B-17-89 COONS HVAC X12 7 3
Commonwealth of Massachusetts
Sheet Metal Pe,�j
Date: a Q 11 141, f El vrit/ , 9*, 33
W �Estimated Job Cost: $ � � 7 Permit Fee: $_nr?
Plans Submitted: YES , NO Plans Reviewed: YES NO
Business License# Applicant License# S�
Business Information: Property Owner/Job Location Information:
Name: 6�1` 4&(VICE SLC Name: Ace
Street: Street: �o
City/Town: GPA�roo�� City/Town: P�
Telephone: T7 8 Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1 M-1- nrestricted license
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 family Multi-family Condo/Townhouses Other
Commercial: Office Retail Y 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:
HVAC v Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailedescription of work to be done:
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INSURANCE COVERAGE:
1 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[],1 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:
By Master
Title
❑Master-Restricted
City/Town
❑Journeyperson
Permit#
❑ Signature of Licensee
Journeyperson-Restricted License Number:
Fee$ 4ee-7
Check at www.mass.gov/dol
Inspector Signature of Permit Approval