HomeMy WebLinkAboutBLDP-23-8527 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
- CITY[YARMOUTHPORT MA DATE 5/20/23 J PERMIT#,LLD -L�- -7
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JOBSITE ADDRESS L42 LIVERPOOL DR,YPT OWNER'S NAME DAVID SCARCHILLI
POWNER ADDRESS ' SAME TEL 508-369-6101 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL—, EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION: v REPLACEMENT: PLANS SUBMITTED: YES 7 NO
FIXTURES 1 FLOOR-i BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB --'
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM i' ii.
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER 3
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR/AREA DRAIN
INTERCEPTOR(INTERIOR) I y II_
KITCHEN SINK
LAVATORY 1
ROOF DRAIN
SHOWER STALL 1
SERVICE/MOP SINK 1i-
TOILET
URINAL ! _-_--
WASHING
MACHINE CONNECTION
WATER HEATER ALL TYPES _
WATER PIPING _
OTHER ■
I
INSURANCE COVERAGE:
I have a current liabili�insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES 0 NO C
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INS JRANCE POLICY v 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: OWNE 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 th est of my knowledge
and that all plumbing work and installations performed under the permit ssued for this application will be in compliance with e ent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R Peter Checkoway J LICENSE# 03417 J RE
MP JP CORPORATION # PARTNERSHIP# ,LLCD#L
COMPANY NAME Checkoway Enterprises 1 ADDRESS 11 Scargo Hill Rd
CITY Dennis STATE MA ZIP .02638 TR g885 i V C D-- i
FAX 508-385-6858 CELL 508-735-9993 ]EMAIL checkent@comcast.net
I MAY 22 2023
BUILDING DEPARTMENT
By:_ _
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