HomeMy WebLinkAboutBLDP&G-17-001844 ' t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
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CITY,Yarmouthport _.�. _, � a MA DATE rbJb/z /4, PERMIT#�HJ/-/1-G7i $qg
0 JOBSITE ADDRESS 42 Wianno Road _ 4 j OWNER'S NAME L.Pope
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3 OWNER ADDRESS Same- _ a _ m m __, �._� P_ TEL IFAx
TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL Ei
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CLEARLY NEW:D RENOVATION:0 REPLACEMENT:J PLANS SUBMITTED: YES 0 NOL
FIXTURES Z FLOOR-4 BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB I
CROSS CONNECTION DEVICE s' J�
DEDICATED SPECIAL WASTE SYSTEM _ .1
DEDICATED GAS/OIUSAND SYSTEM ai ,:�'Eo
DEDICATED GREASE SYSTEM
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DEDICATED GRAY WATER SYSTEM ,
DEDICATED WATER RECYCLE SYSTEM F I.-i <( 41 7 ( � r `_.
DISHWASHER , 1` . I , - _
DRINKING FOUNTAIN [_ f „.:, rr '
FOOD DISPOSER �1_ I I i ' 1
FLOOR/AREA DRAIN
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INTERCEPTOR(INTERIOR)
nottnial ,: ,1 j ,KITCHEN SINK it LAVATORY • , 1, N ,, .: „ .,allient ,
ROOF DRAIN ', i
SHOWER STALL
SERVICE I MOP SINK 11 1
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TOILET i
URINAL = 1 Cii '—I ',
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES 1 [
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WATER PIPING ii ' * I I I I 1I . E, ., ..1[
OTHER BACK FLOW IJIII hII ( ImE I gni
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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 D NO Ej
IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY Q 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 i mplianc with all Perti t pr ision 6f the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Frank W.Roderick LICENSE# 7794 I SIG ATURE
MP JP® CORPORATION# 1762-C ,PARTNERSHIP®# ILLC®#
COMPANY NAME Rusty's Inc. I ADDRESS 222 Mid-Tech Drive
CITY West Yarmouth I STATE MA I ZIP 02673 TEL 508-775-1303
FAX 508-771-9310 CELL 1 EMAIL ssavery@rustysinc.com
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MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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CITY Yarmouthport MA DATE! 10/6/2016 1 PERMIT#/9AP 7-001W
e JOBSITE ADDRESS;42 Wianno Road �;OWNER'S NAME "L.Pone
OWNER ADDRESS Same TEL�_ FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL ID EDUCATIONAL RESIDENTIAL; f_
CLEARLY NEW RENOVATION: ,, REPLACEMENT 3_. PLANS SUBMITTED: YES F�J NO[.
APPLIANCES 7 FLOORS-F BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BOILER �. __ _ i ._ _1:.._ i
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BOOSTER E_ __ JI - r , IL !L, .._ ._._ IFT.-f# _ .. :_ ..l}m 4._�_
CONVERSION BURNER r_ 1( . E,. e , [ JI . , 3 .....J__._... _.,....._J .... '- ,,,._ :)',- __._.
COOK STOVE -- -- 7_ _.. _
DIRECT VENT HEATER , V -_-6 jr ,._ I . j 'I I T _, J w_- J
DRYER ___1'..............-F ____.r.___J _ ._. '__ _ _._.i_ nJ _.1
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FIREPLACE 11
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FRYOLATOR II i Lir-- tl I1 I1 I t"�. = _ (r-If
FURNACE __IL
IIE Il iI, f I t I V GENERATOR ,I I r __._. ._J r J! IJrl' I._.
GRILLE &� ._v�: r __ ..... - m._ .,._ -_
INFRARED HEATER F--- ..._IE.T _.i�� Ii I, _. ....-, ,_ _ 1- -"ir J1 if--1
LABORATORY COCKS _F _ I 'I' 1'i JT _
MAKEUP AIR UNIT - r_��__.I a,1 -._. Er ._ , .1'd S`. _ ' ...�.I . 1--1r _-
OVEN I . _I Ir= 1 Ti F_._ _ __..I-"_....�_,k'_...___. __._. I _-1 ._ w_�€: is
POOL HEATER �.. Er IL J t J- I1 L ii W '� �,*-� .1�...
ROOM/SPACE HEATER [ _,n _r ._.__._.
ROOF TOP UNIT I7.. Ii tC L1 Ir -I' . _. .I J' I __-_. C�j+
TEST _ _. .:._. ,.�._..� __. -- F
UNIT HEATER I; -_If _ !>_ _ 7 T W r z1 1r__-7z
UNVENTED ROOM HEATER -1 - I- TC 3 .i 31 LJ ... 17 - --. Di=
WATER HEATER ,-1--I I. I. I _...I;. lr If-- I: _ " �_ [ I°
OTHER IL- II- tt� i' - _ _ 7_J 1 .
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 i OTHER TYPE INDEMNITY ,,.j BOND r,,
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 b ' mpliarTe with ertinent provision of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER-GASFITTER NAME, Frank Roderick t LICENSE#17794 t , SIGNATURE
MP D MGF-. JP .m JGF[„-�; LPG!0 CORPORATION #[ -1762-C PARTNERSHIP rj# J LLC 0# ___..__
COMPANY NAME: Rusty's Inc ADDRESS1222 Mid-Tech Drive I
CITY :West Yarmouth STATE! MA ZIP 02673 TEL 508 775 1303
FAX 508-771 9310 1 CELLS _ IEMAILI ssavery@rustysinc.com
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