80C WHARF ST - BUILDING INSPECTION Commonwealth of Massachusetts
Sheet iMetal Permit
Date: /2 d�Cl/3 Pcnnitlt _ '\
Fstimated Job Cost: S Permit Fee:
Plans Subn,iltrd: YES _ NO ✓ Plans Reviewed: YES NO
Business License g jti(, Applicant License I# --
Business Intixmation: Property Owner/Job Location Intirrmation:
Name: P1c9t MCci n,�«� ( _ Name: tj
Street: Street: EL
City/Town: C4J�� iE J CC A— MA City/'town: J'q I E
'relephone: 7 Lj'2 - ui �t 5 Telephone: 617 . 5°I
Photo LD. required/Copy of Photo I.D. attached: YES NO_
��--J-1 / �l�l- nrestrictcd license staff Initial
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 gamily_ Multi-tamily_ Condo/ Townhouses v1 Other
Commercial: Office_ Retail _ Industrial _ Educational
Institutional_ Other_
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. _ Number of Stories: _
Sheet metal work to be completed: Nov Work: _ Renovation:
I IVAC_ Metal Watershed Rooting_ Kitchen E.ehattst System
Metal Chimney/ Vents_ Air Balancing_
Provide detailed description of work to be done:
�. VAi.Jn D
INSURANCE COVERAGE:
I have a current liability 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 ❑ 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 boxo,I hereby certify that all of the details and Information I 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
Proeress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:l
By._ 'QJ Master :'�
ri e ❑ Master-Restricted )-r
CliyrTown ❑Journeyperson
Signature of Licensee
Pamut x.- 3 8 G 2
❑Journeyperson-Restricted License Number:
Fees
�� ❑— Check at,. ww-limss.rloviIllil
Inspector signature of Permit Approval