6 NURSE WAY - BUILDING INSPECTION (3) Commonwealth of ivtassachusetts
Sheet Metal Permit
Date: Ira
Pcn„it #
Estimated Job 0m: .S (of 's 00 Permit Pee: S
Plans submitted: YES _ NO_ Plans Reviewed: YES _ NO
Business License # D43AS�C>Ls Applicant License # I DC( ---
Business Intormation: ( Property Owner/Job Location information:
Name: �rlE ��� Name:
Street: ` t°-w�� �R � Street: k G'3 l\-X--s2Se c�y
City/Town: City/Town: � ate_ S�
Telephone: (�L— /f`� Telephone: 7 3� `� 9
Photo I.D. required/Copy of Photo I.D. attached: YES K NO_
'S,Jrrt11i1,L,
J-1 / : 41- nrestrictcd 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 � Multi-family_ Condo/Townhouses Other
Commercial: Office_ Retail_ Industrial Educational
Institutional_ Other_
Square Footage; under 10,000 sq. ft. over 10,000 sq. tt. _ Number of Stories: _
Sheet metal work to be completed: New Work: Renovation: _
IIVAC Metal Watershed Routing_ Kitchen Exhaust System
Metal Chimney/ Vents_ Air Balancing
Provide detailed description of w,or(k�to be done:
�A�in ✓�/C � 4t �i ] �(_lc� ('� i he �9-'� �- 7LtJ(
Ti--
_
INSURANCE COVERAGE: �[p
I have a current liabilityInsurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 yes,V�, No El
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 b467-i'Aereby 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
Prouress Insoectionslnsoec IOUIS
Date Continents
Final 11myectiun
Date Continents
Type of License: �(�\
By_ laster 1 1
tine _ ❑ Master-Restricted
u`tyaoaa ❑JOUrneyperson Signature of Licensee
Ponnil x.
❑Journeypersan-Restricted License Number:
_.----
__l ❑_ -- Check at:vsr.v.ind:;a�ovbl�il
Inspector Sl9naturo of Permit Approval