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HomeMy WebLinkAboutBLDP-19-003379 Unit 306 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ` FI 6;f CITY West Yarmouth MA DATE 11/29/18 PERMIT# `/ `t 0 93 9 • $40 JOBSITE ADDRESS 345 Camp Street,#306 OWNER'S NAME Charles White Management I POWNER ADDRESS 330 Commonwealth Ave,Boston TEL 617.267.1283 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES❑ NOD FIXTURES 7 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 1'0S� i� CROSS CONNECTION DEVICE ; � _ -11.1111 DEDICATED SPECIAL WASTE SYSTEM i [ � k� DEDICATED GAS/OIL/SAND SYSTEM ir [ aL —JIB DEDICATED GREASE SYSTEMri DEDICATED GRAY WATER SYSTEM j ; L � DEDICATED WATER RECYCLE SYSTEMM MMI DISHWASHER a si i M. � :— DRINKING FOUNTAIN '�� � FOOD DISPOSER r r ,rM at�, IM _ FLOOR/AREA DRAIN SMI' '� L MTh INTERCEPTOR INTERIOR a an KITCHEN SINK —5 —�r LAVATORY j___ al_ ;I' NOS ROOF DRAIN ==:===liana. l INGSIS SHOWER STALL 'iM� —' 1111111111111111 SERVICE/MOP SINK ', SMii iM TOILET ,_ _ ICL URINALS. WASHING MACHINE CONNECTION S �1— tLEiE' WATER HEATER ALL TYPES , i S : - WATER PIPING i_' !is .S OTHER ' ss SUMO MI 111111111111.11 ' _ _ s man CE � II illit I'S INSURANCE COVERAGE: ISMIS 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. - CHECK ONE ONLY: OWNER ❑ 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 of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.. 7144t44 '�Q -_ PLUMBER'S NAME Frank W.Roderick LICENSE# 7794 SIGNATURE MPD JP Ll CORPORATION Q# 1762-C PARTNERSHIP❑# LLCQ# COMPANY NAME Rusty's,Inc. ADDRESS 222 Mid-Tech Drive CITY West Yarmouth STATE MA ZIP 02673 TEL 508-775-1303 1 FAX 508-771-9310 CELL EMAIL mburke@rustysinc.com 929254 zie it- GC26� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK I E. 1risan= 1 v- 411F;t CITY West Yarmouth MA DATE 11/26/18 PERMIT# /J/-01'/9":761 ' $40 JOBSITE ADDRESS 345 Camp Street,Unit#306 OWNER'S NAME Charles White Management GOWNER ADDRESS 330 Commonwealth Ave,Boston, MA 02115 TEL 617-267-1283 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:❑+ PLANS SUBMITTED: YES❑ NOD APPLIANCES 1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ I I' _ v ' 1 I BOOSTER I It 1' I' I II ._-_.1' I - rit i 1 CONVERSION BURNER 1 !' I II ' !t r; i COOK STOVE I: I 1: I. DIRECT VEN FIREPLACE T HEATER _ DRYER llit _ FRYOLATOR 11.1111111 GENERAT•• _.t t : GRILLE i LABORATORY COCKS t ; .... m - _- _ MAKEUP AIR UNIT , ! OVEN UNIT HEATER UNVENTED ROOM HEATER 1 It it It t WATER HEATER OTHER t ..i�I;---I, I .. ..t,-- i—I.— I�i 1, — —l - I ---, INSURANCE COVERAGE I have a current liability Insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES G]NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY a 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 D 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. 7a.y4 Rode/rid PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 I SIGNATURE MP 0 MGF❑ JP❑ JGF❑ LPG!❑ CORPORATION D#(1762-C I PARTNERSHIP❑# LLC Q# COMPANY NAME: Rusty's Inc. ADDRESS 222 Mid-Tech Drive CITY West Yarmouth STATE riA I ZIP 02673 TEL 508-775-1303 --. .---- FAX 508-771-9310 CELL EMAIL mburke©rustysinc.com 929254 ti 1f Rivfrt, 049 aisx