B-17-691 - 0009 BRIDGE STREET - Building Permitr
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Commonwealth of Massachusetts
Sheet iNletal Permit 2011 JUL 25 P 12: l
Date: I l
,., // OG Permit t/
(ati Imted Joh Cost: S_��*DCJ �--- _
� - Permit I:ee:
I'l;ins Submitted: YES NO V flans Rcvictvc(l: YES NO v
1 Business License# l o ag 1
� Applicant License#
Business Intiormation: h-r0 C,"tA2Ir'-•C—1 d ;
�� ark�n 'tL roperty Owner Job Location Inti)rmation:
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Name: — ,J. C�l (�/� ,b I e
� Name:: i a.ioQ M�,� IleMDI).S G
Street: '� '�- S�
Street:
City/Town: 3-r ,&/t/ 37 City/Town: ✓ V 1 f 1 O ?C�
tL�4;A t'�
Cclepltune: Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO
J-1 / -I-1-unrestricted license Staf1npi2t
J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. tt. /2-stories or less
Residential: 1-2 Family Multi-family Condo/Townhouses
Other
Commercial: OFtice Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. tt. over 10,000 sq. tt. Number of Stories:
Sheet metal work to be completed: New Work:
Renovation: `
1lVAC Meta! Watershed Roofing Kitchen Exhaust System
Metal Chimney/ Vents ,fir Balancing
Provide detailed description of work to be done:
FOP—
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�(�t L�� M fit Lk:-!Dp $
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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❑
checking the appropriate box below:
If you have checked Yes,indicate the type of coverage by 9
A Other type of indemnity ❑
Bond
liability insurance policy ❑
tthe Iice`hseee rm t nopl cation waives this requirement.
he Insurance U1red by Chapter 112 of the
OWNER'S INSURANCE WAIVER: I am aware that
Massachusetts General Laws,and that my signs
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
ing this
cation
are true and
By chocking thls box i hereby certify i of the details and Infil sheet motel work send ttstaNations performed under I have submitted(or ethe permit dissu d for thils app I ation will be
ion
accurate to the bast of my knowledge and that a
In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Ouct inspection required prior to Insulation Installation: YES NO .
Prnrrress InsI)eCtions
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ColnlnentS
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Type of License:
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By ❑Master "'
retie ter-Restricted Y[ j
plas
❑Journeyperson Signature of Licensee
i
❑Journeyperson-Restricted License Number:
FoaS , .
---_J___.___.— ------- Check at .,•,,.., nt iss.ciu�.1t u
Inspector Signature of permit Approval
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