8 NURSE WAY - BUILDING INSPECTION (3) 14—
Commonwealth of Massachusetts
/ Sheet Metal Permit
PcrmitN ---- - -
1
Fstimatcd Job Cost: S (p__ �j (� Pcrmit Fee: S
PLms Submitted: YES NO Plans Reviewed: YES
/r NO
1usiness License N CAS q,5(o GCo'5— Applicant License k C
Business Information: Property Owner/Job Location Information:
Nano: ���er7ce_ c� Name: N,3R—zW uJ Q -LC—
Ij
Street: �ewP� �2 -*--S Slrect: C6 N9SL� Wr4EI
City/Town: t-01 l we O- City/Town:
'relephone: �� �5`� (o► t� Telephone:
Photo I.D. required/ Copy of Photo I.D. attached: YES NO_
swrnm:d
J-1 (0mrestricted license
J-2/ M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. R. / 2-stories or less
Residential: 1-2 family 'K/- Multi-family— Condo/Townhouses— Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. X1, over 10,000 sq. ft. — Number of Stories:
Sheet metal work to be completed: New %Vork:%,r,,_ Renovation:
IIVAC (Metal Watershed Routing _ Kitchen E.ehallst System
`fetal Chinmey/ Vents_ Air Balancing
PrOvlde detailed
(description
�of work to be done:
P C
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 lh 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 boCereby :ertlfy that all of the details and Information 1 have submitted(or entered)regarding this application are true and
accurate to the best o y 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
Proeress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By _. Master
14,we_ ❑ Nlaster-Restricted ,&SVA JA
CilyrTom) _
❑Journeyperson Signature of Licensee
Pernul R
❑Journeyperson-Restricted License Number:
Foe i _
Check al vr,v.v.in.I55.govAtlrl
Inspector Siipiature of Permit Approval