3 NURSE WAY - BUILDING INSPECTION (003) Commonwealth of tNlassachusetts
Sheet Metal Permit
Omc: Anal - 3 Permit #
Estimated Job Cost: $__ �s�� Permit Fee: S
PLm, Submitted: YES NO Plans Reviewed: YES NO
Business License 4 045q-S�-(7a (aS� Applicant License k !A
Business Information: Property Owner/Job Location information:
Name: 6—T--Da4k t? 'Am toiT_CL, 1'.'%A...
Street: Lk I;:_SQ-W e-I -DV-- * 9) Street: a3 L1 &9t)jg 1.2 c Anq
Cityflbwn:CA-71I��;� city/Town: SS`141� �—
Telephone: 9? C6 b�'] (o(j Telephone:
Photo I.D. required/ Copy or Photo I.D. attached: YES�4 NO
swrnnm:u
J-1 roirestrictcd license
J-2/ DI-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 2-stories or less
Residential: 1-2 familyQ� Multi-family_ Condo/Townhouses_ Other_
Commercial: Office Retail fndustrial Educational
Institutional Other
Square Footage: under 10,000 sq. tt. 0<- over 10,000 sq. ft. _ Number of Stories:
Sheet metal work to be completed: New Work:( Renovation:
I[VAC_ Metal Watershed Roofing_ Kitchen Exhaust System
`fetal Chimney/ Vents_ Air Balancing
Provide delail`ed dese'ipt`ioonn of.%mink to be done:
�p�7G h- � �3°CSC ��'i�_ 'Rt{i' �G2A1-.aEo 5C� C�G✓I�
INSURANCE COVERAGE: I(
I have a current liabilityInsurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yeo❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability Insurance policr5f Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: l 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 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
Prouress Inspections
Date Comments
Final Insuectimi
Data Comments
Type of License:
By faster
rue \ ❑ %faster-Restricted C
coy'r —__ �— ❑Journayperson Signature of Licensee �
Per wit s -- --- \��
❑Jaurneyperson-Restricted License Number:
Pouf - -- --' --- ❑
— - ---- Check at Ll
I
In51jactor Signalure of Permit Approval