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B-17-733 - 0002 BRADFORD - Building Permiti Commonwealth of Massachusetts. ,i�,.r, Sheet Metal Permit Date: {J g d Permit#G -l A I1 00 Estimated Job Cost: $ , ©OCR Permit Fee: r^ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# 6 T �-6 Business Information: I�Dmt 2� Property Owner/Job Location Information: Name: J4+K {1 y& l 1 1C Name: RV Se ti S�C ( & l Street: _I fw Avc Street: 'Z f�r a j fkvd S City/Town: pe.aL 3Daj rA, A 01 q 60 City/Town: S(K l2/I,-'1 M 14 D l f -o Telephone: l 75 3 17 IL( 2 3 7- Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO 61 Staff Initial J- YM-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 4 Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional) Other Square Footage: under 10,000 sq. ft. L over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC f' Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/ Vents Air Balancing Provide detailed description of work to be done: �IX111y/l G2 lieu/ S c�S te,*-J (Y[ 44 C dc—Jm e 'I V.)pei,137 S (ram vE:�Q L, C-�_0 8 q -1 %�_ 3-7%-- 42-3 /7 t I m r-\0m 1,R 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 kr*� Other type of indemnity ❑ Bond.❑ OWNER'S INSURANCE WAIVER: t 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 1 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 Progress Inspections ;; p Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master-Restricted City/Town Viurneyperson. Sigf ature of Licensee Permit# ❑Journeyperson-Restricted License Number: 6 [ :76 Fee$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval