14 WITCH WAY - BPA Commonwealth of Massachusetts
Sheet Metal Permit
('(� Date: � I �Q I �� Permit #
Estimated Job Cost: S �l `��.� Permit Pee: S_ _�U Lv 1 (e
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License # a00 t 1t912j::>t� Applicant License# 4/8 L g7 Z TES 2 ly
I
co Business IInformatio(nn- Property Owner/Job Location Information:
Name: �e.I OLA" Cat I C`"`+ • Name: _kar•erl\ E JQ- cZ
l Street: 11t Iiwy\ 0(5ti4 Street:
City/Town: Cseot���owh City/Town: 5
Telephone: q-28-3Sa "sSOc> Telephone: q-7Q ^ 7LJq - 0709
Photo I.D. required/ Copy of Photo I.D. attached: YES NO
Stan Initial
J-1 / NI-1-unrestricted license
J-2 / NI-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 Condo/ Townhouses_ 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: New Work: Renovation:
IJVAC ✓ Nletal Watershed Rooting— Kitchen Exhaust System
Metal Chimney/ Vents Air Balancing —
Provide dletaill-d descripttiion of%voi-k to be done:
1n5t4V� C2(� CCctI 1fit { ^+o W�' C --�a ScN,J e (AaV)
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 box❑,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
Protress Inspections
Date Comments
Final Inspection
Date Comments
Type ofL" ense:
By aster
Title ❑ Master-Restricted -.
City/Town
❑Journeyperson Signature of Licensee
Pennit ❑
# ^�,�
Journeyperson-Restricted License Number:
Fee S ❑
Check at www.mass.govldul
Inspector Signature of Permit Approval