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HomeMy WebLinkAboutBLDP-23-003765 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH J MA DATE 1/10/23 PERMIT# BLDP-23-003765 JOBSITE ADDRESS 4 JOHN HALLS CARTPATH VILL OWNER'S NAME SISSON MICHAEL L P OWNER ADDRESS 4 JOHN HALL CARTPATH VILLAGE YARMOUTH PORT,MA 02675 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL❑ RESIDENTIAL 0 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 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER WATER PIPING 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 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. SIGNATURE OF OWNER OR AGENT 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. PLUMBERS NAME r checkoway LICENSE 18417 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME CHECKOWAY ENTERPRISES ADDRESS 11 scargo hill rd 11 SCARGO HILL RD CITY 'DENNIS —I STATE MA ZIP 02638 TEL 5083851911 FAX 7 CELL EMAIL checkent@comcast.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE 0 ❑ FEES S PERMIT# PLAN REVIEW NOTES }� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 1,,, l CITY YARMOUTHPORT j MA DATE 1/6/23 PERMIT # 2-\-- / 7 L 5 JOBSITE ADDRESS ri::121-1LHUW/___\1..,_L3IL,........, OWNER'S NAME FREIDMAN/BAYER „ _ _ _. ,.. .._ OWNER ADDRESS j_..___. .___.a_ ., TEL :FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ri EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: i REPLACEMENT: LI PLANS SUBMITTED: YES LI NOL,,i FIXTURES Z FLOOR--I 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/COIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER 1 DRINKING FOUNTAIN _ __ FOOD DISPOSER FLOOR / AREA DRAIN INTERCEPTOR (INTERIOR) _ KITCHEN SINK 1 LAVATORY - ROOF DRAIN SHOWER STALL . _ SERVICE / MOP SINK TOILET ---40-_0 URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER - - AM& -- -i. INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES v NO IF YOU CHECKED YES. PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY i OTHER TYPE DF 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: OWNE 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, e belof my knowledge and that all plumbing wcrk and installations performed under the permit issued for this application will be in compliance with. Il t provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME R Peter Checkoway _ -.�-, __ LICENSE # Li3417 klyURE MP LA JP 0 CORPORATION #[ PARTNERSHIP # LLC # COMPANY NAME Checkoway Enterprises ADDRESS 11 Scargo Hill Rd CITY Dennis STATE L MA ZIP 02638 1 TEL [ 08-385-1911 FAX 508-385-6858 CELL 508-735-9993 EMAIL checkent@ccmcast.net