9 NURSE WAY - BUILDING INSPECTION (3) Commonwealth of iNlassachusetts
V
Sheet I'V[etal Pe RECEIVED
CT ONAL SERVICES
Date:
{{--� 1114 --
Estimated Job Cost: S Peimit fee: S — —
PLms Submitted: YES _ NO Plans Reviewed: YES_ NO
Business License k C�+3xf eC— Applicant License t# --
111siness liltixlmat�ion: ( Property Owner/Job Location intirrmation:
Name: trr.L�C ale Nam 4�e: �u9W4u �d-�
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street: �( e/ � Street: c� OJtZ—�,e
City/Town: L'C�K L(w�n 7�Y1 City/Town: ' � L�
Telephone: 9� ( (� 11 Telephone: C/7G 3 f 2 7
Photo I.D. required/Copy of Photo I.D. attached: YES D�' NO_
swrndu:u
J-1 / �nrestricted license
J-2/ M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 2-stories or less
Residential: 1-2familyC�,_ 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 Rooting— Kitchen Exhaust System—
Metal Chimney/ Vents_ Air Balancing
Provide detailed description of work to be done:
Gi�� tFa Voc-C f/L�J�F�I C/ - C'�L_.c '4 cSZ
--------- -----
5—S. Ooq c\ t t
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 Yet%indicate t e 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 1 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
Iarouress Inspections
Date Comments
Final Inspection
Date Comments
rMaster
License:
By.. p
rine _ ❑ Mester-Restricted
City:Tau-n ❑Journeyperson
Signature of Licensee
Pennd a _
❑Journeyperson-Restricted License Number:
Foe 4 El_
Check at•.vww.m,c;s,rwvh It i
EA�,,A
inspector Signature of Permit Approval
__. ..1