183 NORTH ST - BUILDING INSPECTION (3) Commonwealth of Massachusetts
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Sheet Metal Permit
Date: Permit 9
Fstimated Job Cost: S �u— Permit Fee:
Plans Submitted: YES _ NO /\ Plans Reviewed: YES NO
Business License k Applicant License t# � () -;,) 1,0
Business Intbrmation: Property Owner/Job Location Information:
Numc:�1C�11E � ) CI It �� I' Name: He r' I'\cindeZ
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Street: ( `\ i,er? `n Ci Street:
City/Town: i-I>LNQ Ll ,� IG DI �`Z City/town: JU VI, Gi
Telephone: 7� f 5�3'� Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
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unrestricted license
J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. It. / 2-stories or less
Residential: 1-2 family—12 Multi-family_ Condo/ Townhouses Other
Commercial: Office_ Retail_ Industrial_ Educational
Institutiona Other_
Square Footage: under 10,000 sq. tt. t� over 10,000 sq. ft. _ Number of Stories:
Sheet metal work to be completed: New Work: Renovation:
11VAC_ Metal Watershed Rooting_ Kitchen Exhaust System_
Metal Chimney/ Vents_ Air Balancing
Provide detailed description of work toI be done:
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INSURANCE COVERAGE:
I have a current liabilityInsurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability Insurance policy ❑ Other type of Indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 112 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 Owner's Agent
By checking this box❑.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 sheet metal work and installations performed under the permit Issued for this application will be
In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct Inspection required prior to Insulation Instalfatlon: YES_NO 4,
Proartss Inspections
Date Continents
Final Inspection
Date Comments
Yaster
cense:
By
rifle_ ❑ Niaster-Restricted
Cnyrio.vn ❑Journeyperson
Signa of Licensee
Ponnd#__ /
❑Journeyperson-Restricted h '2License Number: G lJ 2
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Check at'.www.m.lss.jovhlL
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Inspector Slynature of Permit Approval
o`COMMONWEALTH OF MASSA�HUSETTS
• • • • •
y'. BOARD OEa".."
Ch SHEET' METAL,WORKERS a
TISSUES 1THE {FOLLOWINA MENSEat
3$ AS 'A MASTER UNRESTRkgjED ` .
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