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HomeMy WebLinkAboutBLDG-22-005295 .r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY YARMOUTH MA DATE 0March 22,2022 PERMIT# BLDG 22 005295 JOBSITE ADDRESS 59 ROUTE 28 OWNER'S NAME DIPTI LLC G OWNER ADDRESS 59 ROUTE 28 WEST YARMOUTH MA 02673 TEL TYPE OR OCCUPANCY TYPE COMMERCIAL ❑ RESIDENTIAL ❑ PRINT CLEARLY NEW: ❑ RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES ❑ NO ❑ FIXTURES FLOORS—. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR . FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS • MAKEUP AIR UNIT OVEN • POOL HEATER t ROOM/SPACE HEATER • ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER — WATER HEATER 1 I — 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 ❑ NO❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ❑ OTHER 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 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-GASFITTER NAME Ketan Patel LICENSE# 13666 SIGNATURE MP© MGF ❑ JP❑ JGF❑ LPG' 0 CORPORATION❑# PARTNERSHIP ❑# LLC ❑# ] COMPANY NAME: KETAN N PATEL • ADDRESS. 379 PRINCE HINCKLEY RD, ] CITY CENTERVILLE STATE MA ZIP 026322198 TEL FAX • CELL EMAIL mrpatelk(7a.gmail.com S310N M3IA321 NVId #11W213d $:33d El 1101213d 3H1 SV S3A213S N011tl01lddv SI1-11 ON SO), S31ON NO1103dSNI IVNId AINO 3Sfl 210103dSNI 210d 3OVd SIH1 S310N NO1103dSNI SV0 HOf1021 s „ "- r SACHUSETTSa UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK • o CITY\P•11 C ` 1 ti\I-NtI `\,OkA -- MA DATE n /1 1/0/,2 ESTE DDRESS 3 •1 ��-� ,2 OWNER'S NAME I B_I'L`' HA. CANS DDRESS — �� TELcirA-7/t . FAX TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL❑.---- EDUCATIONAL ❑ RESIDENTIAL❑ CLEARLY NEW:❑ RENOVATION: ❑ REPLACEMENT: [• "--- PLANS SUBMITTED: YES❑ Np APPLIANCES- FLOORS.-4 BSM 1 2 3 i 5 6 BOILER gI 9 _ 10 11 12 13 1 ti BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER - DRYER f FIREPLACE FRYOLATOR - FURNACE - GENERATOR GRILLE INFRARED HEATER , LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER • ROOM/SPACE HEATER - ROOF TOP UNIT --� - TEST _ UNIT HEATER UNVENTED ROOM HEATER • WATER HEATER 1 OTHER T INSURANCE COVERAGE I have a current figi___ALkinsurance 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 ❑ 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. J . _ __ SI�NAT RE OF OWNER OP,AGENT CHECK ONE ONLY: OWNER,2' AGENT El : I hereby certify that all of the details and information I have submitted or entered regarding this application are true and a curate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cornpliapcg it0 a Pe inept provision of the �'' Massachusetts State Plumbing Code and Chapter 142 of the General Laws. g L1 PLUMBER-GASFITTER NAME 7 i / , 1 LICENSE# I3.t IC;NATURE MP/Er MP/Er MGF❑ JP ❑ JGF LPGI [I] CORPORATION CORPORA k� ❑# PARTNERSHIP❑t� LLC❑ COMPANY NAME 4.t 1 pl�C 1Ps ADDRESS cI i 1 Hoak. CITY efril, li Lt ! � t(k(r STATE I'`4' ZIP 0 Z.(5 TEL J 9 FAX CELL J R icCI 34 E�5 b /EMAIL i?" 1 ROUGH 5FE TES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES x'a�7J`x� ���. �l� Yes NO THIS APPLICATION SERVES AS THE PERMIT (l ) FEE: v PERMIT { PLAT REVIEW NOTES