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HomeMy WebLinkAboutBldp-19-007069 iR „,1_9 y/l_or; (1(,a ... -C---,-- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK r ' '�— MA DATE 6-10-19 PERMIT# ' -60 #(O� „11=; CITY S YARMOUTH (O JOBSITE ADDRESS 4 ASH LANE,S Y OWNER'S NAME ANDREA MCDONALD . _ POWNER ADDRESS 282 BEACHVIEW AV,PACIFICA,CA 94044 TEL 650-438-0933 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL Li RESIDENTIAL Li PRINT CLEARLY NEW:0 RENOVATION:Q REPLACEMENT:Li PLANS SUBMITTED: YES 0 NO© FIXTURES 7 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 CROSS CONNECTION DEVICE ,� _ , BATHTUB DEDICATED SPECIAL WASTE SYSTEM I _ j a I _ 1 1 _ I_ m ; DEDICATED GAS/OIUSAND SYSTEM 1 , ji ,. 'I- - I -,_'! ;y.,- 1 »,._ _ . I 1_ . ._ , _-,_. ' DEDICATED GREASE SYSTEM ,-.„MIN 1*. DEDICATED GRAY WATER SYSTEM 1 I ,_ i1IiII DEDICATED WATER RECYCLE SYSTEM 1 III , 11111 1 1 DISHWASHER i DRINKING FOUNTAIN RUrI '�`! WI1..NR.. I "lig FLOOR/AREA DRAIN r INTERCEPTOR(INTERIOR) ! i' III KITCHEN SINK LAVATORY ili_i ROOF DRAIN iiii'NM MIR MN PIM 'WII NM MB NM EMI MO ME,NM MB SHOWER STALL 111111111111111111111111111111111111 illIllillIlFllIlliillIllIllIllIllIllFillirlIllitlIllIlrIIIII SERVICE/MOP SINK IIIIIIFBIIFIIIIIIFIIIIIIIF111111lFillIllillIll1111111.IIIFININIIIIIIIIIIIIIIIIIIIIIIIIIFIIIIIIr TOILET flflflfl i I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES L] 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 Q BOND U 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 Ei 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 • my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertin- • ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME R Peter Checkoway. LICENSE# 13417 lel RE MPD JP CORPORATION # PARTNERSHIP Li# # COMPANY NAME Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Dennis STATE MA ZIP 02638 TEL 508-385-1911 FAX 508-385-6858 : CELL 508-735-9993 EMAIL checkenti comcastnet V` /f 1 , i � � � � � � \ � \ � J ,, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Li=.7 CITY 4S YARMOUTH �� MA DATE[6-10-19 :,__ PERMIT# � 1c67 .. JOBSITE ADDRESS[-4 ASH LANE,S Y �.__ OWNER'S NAME ANDREA MCDONALD GOWNER ADDRESS 282 BEACHVIEW AV PACIFICA,CA 94044 TEIi 650-438-0933 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 1 EDUCATIONAL LI RESIDENTIAL j�,; PRINT CLEARLY NEW:L] RENOVATION:. REPLACEMENT:. , PLANS SUBMITTED: YES LJ NOLJ APPLIANCES Z FLOORS—* BSM 1 2 _3 4 5 6 7 8 9 10 11 12 13 14 BOILER _. 'Ng . , - - BOOSTER CONVERSION BURNER 1 ! COOK STOVE � -._ DIRECT VENT HEATER I ._. _ _ _ ro - m DRYER FIREPLACE FRYOLATOR 1 ,a __ _ _ ; i FURNACE -- GENERATOR n �' �: _ �' __ GRILLE SNP MIL IIIN MI ___ _I -. -I; _ INFRARED HEATER ii 1 ( _i -In LABORATORY COCKS nu MAKEUP AIR UNIT OVEN [ . a I POOL HEATER _ 4 _ ROOM I SPACE HEATER 1 I ! ji, ROOF TOP UNIT ..H �` �. p s o , TESTi UNIT HEATER ! III I_ r UNVENTED ROOM HEATERWATER HEATER , —_ 1 1 i __. ..., -� r._ . . I it alit um , l I . _ _ _. " n INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Li I NO LI I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [il OTHER TYPE INDEMNITY i 1 BOND I I 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 n 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 accurate to st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wi al Pe nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME FR Peter Checkoway LICENSE# 13417 SIG RE MP MGF Li JP JGF[1 LPG!0 CORPORATION #L. 1 PARTNERSHIP LJ#I KK] LLC # I COMPANY NAME:1 Checkoway Enterprises J ADDRESS 11 Scamp Hill Rd CITY Dennis STATE I MA I ZIP 02638 TEL'508 385-1911 r_ FAXF508-385-6858 CELL] 08735-9993 EMAIL(.checkentaicomcastnet zi` /I s