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Home My WebLink AboutBLDG-22-004927 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH J MA DATE March 07,2022 PERMIT# BLDG-22-004927 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 � RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 1 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 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❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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. 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 Q MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: [R PETER CHECKOWAY ADDRESS. 11 SCARGO HILL RD, CITY DENNIS STATE MA ZIP 026382306 TEL FAX CELL EMAIL checkent( comcast.net S310N M31A32!NVId #1111213d $ 33d 1111d3d 3H1 SV S3A2J3S NOI1VOIlddV SIH1 oN saA S31ON NO1103dSNI 1VNId AINO 3Sfl 210133dSNI 210d 3OVd SIH1 S310N N01103dSNI SVO HOfON r { MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK =�f�b- CITY YARMOUTHPORT MA DATE 3/3122 __ PERMIT # JOBSITE ADDRESS 35 PHEASANT COVE CIR, YPT OWNER'S NAME PAUL MCDONOUGH GOWNER ADDRESS SAME TEL 617-548-6971 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL ,71 PRINT CLEARLY NEW: RENOVATION: LJ REPLACEMENT: i PLANS SUBMITTED: YES NOn APPLIANCES -. FLOORS-0 BSM 1 2 3 4 5 6 7 ! 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER -IF- - At. COOK STOVE _ I DIRECT VENT HEATER DRYER _ „� FIREPLACE FRYOLATOR —T - _ -___ FURNACE j_ GENERATOR GRILLE ""- INFRARED HEATER LABORATORY COCKS _ - . —.IT . ,,.. MAKEUP AIR UNIT � .� i OVEN � _ POOL HEATER s ._, ROOM / SPACE HEATER; ROOF TOP UNIT TEST = -� = � _ .. UNIT HEATER _ UNVENTED ROOM HEA--ER WATER HEATER OTHER i' I -11 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Li NO i. 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 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 be o y knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Perti n ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME r-R- Peter Checkoway 3 LICENSE #53417 SIGIE MP 7] MGF JP JGF LPGI CORPORATION E1# I I PARTNERSHIP #I LCQ# 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 EMAIL checkent@comcast.net