63 VALLEY ST - BUILDING INSPECTION I
09/2912011 13:05 9787409846 �. �qCITYOF SALEM ri V, PAGE 01/02
Commonwealth of Massachusetts RECEIVED
Sheet Metal Permit INSPECTIONAL SERVICES'
Permit h"14 SEP 30 A 21
(Estimated Job('ast: S 350 6 _ Permit Feu: $ �U
i'hms Submitted: YES ^ NO_ Plans Reviewed: YES NO
f3usiness Lirensc # Applicant License#
l3usiness Information: Property Owner/Jab Location Inrormatiun
Name: Zam, Cia Name: !1 e UAo e C 0 r4e I
Su•cut: 7t�pA►I e�.7 � Strcut:(a3 Ve i l e y ,S -� i
City/1'own: S,9Ie," MA Cityrrown: SAIe/h MA
Telephone: 7yrf 3S9- Na00 Tetepholle: _781 - 1py0 - ,;L 0
Photo T.D. required/Copy of Photo I.D.attached: YES NO -
stair inie:a
J-1 / NI-I-unrestricted license
J-2/ NI-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 2-sturies or less
Resldentlal: 1-2 family Multi-ramily_ Condd/Townhouses_ Other_
Commarciol: Office Retail Industrial Educational
Institutional— Other
Square Footage: under 10,000 sq. f3. - over 10,000 sq. R. _ Number of Storics:
Shcat utehll work to be completed: New Work: Renovation:
I IVAC -N�/ Metal Watershed Routing_ Kitchen Exhaust System
Metal Chimney/ Vents_ Air Balancing
Provide detailed daseription of work to be done:
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09/29/2011 13:05 9787409846 ,F ,:;; CITYOF SALEM PAGE 02/02
INSURANCE COVERAGE:
I have a current I'abili insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No)<
If you have checked Yes, indicate the type of coverage by checking the appropriate box below: /\
A liability Insurance policy ❑ Other type of indemnity El 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.
Y/ — Check One Only
v
Signature of Owner or Owner's Agent Owner Agent ❑
By checking this box❑,I hereby eertlfy that arl of the details and Information I have submitted(or entered)ragarding this application are true and
accurate to the bestlW my knowledge and that all shoat metalwork and Installations performed under the permit Issued far this application will be
In compliance with all pertinent provision or the Massachusetts Building Code and Chaptor 112 of tha General Laws.
Duct inspection required prior to insulation Installation: YES NO
PrOt<ress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
FC�ty,Town
❑Master
❑Master,Restricted `
❑Journeyperson Signature of Licensee
❑JOu meyperson-Restricted
Fees License Number:
�� Check at www,�nass.rtay/dpI
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tnapector Signature of Piermlt Approval
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