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Home My WebLink AboutBLDP&G-16-005593 —f MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ti CITY 41 21d c/fitit!'-J MA DATE yl eX e 7 PERMIT# P//4P-AP-00'3Y5 JOBSITE ADDRESS L"- (//-1jf,1/'v T1J?1 C i 1/111,11 J OWNER'S NAME JdM gy4 / 1 POWNER ADDRESS j c_j M9� TEL 366 --)?i,T FAX J TYPE OR OCCUPANCY TYPE COMMERCIAL I EDUCATIONAL C RESIDENTIAL' PRINT CLEARLY NEW:El RENOVATION:r1 REPLACEMENT:yr PLANS SUBMITTED: YES❑ NO FIXTURES Z FLOOR--. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB —7' —lI I I'— CROSS CONNECTION DEVICE _ — I, _- DEDICATED SPECIAL WASTE SYSTEM _ _ DEDICATED GAS/OIL/SAND SYSTEM _ _I DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM r— —1! DISHWASHER I JL DRINKING FOUNTAIN l FOOD DISPOSER l _ _FLOOR/AREA DRAIN _INTERCEPTOR(INTERIOR) KITCHEN SINK 1-- 1 I LAVATORY __ __- ROOF DRAIN y SHOWER STALL L_ SERVICE/MOP SINK _L,P 1— IF TOILET URINAL WASHING MACHINE CONNECTION _____. WATER HEATER ALL TYPES WATER PIPING --, OTHER ■ &V -,---, i I have a current liability insurance policy or its substantial equivalent E COVERAGE:INSURANC which meets the requirements of b GL NO P] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELJW APR 13 2016 LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY 11 BOND C BUILDING DEPARTMENT OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage req aii.d by Chanter 1a2nf fhe 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 t est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with al nt provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME FR Peter Checkoway LICENSE# 13417 ATURE MP❑ JP CORPORATIONT1# !PARTNERSHIP(-#I LLCM# COMPANY NAME! Checkoway Enterprises ADDRESS 11 Scargo Hill Road CITY; Dennis - —__ I STATE I MA I ZIP 102638 TEL 508-385-1911 FAX 508-385-6858 CELL i 508-735-9993 1 EMAIL 1 checkent@comcast.net _ _ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 1:621i1 , CITY I � ��c7cr5v go ________ I MA DATE Ar l 1 PERMIT# P 7l0-00 l JOBSITE ADDRESSri'c (4);,/,ET i )c&T I/m OWNER'S NAME 7n L)/ci GOWNER ADDRESS r(psyne TEL '6 0 --19sa' 1FAX TYPE OR OCCUPANCY TYPE COMMERCIALS I EDUCATIONAL xrd PRINT CLEARLY NEW: RENOVATION:( I REPLACEMENT: . PLANS SUBMITTED: YES Li NOI APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER t, BOOSTER --� _CONVERSION BURNER MC _ COOK STOVE _ DIRECT VENT HEATER __— �M�®_— ERINDRYER ® ® ®�®' ®IIIIII FIREPLACE EMU �� ®M I®� FRYOLATOR FURNACE 1111111111.1111Er. M -- — _I _GENERATOR _—_� �®111111111111®E GRILLE �' ®EMMEN=—��LINFRARED HEATER —®®_—®' �NE LABORATORY COCKS M--- _�_-- — S�®—� OVENUP AIR UNIT �—�— �-- ®111111..1 POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT =—ME—�_ME �_® --_ --®-- TEST j UNIT HEATER 'r - UNVENTED ROOM HEATER it II WATER HEATER Ill OTHER ni _- —®NM ME II Ill- - INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES El NO L_ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE 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. CHECK ONE ONLY: OWNER f AGENT I I 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 th 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 Pe . provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE# 13417 URE e:7 MP - MGF JP JGF i 1 LPG! CORPORATION I 1# PARTNERSHIP 1 l#L COMPANY NAME: Checkoway Enterprises ADDRESS 11 Scargo Hill Road CITY Dennis STATE MA ZIP 02638 JTEL 508-385-1911 FAX 508-385-6858_1 CELL 508-735-9993 EMAIL checkent@comcast.net 1