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HomeMy WebLinkAboutBLDP-19-001058 al, MASSACHUSETTS UNIFORM APPUCATION FOR A PERMIT TO PERFORM PLUMBING WORK Mita. CRY W YARMOUTH MA DATE 8/21/18 PERMIT#ff4)fri9'GO/n 07s JOBSITE ADDRESS 56 CHANDLER GREY RD,W Y OWNERS NAME TOM SUWVAN P OWNER ADDRESS SAME TEL 401-465-5378 FAX • TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:9 PLANS SUBMITTED: YES 0 NO0 FIXTURES 1 FLOOR-• mu 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB - - - - __ -- -- -- --.. -- --- - _ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM - F -- _ ---- '-- - - --- - -- -- --- DEDICATED GAS/Olt/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I -- — - - DEDICATED WATER RECYCLE SYSTEM DISHWASHER - - DRINKING FOUNTAIN FOOD DISPOSER , FLOOR/AREA DRAIN " , INTERCEPTOR(INTERIOR) - _-- .-_ --- __-- ---- -- KITCHEN SINK _ LAVATORY . - - - - ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET , e._ ' R_ -- URINAL ----- -- --- --- - ---- --- RINALGMACHINECONNECTION - —_ _ -- , - - --- -- ---- --- __ -- WASHINWATER HEATER ALL TYPES 1 WAT--PING - -- - --- - - -. OTHER I . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES 0 NO 0 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 kitormation I have submitted or entered regarding this application are true and accurate to the t of my knowledge and that as plumbing work and installations performed under the paint issued for this application will be in compliance with all • nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBERS NAME R Peter Cbeckoway LICENSE# 13417 SIG MP 0 JP 0 CORPORATION O# ?ARTNERSHIP 0# LLC D# COMPANY NAME Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Demis STATE[ MA ZIP 02638 TEL 508-385-1911 FAX 508-385-6858 CELL 508-735-9993 1 EMAIL chedcent4comrastmet _ -47°Vg _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK [As:;,- �+r Alit CITY W YARMOUTH MA DATE 821118 PERMIT# Ad/17-127/C✓D JOBSITE ADDRESS 56 CHANDLER GREY RD,W Y OWNERS NAME TOM SULLIVAN G OWNER ADDRESS SAME J TEII 401-4655378 FAX i TYPE OR OCCUPANCY TYPE COMMERCIAL0 EDUCATIONAL 0 RESIDENTIAL0 PRINT CLEARLY NEW:© RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES© NO 0 APPLIANCES 1 FLOORS-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER — - BOOSItH -- - - -_ --- -- --- - - --- -- - -- CONVERSION BURNER __ __ --- -- __ _ - -- - COOK STOVE DIRECT VENT HEATER < DRYER - --. - - - FIREPLACE - - - --- - -- - - - - -- -. FRYOLATOR --- - -- -_ - --- '-- - - -- --- _-- -- FURNACE GENERATOR _ . . . GRILLE - INFRARED HEATER - --- -- - --- _--- LABORATORY COCKS i MAKEUP AIR UNIT OVEN -------- --- -- ----- -- ---- POOL HEATER -POOLHEATER 1 - - - - - , - ROOM I SPACE HEATER - - ROOF TOP UNIT -- -- TEST - - - - UNIT HEATER --- -- -- 1 -- -- -- -- --- --- - UNVENTED ROOM HEATER I - - - WATER HEATER I-1- - - - - - - -- - OTHER I - --- --- --- - -- - - --- -- -- -- • INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES a NO p I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHERTYPEINDEMNIFY © 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 © AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regardng this application are the and accurate to theyA-- of my knowledge and that a plumbing work and installations performed under the permit issued for this application will be in compliance wit,all P- '• nt provision of the Massachusetts State PWmbirg Code and Chapter 142 of the General Laws. PLUMBER-GASH l I tit NAME R Peter Ched away LICENSE# 13417 SI TORE MP 0 MGF© JP© JGF 0 LPGI 0 CORPORATION[# PARTNERSHIP D#I LW[# COMPANY NAME Chedwway Enterprises ADDRESS 11 Scargo Hill Rd - CITY 'Dennis - I STATE' MA ZIP 02638 tEL 508385-1911 FAX 508385.6858 CELL 508-735-9993 l'EMAIL ent@comcastnet kt FLT ✓ 649