BLDP-19-000963 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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j CITY Yarmouth MA DATE 8/15/18 PERMIT# //i-DP'/ /�0,,
PenJOBSITE ADDRESS 2 Gulls Cove Road OWNER'S NAME Somadelis
OWNER ADDRESS same TEL 508.769.9608 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL El RESIDENTIAL El
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOQ
FIXTURES 7 FLOOR—, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1 ir I ,
CROSS CONNECTION DEVICE r r �r
DEDICATED SPECIAL WASTE SYSTEM _ r`(
DEDICATED GAS/OILJSAND SYSTEM (�1 I
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM I—(---T---'1-rr _I I/
DEDICATED WATER RECYCLE SYSTEM r-'nr--.`� 1 r.--"I((`'-1I 1
DISHWASHER I11--rel I_"" —I i "`. '—
DRINKING FOUNTAIN I—I III—II I II I
FOOD DISPOSER (�` I—i _ I—i r- (I 111
FLOOR/AREA DRAIN F r [ r
INTERCEPTOR(INTERIOR)
-.' I I _ i rel i �(
KITCHEN SINK , .
LAVATORY 1--: te puss.....isci
(—1.. .„E-1
ROOF DRAIN �
SHOWER STALL priI Ii r--- I
SERVICE/MOP SINK _ I I -1
TOILETr
URINAL 71111-1 ,fs_I linAll
WATER HEATER ALL TYPES 7:: 7`I,-.r-' 1 _ r
WASHING MACHINE CONNECTION I II-"
77
1-'171 . ,..
r EnF I I_ _1II I .
OTHER F.WATER PIPING (—i ,,,1',7
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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
i LIABILITY INSURANCE POLICY❑j 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 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. �7 R
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PLUMBER'S NAME Frank W.Roderick I LICENSE# 7794 7 SIGNATURE
MPD JPD CORPORATION❑+ # 1762-C PARTNERSHIP❑# 1tic Q#
COMPANY NAME Rusty's, Inc. I ADDRESS 222 Mid-Tech Drive ,
CITY West Yarmouth I STATE MA ZIP 02673 TEL 508-775-1303
FAX 508-771-9310 CELL EMAIL mburke@rustysinc.com I -
927570 4-/r1i-
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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0_1 /g` �.fi nt' CITY Yarmouth MA DATEPERMIT#. ��-�clog
JOBSITE ADDRESS 2 Gulls Cove Rd. OWNERS NAME Somadelis
GOWNER ADDRESS same TEL 508.769.9608 (FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL +
PRINT ❑ ❑ RESIDENTIAL❑
CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:ID PLANS SUBMITTED: YES 0 NOD
APPLIANCES 1 FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER ' I —_I'-,^.I I __I 1 ^I I I_ !' __ IL, _I I' l _.�
BOOSTER I Il' I'—_II JI ll 11_1—ll_.11 11 R 7 li , P I' • f
CONVERSION BURNER —1,---_—_-1, fi ii I' f1 fi_)'—IT_JI 1i_Ii_I' Ii I
COOK STOVE I I . II' I' I I' IF l'__!! I I I:- _r^1
DIRECT VENT HEATER I.._ _1' II I I_J' IL 'I: 11 . 11 I'_N I' f,` I: d J. I
DRYER _I'T_I _I' I'_ I'—I'i'_I' 119. 1' 1' 11 11_ I
FIREPLACE ' _I'— I _J' I a-.=J __I I' I h_.__._f'._ ._._
__I I' _J I'_ _I
FRYOLATOR _I'_I'—I'_lL__I'_ :____11=1=1=1=(=LI C'fliCu-
FURNACE =1' 1' f' I' 1'_ ' 11 I'__1' f i 1' I' 1 1 1
GENERATOR 1,�I'�.I'' 1'—.1! 1 1' I' I' II Ii_ --
TI,---I'---1
GRILLE —1!-1'i'-11=11 I�_J'=1'i'-1'_____J' II=J'!_I'_I
INFRARED HEATER 1_.. 1' .11 (' ,-1' _I'—I'. -..J,1r 11 lI. . I'—I' ,.I I--1 --I^—...I
LABORATORY COCKS 1' , I I'�I''_,.� 1' I l' I' I' j1.'_ I' I':. ._ II_ -I
MAKEUP AIR UNIT '= '_I' ii I' I' 1' I' I' I'-1' I—II I'�I I
OVEN I' I!�.I'_ W.l'�1' I'.- 111- '__-1i _I' _f`----1' li�,._1' I
POOL HEATER s-I 1 _1 -..1 1 _I I, _1 ^1 I I I I I _I
ROOM/SPACE HEATER 1' I' J'-1'_ ' l'=1._ I' I' I'_ I' I' I' I' t
ROOF TOP UNIT I P-11-1,-11-1C-11_ _ __J1J'., 11__11-11-11--P 111
TEST _I -1 I --I —I'--I -I�I , I I11'_..__Iz1 .VI
UNIT HEATER 1T1'_1' I! P I' I'.. —11 „ P . IL , L___,_P P____I' 11 I
UNVENTED ROOM HEATER I 1,.. . I. J' I i— I1=f 1 1, I+-1 f;_1 1.—'-I' —I
WATER HEATER 1 I 1 _ I _I I 1 _J 1 —1�I SII 1 —_ I 1
OTHER L I'�I'__.�I' _11 1: I'—J ' _ 1' _ II J,__ ._II_`.' _I "_I
1 imam
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES Q NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY 0 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 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. 7 Rode�rac4
PLUMBER-GASFITTER NAME Frank Roderick I LICENSE# 7794 I 7 SIGNATURE
MP E MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION❑+ # 1762-C PARTNERSHIP❑# LLC❑#
COMPANY NAME: Rusty's Inc. (ADDRESS 222 Mid-Tech Drive (
CITY West Yarmouth I STATE MA ZIP 02673 TEL 508-775-1303 I
FAX 508-771-9310 CELL EMAIL mburke@rustysinc.com I
927570 ii
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