HomeMy WebLinkAboutBLDP-23-000235 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
di CITY YARMOUTH MA DATE 7/14122 PERMIT# BLDP-23-000235
JOBSITE ADDRESS 3 OAK GLEN VILLAGE OWNER'S NAME YOUNG DAVID
P OWNER ADDRESS YOUNG SANDRA 18 WESTVIEW DR MANSFIELD,MA 02048 TEL •
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW:0 RENOVATION:❑ REPLACEMENT:El PLANS SUBMITTED: YES NO❑
FIXTURFS FIOORS—. 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 1
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❑ NO 0
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❑
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 83417 SIGNATURE
MP El JP 0 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 El
FEES$ PERMIT#
PLAN REVIEW NOTES
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
clit—Im
CITY YARMOUTHPORT -J MA DATE : 7111/22 _ _ J PERMIT # 23 - v z 3 S
JOBSITE ADDRESS 3 OAK GLEN, KINGSWAY OWNER'S NAME[DAVID YOUNG 1
P OWNER ADDRESS SAME TEL 'FAX r----
FAX .. 1
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY NEW: RENOVATION: l REPLACEMENT: PLANS SUBMITTED: YES NO
FIXTURES Z FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB _
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM '� I
.�
DEDICATED GAS/OIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM •
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN I
FOOD DISPOSER 1
FLOOR / AREA DRAIN
INTERCEPTOR (INTERIOR) i _ ____ _
----__AmKITCHEN SINK
LAVATORY _1r.
ROOF DRAINt--- -
...
SHOWER STALL
SERVICE / MOP SINK
TOILET
URINAL ,
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES ,J' _
WATER PIPING �—
OTHER -I .�I-
"-it''-:- - _ t
- .r ;r
_
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES i NO
i
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.
CHECK ONE ONLY: OWNER ' AGENT LA
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 . -st of my knowledge
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all ;�-nt •rovision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME R Peter Checkoway LICENSE # 13417 S/1000E
MP / JP CORPORATION # PARTNERSHIP # CLCD#1 1
COMPANY NAME l Checkoway Enterprises ADDRESS L11 Scargo Hill Rd i
. _ _
CITY . Dennis I STATE MA j ZIP E2638 i TEL [508-385-1911
FAX I 508-385-6858 1 CELL [508-735-9993 I EMAIL checkent@comcast.net I
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