HomeMy WebLinkAboutBLDP&G-22-004853 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
y CITY IYARMOUTH MA DATE 3/3122 PERMIT# BLDP-22-004853
v� II `� JOBSITE ADDRESS 35 PHEASANT COVE CIR OWNERS NAME MCDONOUGH PAUL V
P OWNER ADDRESS MCDONOUGH KATHERINE M 15 MARLBORO ST NORWOOD,MA 02062 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El
PRINT
CLEARLY NEW:El RENOVATION:El REPLACEMENT:❑ PLANS SUBMITTED: YES NO El
FIXTURES • FLOORS—, 8SM 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
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 1
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 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
I hereby certify that all of the details and information I have submitted or entered regarding this application are We 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 Ir peter checkoway I LICENSEI16417 I SIGNATURE
MP El JP El CORPORATION ❑# PARTNERSHIP ❑# I I LLC ❑#
COMPANY NAME I ADDRESS 111 scargo hill rd
CITY Idennis I STATE IMA I ZIP 102638 I TEL I
FAX I 1 CELL I I EMAIL I
ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY
FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVE AS THE
FEES S PERMIT#
PLAN REVIEW NOTES
— _
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY YARMOUTH MA DATE March 03, 2022 PERMIT# BLDP-22-004853
- Witt-----7#
JOBSITE ADDRESS 35 PHEASANT COVE CIR OWNER'S NAME MCDONOUGH PAUL V
G OWNER ADDRESS MCDONOUGH KATHERINE M 15 MARLBORO ST NORWOOD MA 02062 TEL
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 RESIDENTIAL
PRINT
CLEARLY NEW: 0 RENOVATION:0 REPLACEMENT: Ej PLANS SUBMITTED: YES El NO El
FIXTURES FLOORS — BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER
BOOSTER
, .
CONVERSION BURNER
COOK STOVE
DIRECT VENT HEATER
DRYER
FIREPLACE ..
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS ,
MAKEUP AIR UNIT
OVEN
POOL HEATER
ROOM /SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER
WATER HEATER 1
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 1-2 OTHER OF INDEMNITY': 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 State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME r peter checkoway LICENSE # 13417 SIGNATURE
MP El MGF ID JP ID JGF El LPGI 1:1 CORPORATION I:1 # PARTNERSHIP CI # LLC 0 #
COMPANY NAME: ADDRESS. 11 scargo hill rd,
CITY dennis STATE MA ZIP 02638 TEL
FAX CELL EMAIL
S31ON M3IA321 NVld
#1101213d $ 333
El El 111V:13d 3H1 SV S3ALI3S NOIlVOIlddV SIHI
oN seA
S310N N01103dSNI IVNIH A1NO 3Sfl 210103dSNI 21Od 3OVd SIH1 S310N NO1103dSNI SVO HJl021