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Home My WebLink AboutBLDP-19-003946 Sfihtinny 11k6 -/ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK mac, LYP=a -`;--;1115, CITY West Yarmouth MA DATE 1/2/19 I PERMIT#/a/P-0-003 Fn $40 JOBSITE ADDRESS 55 Alden Road OWNER'S NAME Murray POWNER ADDRESS Same TEL 774-487-7610 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL 0 PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:Q PLANS SUBMITTED: YES❑ NOD FIXTURES 1 FLOOR-+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE I _ DEDICATED SPECIAL WASTE SYSTEM (— i I I h DEDICATED GASIOIUSAND SYSTEM r DEDICATED GREASE SYSTEM _ snit_ DEDICATED GRAY WATER SYSTEM I� DEDICATED WATER RECYCLE SYSTEM - I_ DISHWASHER r DRINKING FOUNTAIN FOOD DISPOSER FLOOR I AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY I I ROOF DRAIN ' SHOWER STALL .. ; I SERVICE IMOP SINK TOILET F URINAL iI I • WASHING MACHINE CONNECTION (—'I I WATER HEATER ALL TYPES 1„ ' WATER PIPINGI I IL . a � OTHER r 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 El 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. 74 ,Rodes PLUMBER'S NAME Frank W.Roderick LICENSE# 7794 SIGNATURE MPD JPD CORPORATION Q# 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 929606 L,e6L �r� �� -)-'li`/ MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 'F •tart E_t:I_;t CITY West Yarmouth MA DATE 1/2/19 PERMIT# l7-/9-60,2y6 $40 JOBSITE ADDRESS 55 Alden Road OWNER'S NAME Murray GOWNER ADDRESS same TEL 774-487-7610 (FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Li EDUCATIONAL El RESIDENTIALEl PRINT CLEARLY NEW:El RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES NOQ APPLIANCES1 FLOORS-, BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER g I . I, I t !' 1 , BOOSTER m _ .. .- CONVERSION BURNER allIMIESIMENISIIIN COOK DIREECTCTVENT HEATER DRYER I! I' I _I i I. I I t FIREPLACE i I I , _ 1 FRYOLATOR �I I. I ' 1 1 U 1 I` t FURNACE 11-_ — f s� t _sal f I_ 1, =s ._=1� fl � .f ,: 4. '_.._,. _,t.�,..,.- ... T" R"Y'.^ Yh"-., ,«.'a` Wf3""`t..",fit"_" A.....�..- R^"'iC ="T. GENERATOR .__ I �_ _.. _ GRILLE I _ _ I I t I' t, I Ii , INFRARED HEATER ' Iiiitilitmietionniosisitia LABORATORY COCKS _ IL.W ' MAKEUP AIR UNIT I I' Ii I II ! r II J I I qi F . OVEN Ir li I Il H I, r I u I POOL HEATER I ROOM I SPACE HEATER I I' 'F _I, __ I, _ .1 P _k' 1 __..-I ' ROOF TOP UNIT I I--' 1 _ 1 .__ (-_ II I:• l i'' II 11 1! .__I . It TEST ,.._._r '_ I'--I .. I __— UNITHEATER i !i_ , , I _ -I' _ PI 1 t' 6 I!_ ' _._ .._i UNVENTEDROOMHEATER I t1 I;�i` 1 t I;— t �I �t —I 1 WATER HEATER 1 _; _.�° I i ,. ._. i _ ...! OTHER == 1 t, t I, I _. i 1 t t _- fay 1 _I LLt i t f 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 c+ 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 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. 72444 'Rpqely44 PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 ( SIGNATURE MP Q MGF EJ JP Q JGF Li LPGI Li CORPORATION Q# 1762-C I PARTNERSHIPLI#r 1 LLC Q# COMPANY NAME: Rusty's Inc. —_-----1 ADDRESS 222 Mid-Tech Drive CITY West Yarmouth STATE MA ZIP 02673 TEL 508-775-1303 FAX 508-771-9310 CELL EMAILmburke@rustysinc.com 929606 G-CZN- • I