The URL can be used to link to this page

Home My WebLink AboutBLDP-18-005972 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK _' _-4 CITY W Yarmouth MA DATE 4/23/2018 I PERMIT# 6Z-DP�r' -770 5o JOBSITE ADDRESS 19 Lake Road East OWNER'S NAME Frederick Arnold P OWNER ADDRESS Same I TEL IFAXIMIIIIIIII TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL El PRINT CLEARLY NEW:® RENOVATION:❑ REPLACEMENT:0 PLANS SUBMITTED: YES® NOQ FIXTURES 1 FLOOR-0 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB IN.INN jaiii OMB(m Iom Inn Inn Imo h■r;l .Imo Om Mt CROSS CONNECTION DEVICE OM h PM 1111111 UM 11111111 NM OM NM 11111111 MI 1111011 NMI DEDICATED SPECIAL WASTE SYSTEM i,M M ME MN ( Imo,M 11111111 ;IIIIt MI M1 DEDICATED GAS/OIL/SAND SYSTEM In Imo;alli NM 1111111 OM 01111 ME OM n ME Mt Mi NM NM DEDICATED GREASE SYSTEM ligli lair M MI IIIIIII ONE NM swam am in DEDICATED GRAY WATER SYSTEM On MX ME MI ON OMR ill 111111101111. I i IIIIIII 11.111111110 DEDICATED WATER RECYCLE SYSTEM 111.1.11111111111111111110111•111111111 MIN OM II 111111111 MIK INN I ,MIN$1111117a DISHWASHER O OEM MIIIMB 111111111111 Om Mom IN.111111 111111 I 1111111 amiI DRINKING FOUNTAIN M MI ONE N MN MIN PM MR 111111 NM MN FOOD DISPOSER 111111 I I IMO ME II=,I 1111111.11111 MR I I I FLOOR/AREA DRAIN pm{lisimtam, ,g MN OM MN liwillilm I 11=a INTERCEPTOR INTERIOR M,MR NM NM Miff Om Inumi umlOm'I m meg INN ME IIIIIIIIIIIBI KITCHEN SINK 11111.11111111111,0111111111 NM SIM ME ;N M;IIIMI , .111111111-MK LAVATORY P MB —IIII=MI —111111111 M 11111111111111111—'I——i— ROOF DRAIN ME 1111111,MINI MN MB PEN 11111111111111'M'NM', MN ME 11111111 SHOWER STALL mu imi min lam NEB I NM M ME ME ice 111111111111111111,1111111 SERVICE/MOP SINK OM M II=1 OM ME IIIIII IM IMO M WM.11110;NM MN I11111111 TOILET Mil'IMB M 11.11111111111111111 NM MN ME a �N MR URINAL Mailli'NM ram O1 'NMN ,NMMK ! WASHING MACHINE CONNECTION ME MS MN ME NM MIN I♦ MI MIN INN ME MI OIIIIIIIIBI NM WATER HEATER ALL TYPES 111111;WEIii11NE NM ', U ! I : WATER PIPING NM M:MI WM 1111111 ONE NM ME MN 1111111 MN 1.11111111111110111111 imp OTHER BACK FLOW h Ma N;Min M.Nom ins m Il NM ION I—,'—!am am IIIII Om MI Om Om ME in.rim am psi NNE rim Om lam imi mum Imiummimmimmiemon MN an ONIII MI MR MN ME 11111•ME MI 11111111 MEW MN MIMI IMP -iiiimatammamar am'Ci Ian s ow am a am—m laiiiii. alai INN 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 0 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ❑ 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. �ny �� PLUMBER'S NAME Frank W.Roderick I LICENSE# 7794 /SIGNATURE MP El JP CORPORATION Li# 1762-C PARTNERSHIP®#gm. LLC❑# COMPANY NAME Rusty's Inc. I ADDRESS 222 Mid-Tech Drive CITY West Yarmouth I STATE MA ZIP 02673 I TEL 508-775-1303 I FAX 508-771-9310 CELL 1 EMAIL ssavery@rustysinc.com L/e ff