11R WINTER ISLAND RD - BUILDING INSPECTION r
( / Commonwealth of Massachusetts
Sheet Metal Permit
Permit #
lislimated Jot) Cost: .$ �y� 6� Permit I cc: S_
PIanS SubmitlrJ: YF.S _ NO_ Plans RCVICIVCd: YES NO
Business License # - Applicant License # ---
BusinessInt/imnation: / Property Owner/Job Location hirormati�onn:
/ ,Name: �N ((� L -- ' Mime: aett7g�th
;iireet: fer t'�Qciae_., e ! Street: Z& /�/A d�.4,C.. z�''3�
City/fawn: �nU� � X City/Town: / 1=
Telephone: O L��f- C�J(1 V/7- = Telephone:
Photo l.D. required/Copy of Photo 1,D. attached: "YES— NO
swrr i�duai
J-1 m-I unrestricted license
J-2 / M-2-restricted to dwellings 3-Stories or less and connnCrcial up to 10,000 sq. R. / 2-stories or less
Residentlal: 1-2 family_ N(ulti-lumily_ C'undu/ Townhouses Other
Commercial: Office_ Retail_ hidustrial Educational —
hutitutional Other
Square Footage: under 10.000 sq. tt. �j over 10,000 sq. tt. _ Number of Storics:
Slice t metal wor to be completed: New %Vork: _ Renovation:
IIVAC Metal Watershed Roofine _ Kitchen Exliatat System
Metal C'hintncy/ Vents_ Air Balancing
I'm%ide detailed &SCription of work to be done:
��3� � 6t*E �����/:/.jrfjC �� ✓1.,y�� � l/S� /)ljl� l��,L� l't/l/,�/�—
S4e,, /t+, o l 9 -7 0
INSURANCE COVERAGE:
policy or its which meets the requirements of M.G.L. Ch. 112 Yes JNO
I have a current liability Insurance p y ❑
If you have checked Yes, indicate Other a type of coverage by checking the appropriate box below:
❑
A liability Insurance policy 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 chocking this box❑.I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
ed under the
in compliancee
ewbest ith all MY knowlede and that pertinent provision of the ll shoot metal work and installations perfor Massachusetts Building Code and Chapter 112 of he Generrmit al issued for this application will be
ral Laws.
Duct Inspection required prior to insulation Installation: YES_NO—
Progress 111SPectl0lls
Date Comments
Final hlsucction
I111e Comments
Typ�of License:
By Q Master
ntle ❑ Nlasler-Restricted
i
❑Journeyperson Signature of Licensee
i
❑Journeyperson-Restricted
License Number: �W 7�
�:�--- -- -- --- ---- ------ Check 31 rn_i.in.c;r;.,uw!0L
I
Inspector Skjoaturo of Permit Approval