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Home My WebLink AboutBLDP-22-005268 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK u3= s.�[ CITY YARMOUTH MA DATE 3/22/22 PERMIT# BLDP-22-005268 JOBSITE ADDRESS 59 ROUTE 28 OWNER'S NAME DIPTI LLC P OWNER ADDRESS 59 ROUTE 28 WEST YARMOUTH,MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL El RESIDENTIAL El PRINT CLEARLY NEW:❑ RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES El NO El FIXTURFS • FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTE DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER 1 WATER PIPING OTHER OTHER DESCRIPTION: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES El NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY El OTHER TYPE OF INDEMNITY El 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 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. PLUMBER'S NAME Ketan Patel LICENSE 18666 SIGNATURE MP El JP El CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME KETAN N PATEL ADDRESS 379 PRINCE HINCKLEY RD CITY CENTERVILLE STATE MA ZIP 026322198 TEL FAX CELL EMAIL mrpatelk@gmail.com ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVE AS THE ID ❑ FEES$ PERMIT# PLAN REVIEW NOTES MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK 7 CITY ' i J . CL/vU1�LV �� MA DATE ) '� .;?1 U PERMIT# �Z SZ r°� JOBSITE ADDR SS rj 9 Z li ( )V OWNERS NAME 1 1�tv l�{ �]�tce� P OWNER ADDRESS i -- TEL`, X-'I4l--. (`A FAX FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑— EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW:❑ RENOVATION:❑ REPLACEMENT:0— PLANS SUBMITTED: YES❑ NO 0,/ FIXTURES-1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM i 1 DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM ' DEDICATED GRAY WATER SYSTEM ' DEDICATED WATER RECYCLE SYSTEM ' DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER 1 1 FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) r KITCHEN SINK _ LAVATORY • ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET I URINAL j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER , \ . . INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES❑ r 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 ❑ i OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the j Massachusetts General Laws, and that my signature on this permit application waives this requirement. • CHECK ONE ONLY: OWNER R AGENT ❑ SIGN URE F OWNER OR AGENT 11 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 comp• nc-with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. /la)� r PLUMBER'S NAME LICENSE# 21, .6 - SIGNATURE MP❑ JP C RPORATION❑# PARTNERSHIP❑.#a 1 , LLC❑# COMPANY NAME f ) Q(k VR. \ ADDRESS 3� 1 1 (.``�Ce ►'1�nC IC td CITY C<I e, 'J (e' STATE M '1 rl ZIP 07� 7____ I TEL §bpD e4{ 'o o`-) FAX CELL 5-OF er0 1 g DOD EMAIL /'/ rP 4 i A V 3 ma%7 .C.'"l ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT it PLAN REVIEW NOTES