14 UNION ST - BUILDING INSPECTION (2) Nf 1 Commonwealth of (Massachusetts
1 p 7 Sheet 1�(etal Permit
Date: -- "1 /z Permit if
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FsIimaled Job Cost: .y_ t,V— Permit Fee: 'S flan, Subntiued: YES _ NO� flans Reviewed: YES_ NO_---
Business License !t _ ! /O Applicant License /f �Q - -
Business I'' f�"`nfio�nnation: Property Owner/Job Location Information:
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Name: O jI J-IrIC Name: jtllC
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Street:4 �rlH1l�(�S Imo_ Sucet:
City/'town: qG GSA City/-[own:
!'cicpltone: Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES
J- : 1-1-unrestrictcdliccnse qn����
J-2/ M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq• ft. / 2-stories or less
Residential: 1-2tamily-2c Multi-family_ Condo/Townhouses Other
Commercial: Office— Retail— Industrial— Educational
Institutional Other_
Square Footage: under 10,000 sq. tt. —over 10,000 sq. ft. _ Number of Stories:
Shcct metal work to he completed: New Work: _ Rcnocation: A
I IVAC_ Nfetal Watershed Roofing _ Kitchen E.xhaudt System
Metal Chimney/ Vents_ Air Balancing
1'1'ovide detailed description of work to be done:
8 D�Yri
INSURANCE COVERAGE: 004
I have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Y No❑
If you have checked Yes, indicate t Other type of indemnity pe of coverage by checking the appropriate box below:
❑ Bond ❑
A liability Insurance polic '.
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 112 of trle
Massachusetts General La S. 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 I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the besy knowledge and that all shoat 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
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Pro IBsocctimis
Date Comments
Final Insucction
Date Comments
Type of License:
By ❑ Master
rate — ❑ Klasler-Restricted
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❑JOurneyperson Signature of Licensee
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❑Journeyperson-Restricted
License Number:
I
Foe 5 - --- -- — ------- ❑
- -- ----- Check at .v•.ry m.r.;s.�ov?,ILI
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In spaetor Signaluro of Permit Approval