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Home My WebLink AboutBLDP&G-17-001145 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY West yarmouth __ _ _ MA DATE;8130116 PERMIT#f. ��Z�� 1' JOBSITE ADDRESS 162 Iriquois Blvd,WY OWNER'S NAME Joan LeBlanc OWNER ADDRESS [lame TEL 508 775 8491 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL— EDUCATIONAL RESIDENTIAL !.,] PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: + PLANS SUBMITTED: YES NO 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 DEDICATED GAS/OIL/SAND SYSTEM _ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ 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 ALL TYPES 1 WATER PIPING _ OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY f 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 best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit;y7fnent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME R Peter Checkoway LICENSE# 1341747 SIGNATURE MP JP CORPORATION # PARTNERSHIP # 1 LLC #' COMPANY NAME Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Dennis i STATE MA ZIP 02638 _ TEL 508-385-1911 FAX 508-385-6858 CELL 508-735-9993 1 EMAIL checkent@comcast.net l 4 , T • 1 _ _ l 1 4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK k - CITY West Yarmouth MA DATE 8 30 16 PERMIT# /�yh" %7"e/I tf JOBSITE ADDRESS 62 Jriquois Blvd,WY OWNER'S NAME Jon LeBlanc GOWNER ADDRESS same f TEL 508-775-8491 —1FAXI TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL i' PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES 11 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 lir ROOF TOP UNIT TEST -4- UNIT HEATER , UNVENTED ROOM HEATER WATER HEATER 1 OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ! NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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 toFhe 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 Pprtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ArA i PLUMBER-GASFITTER NAME CR Peter Checkoway LICENSE# 13417 SIGNATURE MP i MGF ] JP Li JGF LI LPG!rj CORPORATION �# PARTNERSHIP # LLC Q#i COMPANY NAME:!Checkoway Enterprises ADDRESS Ell Scargo Hill Rd CITY Dennis STATE MAI ZIP L02638 — TEL 508 385 1911 FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@comcast.net