HomeMy WebLinkAboutBldp-19-006709 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
r =0'_ CITY W YARMOUTH MA DATE 5-22-19 PERMIT# gaP'79Y1O CG7Q9
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JOBSITE ADDRESS 38 HUNTERS CIRCLE,W Y , OWNERS NAME JOHN BIANCHERIA
POWNER ADDRESS 8 VENTURA AV,WORCESTER 01604 TEL 508-826-3252 .FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL 0 RESIDENTIAL 0
PRINT
CLEARLY NEW:El RENOVATION:D REPLACEMENT:Li PLANS SUBMITTED: YES J NOD
FIXTURES 1 FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 I 13 14
BATHTUB F./ ®� �r j
.1 V Y r iar r I' t MA 1J V w r
CROSS CONNECTION DEVICE
DED DEDICATED SPECIAL WASTE SYSTEM 1 ! 1.. !
DEDICATED GAS/OIL/SAND SYSTEM I j I I .. I
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN I I II I I a
FOOD DISPOSER I 1 `` I I ,
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) ; i i 'i _ I111111111
SERVICE/MOP SINK
TOILET
URINAL !' .
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES v
WATER PIPING j _ I ,_ _ ..,L. e. - -. . ' _ '
OTHER _..
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D NO 0
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY U OTHER TYPE OF INDEMNITY Li BOND L
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 D
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 with all P nt provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R Peter Checkoway LICENSE# 13417 NATURE
MP 0 JP 0 CORPORATION 0# PARTNERSHIP 0# , LLC D#
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 checkent@comcast.net
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