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HomeMy WebLinkAboutBLDP-23-003188 it MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK >` CITY YARMOUTH MA DATE 12/8/22 PERMIT# BLDP-23-003188 E. I � JOBSITE ADDRESS 27 GRANDVIEW DR OWNERS NAME Peter Quinlan •n• OWNER ADDRESS 27 GRANDVIEW DR SOUTH YARMOUTH,MA 02664 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW: 0 RENOVATION:© REPLACEMENT:❑ PLANS SUBMITTED: YES El NO❑ FIXTURES z FLOORS 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 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE LW COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY❑ OTHER TYPE OF INDEMNITY❑ BOND❑ OWNERS 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 Ir checkoway I LICENS413417 I SIGNATURE MP © JP ❑ CORPORATION ❑# ( I PARTNERSHIP ❑# ( I LLC ❑# I COMPANY NAME I ADDRESS 111 scargo hill rd CITY [(tennis I STATE IMA I ZIP 102638 ( TEL I I FAX 1 I CELL I EMAIL I + MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK �"i® PERMIT# 2 '3 -mil►- CITY( fj, \wko U�-1 I MA DATE=1Zl 0_ -_. I g-� �'n�,/O\/�w •D r, S I OWNER'S NAME e -r & 0 v)Nle/✓ I JOBSITE ADDRESS Y POWNER ADDRESS I66 Poop, Sj g,r,,06J0N- I TELL IFAXI 1 TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL IT RESIDENTIAL PRINT CLEARLY NEW:n RENOVATION:X REPLACEMENT: PLANS SUBMITTED: YES r NO) I FIXTURES T FLOOR-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 I 14 BATHTUB L I' I CROSS CONNECTION DEVICE I DEDICATED SPECIAL WASTE SYSTEM I I DEDICATED GAS/OIL/SAND SYSTEM I I DEDICATED GREASE SYSTEM I i i j u DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM 1 DISHWASHER ! _ L 1 11 1 1' DRINKING FOUNTAIN I I s FOOD DISPOSER FLOOR/AREA DRAIN ;INTERCEPTOR(INTERIOR) P11111/11101! j 1 I I �KITCHEN SINK j ILAVATORYROOF DRAIN 1 1' I' j In SHOWER STALL LSERVICE/MOP SINK ! 1 TII 1 TOILET URINAL WASHING MACHINE CONNECTION Il. WATER HEATER ALL TYPES - I, Ij I I � I 111111111111111 1I I WATER PIPING p 1 it I j j i i OTHERL u 11 j I I 1 I i 1 1 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES I i I NO (T IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C OTHER TYPE OF INDEMNITY BOND n 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 1 I AGENT SIGNATURE OF OWNER OR AGENT accurate I hereby certify that all of the details and information I have submitted o issued regarding s nithis applicationill application compliance true and with all to the besaulsion of knowledge he and that all plumbing work and installations performed under permit Massachusetts State Plumbing Code and Chapter 142 of the General Laws. —, PLUMBER'S NAME R Peter Checkoway w _ LICENSE# 13417 SIGNA E PARTNERSS_]#� I L Cl# MP�u JP D CORPORATION i#I—�� HIP � E ����_ ADDRESS�11 Scargo Hill Road _�„___.__tl_____..�.�.�- I COMPANY NAME, Checkoway Enterprises ---- -, TEL, 508 3851911 1 i STATE MAi ZIP 02638 CITY Dennis _ __ _�_, _,____ _ FAX 508-385-6858 CELL L5_(2. 9..E EMAIL 1 checkent@comcast.net_ -- `