19 BOARDMAN ST - BPA-14-768 HVAC uommonweaun of inassacnusetts
Sheet Metal Permit RAC-A5�
Date: Permit#
Estimated Job Cost: $ Permit Fee: $
Plans Submitted: YES_ NO Plans Reviewed: YES NO_
Business License#P -- Applicant License # //.
Business Information: Property Owner/Job Location Information:
Name Name: o
Street: / L e S i e Street:/q 5,
City/Town: L /G!/� City/Town: .GI�
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Telephone: ��LKQj/a-lll� Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES Rz7 qI 4-7
NO_ a L�
Staff Initial
J-1 /unrestricted license P S I�,pJ rc y S r_0Y-n c�.� ,
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 Z 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:
I-IVAC Z Metal Watershed Roofing_ Kitchen Exhaust Systemca
s V
Metal Chimney/Vents_ Air Balancing
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Provide detailed description of work to be done: �.
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INSURANCE COVERAGE: 1
I have a current liability insurance policy or Its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 2 no❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Ly' Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: 1 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 boxff,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
Citylrown
❑Joumeyperson Signature of Licensee
Permit#
❑Joumeyperson-Restricted License Number: /4� ,?,?
Fee$ ❑
Check at www.mass.00vIdol
Inspantor signature of ermit pi al