 1 11 1— rr ---- -----1
1f 'f 1f I 1r 1 nr— -1 1, t
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ❑ 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 and accurate to the b-: if my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertt%r ,
. ovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE# 13417 SI, " RE
MC MGF❑ JP JGF❑ LPGI❑ CORPORATION❑# PARTNERSHIP❑# LLC 0#
COMPANY NAME: Checkoway Enterprises ADDRESS 11 Scargo Hill Road
CITY Dennis STATE MA ZIP 02638 'TEL 508-385-1911
FAX 508-385-6858 CELL,508-735-9993 EMAILI checkent@comcast.net
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