HomeMy WebLinkAboutBLDP-19-003380 I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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-�"=g l; CITY West Yarmouth MA DATE 11/29/18 (PERMIT# /Y-✓»?-� 9; 'S
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$40 JOBSITE ADDRESS 121 Cam Strt ,��(
p eeOWNER'S NAME Alpert f
POWNER ADDRESS 17 Glen Oak Drive,Wayland,MA 01778 TEL 781.223.3496 FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0
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CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOD
FIXTURES 7 FLOOR—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB 1- Mar a in! Wi
CROSS CONNECTION DEVICE , ,_ I r IT , . r I
DEDICATED SPECIAL WASTE SYSTEM 1 Int r Mt , III , — ' '
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DRINKING FOUNTAIN SIS5
FOOD DISPOSER 5 555 stawain
FLOOR I AREA DRAIN
INTERCEPTOR INTERIOR a,— alit= lailararallit - ',11.1111
KITCHEN SINK ,111111•11.11SWINSEINIUMISINIUSSIMS1111•1111111alt
LAVATORY ,
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SHOWER
TOILET I
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WASHING MACHINE CONNECTION *WI la a ear_SS, MN.
WATER PIPING
OTHER #55. 155
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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
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 0 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. 71414 Roared
PLUMBER'S NAME Frank W.Roderick LICENSE# 7794 SIGNATURE
MP +❑ JP CORPORATION 0# 1762-C PARTNERSHIPQ# LLC 0#
COMPANY NAME Rusty's,Inc. ADDRESS 222 Mid-Tech Drive
CITY West Yarmouth STATE MA ZIP 02673 I TEL 508-775-1303
FAX 508-771-9310 CELL EMAIL mburke@rustysinc.com
929257 G-it/f
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E MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
• .:Wife CITY West Yarmouth A ' MA DATE 11/26/1$ PERMIT#/ P,I tDg3fQ
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$40 JOBSITE ADDRESS 121 Camp StreetI OWNER'S NAME Lpert
GOWNER ADDRESS 17 Glen Oak Drive,Wayland,MA TEL 781-223-3496 tFAX 1
TYPE OR OCCUPANCY TYPE COMMERCIAL Ea EDUCATIONAL❑ RESIDENTIAL ID
PRINT
CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:D PLANS SUBMITTED: YES❑ NOD
APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER '_ f'. if jr-tl- —I; i.{i_jii?� F,:p� ha;,�i, d
BOOSTER ' t I I _ I i 11.x! i I tit_t Ii - t' 1
CONVERSION BURNER �_ _ si.� ! _ ___t _ _ I _, _. I! r, _ I t I 1i N f H r' f
COOK STOVE 1 4 a t; n — r t
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DIRECT VENT HEATER 1 E1 _ ti I I II !! ! , t II It II t t
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DRYER _w,z„_fi 1t tl Pi— €h-.--t`d _, It h f t- I' !1 ,Il e�
FIREPLACE d 1' v I r 4t f i h -1 II—_°
FRYOLATOR I I t' , II IF f, _., 11 1i r, i' I ¢
FURNACE I 11 i I I 1'
GENERATOR
GRILLE t, t tl SI ti I I ' __._ .' . ..- I I . ._. t __ t
INFRARED HEATER 1 IF 0 ii 11 . il II I I -- , }r.. . I�,_ _ H I .._-_ d
LABORATORY COCKS +, - +i I
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MAKEUP AIR UNIT H 1 1 n ,i € I fr ti
OVEN � I t i i J, I 1 1 r i t t' I
POOL HEATER R I ! k S %' r_ .. _I _-_ _` __._,t.,— ...,�t--..�f____. t
ROOM/SPACE HEATER I I1 11 1' I; t I I f` N j `I I I
ROOF TOP UNIT , i, 11 I, 1l I ; 3
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UNIT HEATER I r I, r II f1 __ 11 ti ti I :
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