22 SHILLABER ST - BUILDING INSPECTION (2) Comijim realth of iNlassachtlsetts
Sheet Metal Permit
Lstimated Job Cost: .S lob/f Pennit Pre: $ -- -
Plans Submitted: YES NO vf/ �!` Plans Reviewed: YES NO ---
Business LICCn5e 1/ Applicant License /#
Business InIbrnation: Property Owner/Jub Location information:
il0'� lyf'
Name: �/ f/!7y �a /�o,b, Name: C ��I J-1'117e ��A'u'Zl
Sti (IyI /`I/// l Street:
City/'lbwn: �{� //ty /���b p�n� City/Town: -S-Q l/'i
I'clephone: / ��q10 Telephone:
Photo I.D. required/Copy oP Photo I.D. attached: YES_ NO
s„rn�au:a
J-1 / M-l-unrestricted 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: 1-2 family Multi-Family_ Condu/ Townhouses_ Other
Commercial: Office_ Retail_ industrial_ Educational _
Institutional Other
Square Footage: wider 10,000 sq. tt. )—/ over 10,000 sq. tt. _ Number of Stories:
Shect metal work to be completed: New Work: Renovation:
11 VAC 7)—< Metal Watershed Routing_ Kitchen Exhaust System _
` eWl Chimney/ Vents_ Air Balancing_
Provide detailed description of work to be done:
� C c° � G J'`i✓c�6��O/7 lc��'�or�j �O/�l�i'
i
INSURANCE COVERAGE:
I have a current liabilityInsurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No El
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
Other type of Indemnity El Bond ❑
A liability Insurance policy ❑ Yp
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
ut Owner Agent ❑
Signature of Owner or Owner's Agent
By chocking this box❑.I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
In complianceowbest ith all pertinent my knowlede and that pertinent provision of the ll shoot metal work and instaltions perfored Massachusetts Building Coda and Chapter 112 of lder the prit he Generalo issued for this application will be
Laws.
Duct Inspection required prior to insulation Installation: YES_ NO
Proeress IlljRKq!M
Date Comments
Final inspection
Date Comments
Type of License:
By .. ❑ Master /�
rule ❑ klaster-Restricted r(,�d(
C dy:romn ❑JOurneyperson Signature of Licensee
pem,q x _ ❑Journeyperson-Restrictud
License Number:
rod 3
--- ------ Check at LI
I
Inspector Slynatt o of permit Approval
£OMMONWEALTH OF MASSACHUSEITS
miallaium
SHEET P.9ETAL �V0.9KERS
AS A JOUPNEYPEkSON U RISTRICTEL°� )
ISSUES THE ABOVE LIGENS TO
�l
TOfJD M BULLI IJ :�; y �` I16
7 HENDERSCrN 4T .; 31_- Ih
SOMERVIL.LL f1A 0°1.)�i5 2511°
1222Jt• 02/28/t , I3653
f Foltl Then Detach Along All Pedorati s
r