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2 NURSE WAY - BUILDING INSPECTION (002) Commonwealth of iNiassachusetts Sheet Metal Permit Estimated Job Cost: $_ SC 7 Permit Fee: .S— Plans Submitted: YES — NO_ flans Reviewed: YES NO Business License rr Od tA<-6- C) Applicant License r# y 9 -- Business Intittmation: Property Owner/Job Locatirn, Information:7 Name: z� \ � �� C_ Namo: _1ar�+h�,c . 42 ,ll1 t k Street: Street: Q15- AQ2Se City/Town: C-2 Lt,he. rtx-e ti City/Town: JraILAA I'elephone: l7 p (� jam( l l Telephone: Cog 3f -, �S Photo I.D. required/ Copy of Photo I.D. attached: YES NO swrrv��w:�t J- AHD, irestricted license J-2/ M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. 11. / 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. ti, over 10,0000 sq. tt. — Number of Stories: Sheet metal work to he completed: New Work: V\ Renovation: I IVAC_ Metal Watershed Routing _ Kitchen E.rhalrst Systun— Metal Chimney/ Vents_ Air Balancing — I'rovidc detailed description of work to be done: S✓IS:�1�.Q �A/ �:-Leeal. �'lo'C�, /A/ t1ZL �-c�rz.,}rr�t c�:rc�l,�_ --_�La�� / (' ivyC_� �C�rG �-N L �`C 1i ✓ItUG�'�� -- - - INSURANCE COVERAGE: I have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No El If you have checked Yes, indicate t ty Other type of coverage by checking the appropriate box below: ❑ A liability Insurance policy 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(of entered)regarding this application are true and ons performed uner the prit In complian eewbest lth all pertinent my knowledge and that pertinent provision of he ll shoot metal work and Massachusetts Building Cods aind Chapter12 of the G neeraln issued for this application will be Laws. Duct inspection required prior to Insulation Installation: YES_NO Prouresslnsipections Date Comments Final htxuectiun Date Comments i Type df License: k §ter \\ ©r _ yt rdle _ " ❑\Nla�ter-Restricted ro:•.n ❑Juoneyperson Signature of Licensee ►VV� I Panne s_---_------ ❑Jou rneyperson-Restricted LI �� License Number: I rod i _- ---- -- - — ❑ ----- _----- Check at '+!'•v_v.ul.l s`:.•luy'iIL I I Inspector Signaturo o mit Approval �