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HomeMy WebLinkAboutBLDP&G-19-003685 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTHPORT MA DATE 12/12/18 PERMIT#/ & J&J G> JOBSITE ADDRESS 74 PHEASANT COVE CIRCLE,YPT —1 OWNER'S NAME TERRY BANE OWNER ADDRESS 8 APPLE HILL LANE,STONEHAM TEL 781-272-2792 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL � PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES I 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 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 tr- be of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with a P- - •rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME R Peter Checkoway LICENSE# 13417 SI RE MP JP CORPORATION # PARTNERSHIP # LC # COMPANY NAME Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Dennis STATE MA ZIP r 02638 TEL 508-385-1911 FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@comcast.net l� l� I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Ei:-1liitiM$ :_ _ CITY ARMOUTHPORT MA DATE 12J12/18 PERMIT# / I2/9`C l Y6 r JOBSITE ADDRESS 74 PHEASANT COVE CIRCLE,YPT OWNER'S NAME TERRY BANE GOWNER ADDRESS 8 APPLE HILL LANE, STONEHAM TEL 781-272-2972 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL i] PRINT CLEARLY NEW: i RENOVATION: REPLACEMENT: 1 PLANS SUBMITTED: YES J NO APPLIANCES 1 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 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ONO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE INDEMNITY BOND ' 1 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 b of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all P� provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. //�J PLUMBER-GASFITTER NAME 1 R Peter Checkoway LICENSE# 13417 G' SOO RE MP i MGF JP El JGF LPGI CORPORATION D# PARTNERSHIP # 1 LLC Q# COMPANY NAME: Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Dennis STATE MA ZIP 02638 TEL 508-385-1911 FAX 508-385-6858 !CELL 508-735-9993 EMAILrcheckent@comcast.net