12 RICE STREET BPA-17-114 42-511S
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Commonwealth of Massachusetts
Sheet Metal Pim " w
Date: 2 -21-U(7- 2811 FEBP2r�lig 121" i b.
Estimated Job Cost: $ x,500 Permit Fee: $
P1ans.Submitted: YES NO Plans Reviewed: YES NO
Business License# Applicant License#
Business Information: Property Owner/Job Location Information:
i� Il SI1V' Name: Jae Q���'
Name: �
Street: 2 -0,1 le l S Street: 12— GQ s �-
City/Town: QAC 6O4:� /I') City/Town: &lei
Telephone: qG 6 -q) 3 a- Telephone: 01 �_
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
di-
M-1-unrestricted 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 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 Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
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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 Gen I Law nd 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 taws.
Duct inspection required prior to insulation installation:YES NO
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
BY El Master r-9
Title ❑Master-Restricted
City/Town QJaurneyperson
Signature of Licensee
Permit# � ('�
❑ C
Journeyperson-Restricted License Number: [ � 't'
Fee$ ❑
Check at www.mass.gov/dpi
Inspector Signature of Permit Approval