HomeMy WebLinkAboutBLDP-23-000033 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
ei CITY 'YARMOUTH I MA DATE 17/5/22 I PERMIT# BLDP-23-000033
JOBSITE ADDRESS 12 BOULDER CIR
I OWNER'S NAME ICROWLEY KEVIN BARRY
OWNER ADDRESS ICROWLEY MARY ANN 7 FAIRWAY LN PEMBROKE,MA 02359 TEL
TYPE OR
OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑
FIXTURFS = FLOORS—+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1
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 1
ROOF DRAIN
SHOWER STALL
SERVICE/MOP SINK
TOILET 1 1
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 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.
PLUMBERS NAME Ircheckoway J LICENS4113417 I
SIGNATURE
MP 0 JP ❑ CORPORATION ❑# I I PARTNERSHIP ❑# I I
LLC ❑#
I I
COMPANY NAME ICHECKOWAY ENTERPRISES ADDRESS 11 scargo hill rd 11 SCARGO HILL RD
CITY 'DENNIS I STATE MA
ZIP 02638 TEL 5083851911
FAX CELL
EMAIL checkent@comcast.net
i
A \ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
• -Z
Lj f CITY l YARMOUTHPORT MA DATE 6/28122 PERMIT# Z 3— oo 3 3
JOBSITE ADDRESS L2 BOULDER CIRCLE,YPT I OWNER'S NAME KEVIN CROWLEY
1
POWNER ADDRESS[SAME . TELI 781-603-6057 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL 0 RESIDENTIAL El
PRINT
CLEARLY NEW:Q RENOVATION:0 REPLACEMENT:Q PLANS SUBMITTED: YES 0 NOD
FIXTURES-1 FLOOR-4 4.BSM 1 2 3 4 5 J 6 i 7 8 t 9 10 11 12 13i 14
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM I
, r 'ram z
4,_
DEDICATED GAS/OIL/SAND SYSTEM ' i ,
DEDICATED GREASE SYSTEM __L, O"
�_.
DEDICATED GRAY WATER SYSTEM �_ 1 t --I _i II
!
DEDICATED WATER RECYCLE SYSTEM I, ,
DISHWASHER '
_1—_ _I .
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN .i...,
'
Ai
INTERCEPTOR(INTERIOR) ▪ ,i ��
KITCHEN SINK _ � 1 v
LAVATORY ▪ ? 1 I —i--. _ _ _
ROOF DRAIN v� �� s'��
SHOWER STALL �- .
SERVICE 1 MOP SINK a i 4,, �. 1 -
SER I .1_. -.. .
URINAL ; ? p ? _ .
- 1 .
_,..i _ 1
Is A. I
WATER HEATER ALL TYPES —Y a I,
RING MACHINE CONNECTION v
WATER PIPING
OTHER tI
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent q t which meets there requirements of MG
L GL Ch.142. YES 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 El 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.
SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to th= .-- 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-rt'•- •rovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME I R,Peter Checkoway ,.1 LICENSE#113417
`- 1 SI, RE_-
MP[ JPD CORPORATION 0#1 PARTNERSHIP®#f LLCD#+
COMPANY NAME I Checkoway Enterprises ADDRESS 11 Scar o Hill Rd
CITY!Dennis � �� -�-
STATE MA ZIP 02638 TEL 1508-385-1911m u
FAX!508-385-6858 I CELL 1508-735-9993 EMAIL checkent@corncast.net