6 MOUNT VERNON ST - BUILDING INSPECTION (2) �02Z
RECEIVED.
INSPECTIONAL SERVICES
Con"I lonfvealth ot'INlassachusetts
1114 OCT -b A 11: 4D1
Sheet Metal Permit
Date: /p y/dO,�
Permit a
listiInatcd Job Cost: .S �3�' SD OD
Permit Pee: 5���
flans Suhmiltcd: YES_ NO Plans Reviewed: yF.S_ NO
Bn9lnell' License/t Applicant License# gjjO -----
Business Intimn:rtioo' Property Owner/Job Location fittimnation:
Nance: -tare o '�i�r ) /
Nano: �--
,Street:-�Ll� l�lU
Street:
City/Town:
City/Town:
Telephone:
Telephone:—77EC-a/,,P) 4335/
Photo I.D. required/Copy of Photo I.D. attached: YES_LXINO_
J-1 /b(-I tnrestricted license s`"Q
J-2/ M-2-restricted Ndw74ulti,fiamily-
-stories or less and commercial up to I O,o00 sq. It./2-stories or less
Residentlal: 1-2familY_ Condo/Townhouses
__ Other
Commercial: Ottice_ Retail Industrial
— Educational—
Institutional Other_
Square Footage: under f 0,000 sq. tt.v over 10,000.4 tt._ Number of Stories:
Sheet metal work to he completed: New Work:
_ Renovation: _In-� '
"VAC' Metal Watershed Rootin
b_ Kitchen Exhaust System_
Metal Chimney/ Vents_ Air Balancing
1'10vide detailed description of work to be done:
— fir I✓I .r it Q /3 ,
S+v-1.gr T�) �l.o . Iolts
INSURANCE COVERAGE: 1
icy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes No❑
I have a current liabilityInsurance Po
y
If you have checked Yes,Indicate the ps of coverage by checking the appropriate box below:
A liability insurance policy Other type of Indemnity ❑
Bond ❑
OWNER'S INSURANCE WAIVER:A that mare that the
nature licensee
this pedoes rms not have the
Insurance
this overage required by Chapter 112 of the
Massachusetts General Laws, Y 9
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent -
By chocking this box ,1 hereby certify that all of the details and Information 1 have submitted(or entered)regarding this application are true and
tions performed under the pgmtt
in compliance with all'my knowlede and that al part pertinent provision of thelMaseat metal work and chusetts Building Codeaa issued for this application will be
and Chapter 112 of he General Laws,
Duct Inspection required prior to Insulation Installation:YES__NO
PrnnreSS Illsucetinms
comments
Date
FiB 11 lu+pcctian
comments
Date
Type of License*
F
MasterI❑Master-Restricted �-d1'I °-h4 W___ ---- ❑Journeyperson Signature of LiCenSee I
/y
Pun„t a,-_. ❑Journeyperson-Restricted License Number: %�-----
roe> ._.__._._._---_.—.- . . ❑__— Check at:•r. ...r g,.gu•r.' IL
Incpoctar Signature of Permit Approval --
:y SACHl1SETT
T— lvrw5-LICENSE aT"I,
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834TT3 Joseph Bureau ohs Bureau and Bon CeNficate of Insurance (page I of l) 054201409G5:19 AM
i R& CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER ME COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS),AUTHORMED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: If the wrote holder is an ADDITIONAL INSURED,IBa polieVies)must ee aneased N SUBROGATION IS WAIVED.SUMVel to
the forms and con ft ons Of Ne pollcy,wrlaln pollclw may mqulre an endorsement A statement on this cerlifcae does net center r19hr,b the
certlNcaM M1WEer In lieu of such andomarmallal.
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INSURIEFF
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERnFY THAT THE POLICIES OF INSURANCE LISTED BELGN HAVE BEEN 195UE0 TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUWFCT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES,LIMIT SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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CERTIFICATE HOLDER CANCELLATION
END LDANYOFTNEABOVEDESCRIBED POfICIBM BE CANCELLED BEFORE
Insuretl Copy THE E%PIMTIOH GATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WNHTHE POLICY PROVISIONS.
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