31 ARBELLA ST - BPA-12-150 HVAC Commonwealth of Massachusetts
Sheet Metal Permit
Date: o� O Permit#
Estimated Job Cost: $yOZt 29 Permit Fee: $ /
Plans Submitted: YES /GNO Plans Reviewed: YES NO_
Business License# 6 O Applicant License#
Business Information: Property Owner/Job Location Information:
Name: ,!E//--/ �r12[fK S Name: Zone 9 1�
Street: ��? �1�h.�'i2�1/C L � ' Street: �/ 4 LI A S7
City/Town: t C�-i eV, AACity/Town: 7Q
Telephone: �Ta $�?07 /aeE Telephone: 7ki 223 0
Photo I.D. required/Copy of Photo I.D. attached: YES_ NO
Staff Initial
J-1 /M-1-unrestricted license
J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less
Residential: 1-2 family Multi-family_ Condo/Townhouses_ Other
Commercial: Office Retail Industrial_ Educational_
Institutional _ Other_
Square Footage: under 10,000 sq. ft.Z over 10,000 sq. ft. _ Number of Stories:
Sheet metal work to be completed: New Work:_ Renovation:
HVAC.k' Metal Watershed Roofing_ Kitchen Exhaust System
Metal Chimney/Vents_ Air Balancing
Provide detailed description offl/work to be done:
/A / �/
INSURANCE COVERAGE: -- /
I have a current liabilityinsurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes ak o❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box"I I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit Issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES_NO_
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By Master
Title ❑ Master-Restricted
city/rown ❑Joumeyperson
Signature of Licensee
Permh# / p �
❑ m Joueyperson-Restricted License Number: (00")-
Fee$ �� ❑
n. Check at www.mass.gov/dpi
Inspector Signature of Permit proval
it