B-17-997 - 0043 BOSTON STREET - Building Permit \ r 9
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Conmlon«'ealth of Nlassachu16;' &t'sl`
Sheet cNletal Permit 2011 OCT 10 A 11: 0i
Date:
[i• - Permit#
a-- Estimated Job Cost: .S aUC�(u. of - OQ.- _
�-- - Permit Fee: S 22 0 ---
Plans Submitted: YFS I,�NU Plans Reviewed: YES ,NO
1
Business License# 1 Applicant License# �9 _ ---
Business Information: / Property Owner/Job Location Information:
Nano: _� �S�Sy�-�.�
Nanne:
Street: �0a •�
- Street:
City/'Town: wl A- City/Town: 'L)
Telephone: _ ct 7o `y(a Telephone:- bi5'�a 31,3
Photo I.D. required/Copy of Photo I.D. attached: YES NO
J-1 / J1-1-unrestricted license s►,rri ►r►a►
J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,OU0 sq. ft./?-stories or less
Residential: 1-2 tarnily Multi-tainnily L Condo/Townhouses
Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq, tl. Number of Stories:
Sliect metal work to he compacted: New Work:
Renovation:
I IVAC 1Z ►Metal Watershed Rootin
b Kitchen Exhaust System -
Metal Chimney/ Vents Air Balancing
Provide detailed description of work to be done:
INSURANCE COVERAGE:
I have a current liabilityinsurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes o❑
if you have checked Yes,indicate the pe of coverage by checking the appropriate box below:
A liability insurance policy
( Other type of indemnity ❑ Bond ❑
aware that the licensee does not have
caN the Insurance coverage n waives this s requirement wired by Chapter 112 of the
OWNER'S INSURANCE WAIVER:I am
Massachusetts General Laws.and that my signature on this permit app
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
J application will be
By chocking this box1�1 i hereby certify that
tiall shoot metalwork an�installed pertonmed under the permid(or entered) tassu d faing this thl!appn are true and
accurate to the best of my knowledge and
in compliance with all pertinent provision of the Massachusetts Building Cods and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation:YES NO
Prot-tress [nsprctions
Comments
Date
Final [nsncction
Comments
Daw
Type of
By L' nse:
aster f
i
rate ❑Master-Restricted
❑Journeyperson gnature of Licensee j
I
c�erm,t x. ❑Journey person-Restricted Li ense Numb
red 5 - -- --- ❑ ----- heck at:ry v mas s.clov'ct
6A-
Inspector Signature of Permit Approval