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HomeMy WebLinkAboutBLDP-23-001868 #594 F t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ,, t./ CITY YARMOUTH MA DATE 10/7/22 PERMIT# BLDP-23-001868 r JOBSITE ADDRESS 590&604 ROUTE 28 OWNER'S NAME KOPLOW STEVEN TR D OWNER ADDRESS RK REALTY TRUST PO BOX 489 BROOKLINE,MA 02446 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL ❑ PRINT CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES NO❑ FIXTURFS 1 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 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 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 0 NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 ADDRESS 11 scargo hill rd CITY dennis STATE MA ZIP 102638 TEL FAX CELL EMAIL I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK Ai ae1— l i CITY W YARMOUTH _.a. _ __ . MA DATE 10/4/22_v PERMIT# Z — l 651 •k_ c. JOBSITE ADDRESS 594 ROUTE 28,(BASIL THAI CUISINE OWNER'S NAME PRACHA SOMKITCHAROEN POWNER ADDRESS I TEL 508-280-0893 ANN 'FAX TYPE OR OCCUPANCY TYPE COMMERCIAL M EDUCATIONAL LI RESIDENTIAL 0 PRINT CLEARLY NEW:0 RENOVATION:0 REPLACEMENT:0 PLANS SUBMITTED: YES 0 NO FIXTURES-1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I _JI . .. r Y CROSS CONNECTION DEVICE l w�. DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I j DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM , DEDICATED WATER RECYCLE SYSTEM , DISHWASHER li •. WW1 Milt inn 1111P IIIN KITCHEN SINK LAVATORY ROOF DRAIN ..,._ , 7 ...„ e , , , I SHOWER STALL ._ SERVICE/MOP SINK m _ I TOILET w URINAL i WASHING MACHINE CONNECTION F WATER HEATER ALL TYPES 1 ( WATER PIPING 1 OTHER Hee, I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El 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 Lj 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 information I have submitted or entered regarding this application are true and accurate t. - •est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all -- ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 0 r PLUMBER'S NAME R Peter Checkoway LICENSE# 13417 ATURE MPO JPO CORPORATIONO# 1PARTNERSHIPLj# LLCL_I# 3 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 a@comcast.net