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Home My WebLink AboutBLDP-16-003856 RECEIVED MASSACHUSETTS UNIFORM APPLICATION FORA PERMIT TO PERFORM °L Mpp)(IIOR i , . t(, J�1 L_ AM 8 CITY 161,ycwA 7f✓1/" MA DATE /2)30/ir 1 PERMIT# _*--20.7-49:-A)LYR3g O V t,. BuiL iNJut_rr.�� c-NT 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 - � I- �1 , _- m - 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 I_I__'I_ 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 ij, =am jus — —I I 1 ll 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 to G /"!! //J • Q^ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK n/ R W: —a -"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 teg tfr J// /2 WX7