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HomeMy WebLinkAboutBLDP-22-006642 r �1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK l Py CITY YARMOUTH MA DATE 5/17/22 PERMIT# BLDP-22-006642 lI' JOBSITE ADDRESS 105 BAYVIEW ST OWNER'S NAME Joe Desousa P OWNER ADDRESS 105 BAYVIEW STWEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES • FLOORS—I BSM 1 2 3 , 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY 1 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER WATER PIPING OTHER 2 OTHER DESCRIPTION:bar sink,laundry sink INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND❑ 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. 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 best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME r checkoway LICENSE 16417 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME CHECKOWAY ENTERPRISES ADDRESS 11 scargo hill rd 11 SCARGO HILL RD CITY DENNIS STATE MA ZIP 02638 TEL 5083851911 FAX CELL EMAIL checkent@comcast.net MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK o ssi� �.tih CITY WEST YARMOUTH __ ,__ r______ MA DATE 5112122 PERMIT# �� t,4�- JOBSITE ADDRESS 105 BAYVIEW ST,W Y , OWNER'S NAME JOE DESOUSA POWNER ADDRESS 33 FISKMILL RD,MILFORD TEL 508-922-9345 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL 0 RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:D REPLACEMENT:U PLANS SUBMITTED: YES 0 NOD FIXTURES 7 FLOOR-F BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ,_._ 1 l CROSS CONNECTION DEVICE NINO INN INN INN NINO III.1i INN MUNI MINN INN NM NMI MI MN NEI DEDICATED SPECIAL WASTE SYSTEM ini MIN 1111111 NM MI'MN NMI INN i III NMI NMI NM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM I_ 1, I DEDICATED WATER RECYCLE SYSTEM 1 1 , ' DISHWASHER i- _ 1 DRINKING FOUNTAIN I __ ._ �I 1 } FLOOR/AREA DRAIN .1...1.10 NMI MIN NMI NNW Int NMI NE NM MI INNIF MI NMI INTERCEPTOR(INTERIOR) 1 1 _.._. _ .. l � l KITCHEN SINK LAVATORY 1 1 1 1 ROOF DRAIN a . ._.�. a. :'� SHOWER STALL �? 1 ,1 _1 1 TOISELET MOP SINK is um am mum no ' I I ! ninali URINALWASHING MACHINE CONNECTION 1 ii I � 1 11 ' � ( 1 1I it WATER HEATER ALL TYPES NalNMI=MIN UN MN MOM NM 1111.11111111 NMI IMMI NM 1.1111111.1111 I _- WATER PIPING � _,- I�. _- .....,OTHER xQ 'i--- Yi."' i it I V A Y+'-�� i 1�5 rii.Wll1 BAR SINK LAUNDRY SINK&PUMP„-, 1 � 1 _ . _ ___ i IL I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES D NO Li IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE OF INDEMNITY El BOND D 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 regarding this application are true and accurate t. •- best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with/ ;ent_Rrovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME R Peter Checkoway LICENSE# 13417 :, TURE MP( JPI CORPORATION D#�, u IPARTNERSHIPLi#L LCL # -_, :._ u _ COMPANY NAME Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY I Dennis !STATE I MA ZIP l 02638 TEL 508-385-1911 FAX 1508-385-6858 1 CELL 1508-735-9993 I EMAIL I checkentt�comcast.net _