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Home My WebLink AboutBLDP-19-002544 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK j CA., 4k :r<x'�—i"" —"'" 4 CITY YarmouthportMA DATE 10/22/18 PERMIT#�.�r �'29 cR54' ' JOBSITE ADDRESS 71 Early Red Berry Lane OWNER'S NAME Pickering P OWNER ADDRESS Same TEL 508-362-1342 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES 0 NO0 FIXTURES 7 FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 r—I—il—i I-"( 1-1I I CROSS CONNECTION DEVICE rr r r -r - DEDICATED SPECIAL WASTE SYSTEM1=-1-- DEDICATED GASIOIVSAND SYSTEM I I r- I _ r— DEDICATED GREASE SYSTEM 1111110. 11111MI( _ I�`r DEDICATED GRAY WATER SYSTEM _ y_. DEDICATED WATER RECYCLE SYSTEM 1 . I I .. DISHWASHER DRINKING FOUNTAIN ,m1 ( , FOOD DISPOSER I� (— FLOOR 1 AREA DRAIN INTERCEPTOR(INTERIOR) I KITCHEN SINK VATORY•.• I _ I • ISla ., . 'i l I i SHOWER _t_,s_ , ROOF1111A1-1-71,„ I ( I - I SERVICE I MOP SINK a _. 1-1-1 TOILET C. I i !n 1 1 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 Q OTHER TYPE OF INDEMNITY ❑ BOND 0 • 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 0 AGENT 0 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. 214414 Reelted PLUMBERS NAME Frank W.Roderick LICENSE# 7794 SIGNATURE MPO JP CORPORATION O# 1762-C PARTNERSHIPQ# ac 0# COMPANY NAME Rusty's,Inc. ADDRESS 222 Mid-Tech Drive CITY West Yarmouth STATE MA ZIP 02673 TEL 508-775-1303 FAX 508-771-9310 CELL j EMAIL mburke@rustysinc.com 928744 f /12-6 IS ///3,7 ar, MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Tit"EI=r' CITY Yarmouthport MA DATE 10/22/18 PERMIT#Aigt19"6qSyr JOBSITE ADDRESS 71 Early Red Berry Lane OWNER'S NAME Pickering OWNER ADDRESS same TEL 508-362-1342 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:ID PLANS SUBMITTED: YES❑ NOQ APPLIANCES 1 FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER T11__J _-1' _IL,_J ' 11_1'�I'i_ '__1'�; BOOSTER I_J/ii Ii-ii_Jlii_ _j 11_1!_1'i1 1'_I� CONVERSION BURNER I_li_)ir_11 Ii_j'_ �' I�__j' J1—I_ COOK STOVE (' J' �Ih1J' I rIJ .._ - _f __ P m1 DIRECT VENT HEATER -�- 1-I'_)!_I' i' I_l'�I`_ DRYER 1- !TI'. Ji_II Ji_ I I —J - .1 1'_I FIREPLACE _1' I __I'.�.,_I' I I'. !'_.._1! I , J {, _1 FRYOLATOR 1— 11—i1i1 11—11 II II i' p FURNACE _JI_li_J, 1'i I' J`J' 11- _I _ GENERATOR I _._l 1 ____I' 1 J —J �'_ _1 �I i I 1 GRILLE Ji I+- 11 II__I _i'_J'_,.1'._.__1 II I INFRARED HEATER 1-1"_I'. IT-11-11 11�lillM�ll�! TI'�zl'�I'11 LABORATORY COCKS I _I _L- I' 1 �I' 1 I 11 _.,I 1 MAKEUP AIR UNIT J1 _ I' I._.. ' I'i' `li ..f Il..__ 1' .__I' I • ROOM/SPACE HEATER 11 1 I' 111' II II II IP II IL I 1 OTHER I'- 1' J' II��I ', I� i 1 IJ'_ I1_1�1{! I' I' J' I 11 I I� J' i� i' I I`— I iI 1' I — 1 1-1'_1 INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES El NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY p 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. 93ug4 ROt4Jlid PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 I SIGNATURE MP U MGF❑ JP❑ JGF❑ LPGI❑ CORPORATION 0# 1762-C PARTNERSHIP❑# LLC❑# COMPANY NAME: Rusty's Inc. ADDRESS 222 Mid-Tech Drive CITY West Yarmouth � STATE MA ZIP 02673 TEL 508-775-1303 FAX 508-771-9310 CELL EMAIL mburke@rustysinc.com 928744f7 th/g Ork