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HomeMy WebLinkAboutBLDP-22-007184 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ��0T vp . CITY YARMOUTH MA DATE 6/13/22 PERMIT# BLDP-22-007184 JOBSITE ADDRESS 21 MAYFLOWER RD OWNERS NAME jason stabach P OWNER ADDRESS MA 02067 TEL[ TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:m RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO El FIXTURFS • 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 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 will be in compliance with all Pertinent provision of the Massachusetts Slate Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME r checkoway LICENSE 18417 SIGNATURE MP El JP El 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 ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ El FEES; PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 4--7-1:7-=-7--,. .,t ,________ 2_ 2 - ---to-7 CITY WEST YARMOUTH MA DATE 6/6/22 ' PERMIT # ill- JOBSITE ADDRESS 21 MAYFLOWER RD, W Y 1 OWNER'S NAME[JASON STABACH POWNER ADDRESS �335 GRISWOLD RD, WEATHERSFILED, CT 06109 TEL 860-798-1573 FAX 1 _ TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: i RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES -1 FLOOR—i BSM 1 2 3 4 5 6 I 7 8 9 10 11 12 13 14 BATHTUB ( -1F CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM :r_ DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM L DEDICATED GRAY WATER SYSTEM [ DEDICATED WATER RECYCLE SYSTEM ! DISHWASHER 1 i DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN _ INTERCEPTOR (INTERIOR) it J[ _ _ KITCHEN SINK IF LAVATORY , i I ROOF DRAIN � +� SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION I WATER HEATER ALL TYPES , i =tot WATER PIPING OTHER1 'min- ' a ..491•11•11.116- INSURANCE COVERAGE: _ I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES TT] NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Li OTHER TYPE OF INDEMNITY 0 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 the est f my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pe ' t ovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Z-I PLUMBER'S NAME P ter Checkoway LICENSE # 13417 SIG RE MP i JP CORPORATION # .PARTNERSHIP # COMPANY NAME L Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Dennis STATE L MA ZIP 102638 1 TEL 508-385-1911 FAX 508-385-6858 CELL [508-735-9993 I EMAIL icheckent@comcast.net