BUILDING PER APP B-17-49 0 q,� -2
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Coninj«nivealth of?Vtassachusetts
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Sheet IVietal Permit 'all JAN 23 A
Date: � y 1'crneit
l: tine:etcd Job('(rat: Permit l e e': A2 e>6
Plate,Submitted: YEAS NO 111ans Re vitnvud: Y S NO
Business License:# no( Applicant License �
Business Information: 1 n PnVerty Owner J Job Location Information:
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Name: �S�?�'.�z 2Li ( eiaC e t) lamer: i-fe!a ){`U n- Ve V- _Y)t
street:� � p�s� ��-� strep t � �rn�T��� 9V
City/` own: P_Y-') Cityrrown:
Telephone: is-.2%5 - Telephone- (C I - 5l0 - Q 13�J
Photo I.D.required 1 Copy of Photo I.D.attached: YES ( .. .�
err ems€
J-1 l M-1-unrestricted license
J- 11t- -resteri:te todwellings 3-stories or less and commercial up tee 1 tt.000 xy. ft.I?-storics or less
Residential: 1-2 family Multi-family Corte 1 Townhouses Otlar
Commercial: Office Mail Industrial Educational
Institutional talar
Squame Footage: under 10.000 sq. ft, over 10.000 sqft. Number of Stories:
Sheet metal work to he completed: New Work: Renovation:
IIVAC Metal Watershed Roofing Kitchen Exhaust-System
Metal Chimney/Vents .lir Balancing
Provider detailed description of work to be duets:
m(�et✓e�`� t(Ly
INSURMCE COVERAGE:
1 nava a current fiabifity Insurance policy or its equivalent which meets the requirements of M.G.L.Ch.142 Yes Q No 0
It you have checked YAM Indicate the typo of coverage by checking the appropriate box below:
A liabilityinsurance '
polity � ��type of Indemnity �] Bond � i
3
OWNER'S INSURANCE WAIVER:lar»aware that that licensee dna boyo the Insurance covorago required by Chapter 112 of the
Massachusetts General Lays,arxi that nay s ature on this permit application waives this rvI ulvemont. }}
Check One Only 1
Owner Agent 0
'Ackre oft s Amt {
By che"S tltb hastj I hereby cwft Mat an of ow dewft and Mft"ratim 1 (or saa r0owdifta thk sM110011at We and
acturaft to Haw bad at my knowledge and Mat all MW work and katailadons perlbnmd undw Ma pewit bred tar Oft applicatim WO be
in eomobncs wfth#M pvtIvient prodelon offt Maossdomwft ft""code and Chapter 112 0(M*GwW*i UMM
Dud Inspection required prior to Insubdion Instatllittim:YES NO
ELogt'ess tnspeyiotns
gatexarr MON
Final tttspect n
at• t nments
Type of License:
By
312_W Q ,taster-Restricted
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�`a�nat flll.;censee
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0Joutr,&4pevsw-ResUkcted
License Nur;
Check at ,imisja-v,'d4jI
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