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Home My WebLink AboutBLDP&G-19-003898 . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK fig CITY South Yarmouth MA DATE 12/31/2018 j PERMIT# $ao :• JOBSITE ADDRESS 97 Baker's Path OWNER'S NAME[Balboni POWNER ADDRESS 10 Pleasant Street,South Yarmouth TEL 508-776 6410FAX TYPE OR OCCUPANCY TYPE COMMERCIAL� EDUCATIONAL Li RESIDENTIAL.. PRINT CLEARLY NEW: 0 RENOVATION:g i REPLACEMENT:= /I PLANS SUBMITTED: YES E NOg FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB i . ...W�.L_, ii ,.., i CROSS CONNECTION DEVICE ; sw. L IF DEDICATED SPECIAL WASTE SYSTEM I �y DEDICATED GAS/OIL/SAND SYSTEM " ' 3 DEDICATED WATER RECYCLE SYSTEM r- — r--- F--- 1.-- fillfiNall nrrUIIIIIUIMIII.1rjwrnpgj---T- 1— , � a INTERCEPTOR INTERIOR) i ,• r,. � i ,_. KITCHEN SINK l _ rim 1 I� .= I t- SERVICE/MOP SINK • r I € __. '____,._.I _ ... 1 .__.. __.. TOILET r-- ` � URINAL u� II_w��_ � „ _ WASHING MACHINE CONNECTION r.. __ WATER HEATER ALL TYPES 1 1 ' J WATER PIPING L—, I - 11 3� l ,'� _ ' _p OTHER I �.. . t IL J 3� �� [-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 Lj OTHER TYPE OF INDEMNITY Li BOND Li 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 Li 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. 91444Ro�G�PLUMBER'S NAME Frank W. Roderick LICENSE# 7794 j SIGNATURE MP r:ljj JP D CORPORATION . #N 1762-C' PARTNERSHIP J#[ LLCLk _ . __ 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 I CELL EMAIL mburke rusty sinc com 929610 117;'1- , MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK ®"tfl. r CITY South Yarmouth MA DATE' 12/31/18 PERMIT# /3/-,0117`vr' PS f $40 JOBSITE ADDRESS 97 Baker's Path OWNER'S NAME Balboni GOWNER ADDRESS 10 Pleasant Street,South Yarmouth TEL 508-776-6410 FAX TYPE OR -, PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL CLEARLY NEW: RENOVATION: REPLACEMENT: i PLANS SUBMITTED: YES NOJ APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER r w �r BOOSTER I n. , __. CONVERSION BURNER 1 ,..r ., . . , jM ---P .. COOK STOVE .. , DIRECT VENT HEATER i_ ., I '' .. DRYER �_.w FIREPLACE � FRYOLATOR -4 _. FURNACE GENERATOR i GRILLE INFRARED HEATER___ o. , LABORATORY COCKS MAKEUP AIR UNIT , 's tFs,,,,, OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT n . TEST UNIT HEATER t1 1 UNVENTED ROOM HEATER WATER HEATER OTHER i— ,� .� -..ems t, ,,, « .,,;xi,+ 1,, ,-1 is -,�..,,-. �«--4 , f. INSURANCE COVERAGE — I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ¢ .,;;NO I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ; iF OTHER TYPE INDEMNITY 'r--1 BOND Li 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 =„,„„j 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 withrtinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ��'7 1!`U PLUMBER-GASFITTER NAME Frank Roderick LICENSE# 7794 SIGNATURE MP',::,:i MGF E i JP_...._ JGF- LPGI ' CORPORATION si # 1762-C PARTNERSHIP r # LLC 1# ' COMPANY NAME:, Rusty's Inc. I ADDRESS 222 Mid-Tech Drive , CITY West Yarmouth 1 STATE MA ZIP 02673 TEL 508-775-1303 FAX`508 771 9310 1 CELL, 1EMAIL mburke aQrustysinc com 929610w