HomeMy WebLinkAboutBLDP-18-001635 Unit 203 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
lyl CITY WYarmouth MA DATE 9/11/2017 PERMIT#/�'�✓f/z/ /�0g✓C
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JOBSITE ADDRESS 345 Camp St Unite 203 OWNER'S NAME Charles White Management
4P in NU OWNER ADDRESS Same TEL FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑+ PLANS SUBMITTED: YES El NO❑+
FIXTURES 1 FLOOR—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB II I"`d hl—I I I i I-11-1 .
CROSS CONNECTION DEVICE I 7-4 I i, r r d r I
DEDICATED SPECIAL WASTE SYSTEM F-17---— I i 1-1 1 _ l I— I I—i
DEDICATED GAS/OIUSANDSYSTEM f=AI _1[-1I—(-1—If _ MMI---. I— I 'I—� li
DEDICATED GREASE SYSTEM f- _ „ .t �I � „„ 1 ��
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DEDICATED GRAY WATER SYSTEM f-1( II ( [, _ ( I _ q 1
DEDICATED WATER RECYCLE SYSTEM I If ,__ I Ir , U I I _ (_I, II
DISHWASHER Hf
DRINKING FOUNTAIN f II 1 II , w (� fI-1f -i[t-dii. .
FOOD DISPOSER L _11—d—d I-1 '(-1 '11---11—,--177i
FLOOR IAREA DRAIN I 1- 'n I l N r
INTERCEPTOR(INTERIOR) III—II II I T1 , 1 rI'I
KITCHEN SINK
LAVATORY f d1_ , 1 , _ , IJ. , i I I II 1 ,,.I1 . 41I
ROOF DRAIN I , U ,, I I I , �I C losiIt
SHOWER STALL dl ,
SERVICE IMOP SINK f U j I (—I(�i II—1I-1 , I I
TOILET L _ Md Io r 1
URINAL I t[—f Cr) — iacs r t—ir-1—.
WASHING MACHINE CONNECTION FT" IIII —II— I 1—'I "— I—I—I
WATER HEATER ALL TYPES �1__I_IIs_ —PII `s—r I— 1—(— '
WATER PIPING II _( , dI I __ [-1-1I-1 i
OTHER I-BACKFLow I—ii(—il If I _ '—d _� (-i—i —I 1
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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 0 NO El
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY ElOTHER TYPE OF INDEMNITY ❑ BOND El
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. f N`{ w, /I / A
PLUMBER'S NAME Frank W.Roderick LICENSE# 7794 SIGNATURE
MP1:1 JP❑ CORPORATION Q# 1762-C PARTNERSHIP❑# LLC❑#
COMPANY NAME Rusty's Inc. ADDRESS 222 Mid-Tech Drive
CITY West Yarmouth STATE MA ZIP 02673 J TEL 508-775-1303
FAX 508-771-9310 CELL EMAIL ssavery@rustysinc.com g1
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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"14,tc CITY WYarmouth MA DATE 9/11/2017 PERMIT# /79- -x/695
4 -P JOBSITE ADDRESS 345 Camp St Unit 203 OWNER'S NAME Charles White Management
GOWNER ADDRESS Same TEL (FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ii RESIDENTIAL
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES D NOD
APPLIANCES 7 FLOORS BSM 1 2 3 4 5 67 8 9 10 11 12 13 14
BOILER 1- I I' I I I I' I I I I 1J'TI ____ I
BOOSTER I' I'_I_i1_11'�!iI�: . 11, . I]_ _J __jL�_1•_I'_I
CONVERSION BURNER I' I' Ii I, II II—Ii_'I1=J1 II_1: f' p —I
COOK STOVE I:__I —J I I' AI. I —J—1 l' 1 1 _1 _ I
DIRECT VENT HEATER I' I' —I'_ J1___11_J1_ II—_JI -IL_J' _II ' f' (' I
DRYER {--1 _ I'_ '_— f1 1_,_- 1 — 1 � y ._
FIREPLACE __I,T_I 1 __! _— )
FRYOLATOR I" l i 1i_III I___I i II IIfl_, ull .._...f
FURNACE II 11____I1 —11-1'—_I', 11_31 11 �I F 11_______11 11-11 I
GENERATOR ---1 ---1:_-___1.— '---I I.-1 --I 1 1 !1-1 —t'_1 _I —I
GRILLE I 1. I. I'_I I'_I1_11_11 ] 1 1 11_11_1 H 1
INFRARED HEATER f---p I' I I—l' I I I' I' f i I' fp 1' I' I' I I
LABORATORY COCKS . 1 1 _1 !1 I 1 I _1 _1 I 1 l' , 1 1 1 1
MAKEUP AIR UNIT I—I —_ li 1 I,-)1_.—_I'�)I- _V___)' li , Ii_ I, I' f ittcJ
OVEN :.I -11--_11 ____I
1-i- 11 �I _ I1---I' II I.' I' 1'_ „ 11,T,—I'�1'l, IL�.�.I
POOL HEATER I _I _�I __ I _ I . , I It I. !' Ii_ —I'�.1' ! 11 I
ROOM I SPACE HEATER 1 1(--11—..11--1{____.1f
-1' -11�11__._I" 11—...11._. .1,_71,1__._ I1 :j .1;_._,1'__I I,—,_1
ROOF TOP UNIT l-—P--1i__N_I' __.11--'II—II p —II 1' —, 11_ —J�--Ill— p-- 1
TEST —i .— I II I I I '—I —1 =1i1'_1_I — I 1 I
UNIT HEATER - - - 1 •I'IL-C D -i ./4' I!_{!_i'-I' 11 --I1_I I _I
UNVENTEDROOMHEATER I' I I' l'.----1' II_J'_J': 1'_)1_I I_I' I:_I
WATER HEATER 1-1_I', . I I ^I 1 I , I !I 1 I __1 I. I 11 I
OTHER I' I iI'__1 —1'�II, 11 I1 I'�III'_ . J' I. I' 1
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Ji_ I - I'. 11�J!_1'._J1.{.�Ji-11- 11_ II 11�J1`I —_ I,> `_I
! 1 _,l __-1 _ l'.._ l' I _I �1" i _1 I' I._ I f' I, ®-I
IJL'..,.._..i __..J' J 1fl11_J I.flJ I .._I I... f'.. ..11......J 1 - i"-l'__ _JEL !
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO ❑
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY 0 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 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. ii
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147
PLUMBER-GASFITTER NAME Frank Roderick LICENSE#74—I f SIGNATURE,
MP ED MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION Q# 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 1
FAX 508-771-9310 I CELL - EMAIL ssavery@rustysinc.com -- -
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