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Home My WebLink AboutBLDP-22-007049 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY YARMOUTH MA DATE 6/6/22 PERMIT# BLDP-22-007049 JOBSITE ADDRESS 6 GEORGETOWN LANDING OWNER'S NAME karen dunn P OWNER ADDRESS TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL ❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES NO❑ FIXTURES FLOORS—, RSM 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 1 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION 1 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 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'S NAME r checkoway LICENSE 18417 SIGNATURE MP ❑ JP ❑ CORPORATION ❑# PARTNERSHIP ❑# 1 LLC ❑# COMPANY NAME CHECKOWAY ENTERPRISES ADDRESS 11 scargo hill rd 11 SCARGO HILL RD CITY DENNIS STATE MA ZIP 02638 TEL 5083851911 FAX CELL EMAIL checkent@comcast.net ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK l= ' CITY SYARMOUTH MA DATE 613122 __ PERMIT # ( a 4, 5 ,l JOBSITE ADDRESS 6 GEORGETOWN LANDING, S Y OWNER'S NAME KAREN DUNN _ 1 pOWNER ADDRESS 5 HURON RD, ACTON I TEL 248-797-1111 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ( RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB IM ___-11111 ___Inn. CROSS CONNECTION DEVICE - 1111•MI 11111111 �__ IMI DEDICATED SPECIAL WASTE SYSTEM MIMI __ �� __M_ DEDICATED GAS/OIL/SAND SYSTEM __ ' __II- NMI DEDICATED GREASE SYSTEM '��11 DEDICATED GRAY WATER SYSTEM lr _—_ 1 _ DEDICATED WATER RECYCLE SYSTEM i _ _ _ mid _.. '. ._-_ _ —� mor DISHWASHER 11111 110111 MI NM 41111111M110111 M DRINKING FOUNTA,N FOOD DISPOSER FLOOR /AREA DRAIN MINIM11111 M_1111111.11111111__IIMI ___ INTERCEPTOR (INTERIOR) NO11.11111 MIII KITCHEN SINK wir- LAVATORY — : "magi : ROOF DRAIN MIN __ SHOWER STALL IIM 7. .. SERVICE / MOP SINK TOILET _ URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES WATER PIPING E 11111111111110101111111 _ OTHER __ Mao 111111 IIIIIIIM WI NW 111111111111111111 INSURANCE COVERAGE: I have a current Iiabili[insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES i NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY '; OTHER TYPE OF INDEMNITY l 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 t,. t - .est of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian with /' : nent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ` -V -// PLUMBER'S NAME R Peter Checkoway y : LICENSE # 1 3417 SURE MP i JP CORPORATION #1 _ ,JPARTNERSHIP®# ILLCLJ#L COMPANY NAME Lcheckoway Enterprises I ADDRESS F11- Scargo Hill Rd CITYLDennis STATE MA-1 ZIP 02638 -I TEL 508-385-1911 i I FAX L508-385-6858 1 CELL 508-735-9993 EMAIL checkent@comcast.net I