HomeMy WebLinkAboutBLDP-22-006108 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
yr, CITY [YARMOUTH MA DATE 4/22/22 PERMIT# BLDP-22-006108
JOBSITE ADDRESS 26 GROVE ST OWNER'S NAME Rebecca Coleman
P OWNER ADDRESS MA 02673 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW:El RENOVATIONS.El REPLACEMENT:El PLANS SUBMITTED: YES El NO El
FIXTURES • 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 El NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El BOND El
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 wit be in compliance with all Pertinent provision
of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R Peter Checkoway LICENSI71116417 I SIGNATURE
MP El JP El CORPORATION ❑# PARTNERSHIP ❑# Lc ❑#
COMPANY NAME IR PETER CHECKOWAY ADDRESS 111 SCARGO HILL RD
CITY !DENNIS I STATE IMA I ZIP 1026382306 I TEL I
FAX I I CELL I I EMAIL Icheckent@comcasl.net
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY
FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE ❑ ❑
FEES$ PERMIT#
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
t(
; fir J CITY WEST YARMOUTH MA DATE [4119122 PERMIT # L Z -US
JOBSITE ADDRESS 26 GROVE ST, WY 1 OWNER'S NAMELREBECCA COLEMAN I
POWNER ADDRESSF2TA-E-RFIELD DR, E SANDWICH TEL[617-610-6616 IFAX1111111111
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION: i REPLACEMENT: PLANS SUBMITTED: YES ' N0r]
FIXTURES -1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB ---
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM —�' � y
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM I
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM IL ti
DISHWASHER 1 I ____ _ L
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR l AREA DRAIN '
INTERCEPTOR (INTERIOR) -_ l
KITCHEN SINK L 1 -S _.-_._
LAVATORY ---1! fI- �. __ 1 __-
ROOF DRAIN
Li t
SHOWER STALL ____.� a �
_#.i..o
SERVICE / MOP SINK �.____ y� I. 1
TOILET L..
URINAL
l ' -- .
WASHING MACHINE CONNECTION i IF1 r—
;: . -ui1
WATER HEATER ALL TYPES
WATER PIPING r - -.
OTHER r- 1
- ----_
4LP AIR- NMI, -011NIMIIMIN.
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INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES i NO
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY [i 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.
CHECK ONE ONLY: OWNER [ AGENT
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 t • •- t of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all 9e • - • provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. I
/.Z
PLUMBER'S NAME R Peter Checkoway LICENSE # 13417 SI TU
MP i JP CORPORATION#L 3PARTNERSHIPEJ#' � _JLLC #[
COMPANY NAME Checkoway Enterprises ADDRESS 11 Scare Hill Rd
CITY Dennis STATE MAJ ZIP 02638 TEL L5o8-385-1911
FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@comcast.net