18 NORTHEND AVE - BUILDING INSPECTION (4) c� t��,2-1 q3�1 ,� �� ✓y�
Commonwealth of Massachusetts
J— Sheet Nletal Permit
Date: Permit #
Estimated Job Cost: S Permit Fec: 6
Plans Submitted: YES NO_ Plans Reviewed: YES NO
Business License # Applicant License #
Business Information: Property Owner/Jobl Location Information:
I Name: Name: Q- -C"I-� S2
Street: Street: 'v a4e4 .10
City/Town: City/Town: So. MA • 61410
'telephone: Telephone:
Photo I.D. required /Copy of Photo I.D. attached: YES_ NO_
start imat
J-1 / J4-l-unrestricted license
J-2 / NI-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 2-stories or less
Residential: 1-2 family -)(— Multi-family— Condo/ Townhouses— Other
Commercial: Office Retail Industrial Educational
Institutional_ Other_
Square Footage: under 10,000 sq. ft. -�—/ over 10,000 sq. ft. _ Number of Stories:
Sheet metal work to he completed: New Work: Renovation:
I IVAC _ Metal Watershed Rooting_ Kitchen Exhaust System
Metal Chimney / Vents_ Air Balancing
Provide detailed description of work to be done:
3 f!' S d PV n M �Efr� rt�(�t10 F9
-- ----- -- —------------- - - --
INSURANCE COVERAGE:
I have a current liability insurance 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 chocking 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 installation: YES_NO
Progresslnspections
Date Comments
Final Inspection
Date Comments
Type of License:
By ❑ Master
Title ❑ Master-Restricted
City/Tcwn
❑Journeypers°n Signature of Licensee
Pennil x
❑Journeyperson-Restricted License Number:
Pee S
Check at sv,vsv.nctss.govrdpl
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inspector signature of Permit Approval —
` CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
120 WASERNGTON STREET 3n FLOOR
'ILL. (978)745-9595
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THomAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CODaUSSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Date
Job Location 1N1 Ur��o0' h& "
Home Owner Address ZX 1,1 yd)Gc�®�
l�Or
Present Mailing Address ID XY �
The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one>or two-family dwelling, attached or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two year period shall not be
considered a homeowner. Such "homeowner' shall submit to the Building Official, on a form acceptable
to the Building Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and
other applicable by-laws and regulations.
The undersigned "homeowner" certifies that he/she understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'SSIGNATUR ��/ /
APPROVAL OF BUILDING INSPECTOR � N IMc�/