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Home My WebLink AboutBLDP-21-001143 o rr/hM I/ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '" CITY YARMOUTH MA DATE (September 03,202 PERMIT# BLDP-21-0011403 =II JOBSITE ADDRESS 7 WOODSIDE CIR OWNERS NAME SHAYLOR ROSE M TR • G OWNER ADDRESS SHAYLOR REAL ESTATE TRUST 7 WOODSIDE CIR YARMOUTH PORT MA TEL 02675-1800 TYPE OR OCCUPANCY TYPE COMMERCIAL 0 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 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 I 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 checkentacomcast.net �1tS r�� 0/- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK , s _,_CITY YARMOUTH MA DATE September 03,202 PERMIT# BLDG-21-001143 `� JOBSITE ADDRESS 7 WOODSIDE CIR OWNERS NAME SHAYLOR ROSE M TR G OWNER ADDRESS SHAYLOR REAL ESTATE TRUST 7 WOODSIDE CIR YARMOUTH PORT MA TEL 02675-1800 TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ID 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 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER 1 FIREPLACE FRYOLATOR FURNACE GENERATOR 1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST 1 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 El 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 El MGF ❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME: R PETER CHECKOWAY ADDRESS. 11 SCARGO HILL RD, CITY DENNIS STATE MA ZIP 026382306 TEL I FAX CELL EMAIL checkentAcomcast.net ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION KIES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE:$ PERMIT# PLAN REVIEW NOTES 1` I .,-r, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - W P' CITY I YARMOUTHPORT K v i MA DATE 18/19/2020 PERMIT # 'i' bW I Ni3 JOBSITE ADDRESS 7 WOODSIDE CIRCLE, YPT 'OWNER'S NAME MA EW HATCH GOWNER ADDRESS SAME TEL 978-766-7001 FAX , TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL 71 PRINT CLEARLY NEW:, RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES ' NO APPLIANCES Z FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER , 1BOOSTER CONVERSION BURNER COOK STOVE I DIRECT VENT HEATER DRYER i FIREPLACE -1'' FRYOLATOR W � �� ' �FURNACE S 7� ,GENERATOR ,.r, i c" �¢ if 1 — 1 GRILLE lw r fl INFRARED HE LABORATORY idt S g iz _ z= ______________ __ah__________.,___________ __,, MAKEUP AIR AI i o �� OVEN g POOL HEATE ROOM / SPACE HEATER ROOF TOP UNIT TEST 1ti---- _. UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER r. _rt i' `4111116k '4. _ _, , . j .. W. INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES i NO 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 .--r-; I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to th 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 provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME R Peter Checkoway LICENSE # 13417 -- ATURE MP i MGF JP JGF LPG; CORPORATION # PARTNERSHIP # LLC # 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 t,t � 5 I. .-- �I