4 BOSTON ST - BPA-16-576 HVAC @ DEB'S DINER GK 3S CK l 1�
Commonwealth of Massa chuset4CEIVE.9
'ISPECTIO.MAL SERVICE.,
L0 Sheet Metal Permit
I 1016 MAY 9 P 1: Ob
Date: S I�/to Permit
Estimated Job Cost: $ J�0O. (3Q Permit Fee: $
(� Plans Submitted: YES NO Plans Reviewed: YES NO
1
Business License # _ y 3 Applicant License # - 13 3
Business information: � Property Owner/Job Location information:
Name: 00-'--)/ JTG�Uy2 S t�l/� Name: O�,S D t-/1 e-r,
Street: co NSU1��nCh Street: Oys-}-CVL Ste.
City/"foam: L-Uoth /117(le, a/ City/Town:
Telephone: 76/-225 —7 y3 I Telephone:
Photo I.D. required/ Copy of Photo I.D. attached: YES NO_
starri"dad
J-1 / M-1-unrestricted license
J-2 / NI-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: Off-ice 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: ✓
NVAC _ Metal Watershed Rooting_ Kitchen Exhaust System ✓
mietal Chimney / Vents_ Air Balancing
Provide detailed description of work to be done:
INSURANCE COVERAGE: '• '~''
I have a current liability insurancg;golicy or its-equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No❑
?4 f
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy E� 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 ❑
6
Signature of Owner or Owner's Agent
By checking this box[_],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:
0y M Master
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit# ' IS le
❑ I
Journeyperson-Restricted License Number: —
Fee S ❑
Check at www.inass,ryov(dpl
Inspector Signature of Permit Approval
6/6/2016 Accela Cifizen Access
Announcements Register for an Account I Login
r._. __..—_____ __. __..--__ 1
LSearch... �I
Need Help? For technical assistance in using this web application, please call the
ePLACE Help Desk Team at (844)733-7522V or(844)73-ePLAC between the hours
of 7:30 AM-5:00 PM Monday-Friday, with the exception of all Commonwealth and
Federal observed holidays. If you prefer, you can also e-mail us at
ePLACE helodesk(o)state.ma.us. For assistance with non-technical issues, please
contact the issuing Agency directly using the links below.
Translation Information -Click Here
Browser Compatibility:
. For Application/Renewal:lf your application requires a file upload, Microsoft
Silverlight is required to do so. Please see the link below for instructions to download
Microsoft Silverlight. Silverlight Download
. File a Complaint:lnstructions above apply for filing a complaint if you are uploading
a file/picture.
Home Manage Licenses, Permits & Certificates File&Track Complaints
Please refer to the Licensing Entity's website for additional information regarding the status and discipline information shown below.
For DPL information,please visit the DPL website.
For ABCC information,please visit the ABCC website.
Information Pertaining To:
Sheet Metal Master 11567
Licensee Detail
License Number: 1IS67
Licensing Entity: Board of Examiners of Sheet Metal Workers
License Type: Sheet Metal Master
Type Class: M1
License Issue Date: 05/02/2011
License Expiration Date: 05/28/2018 Status: Current
Current
Discipline:
Other Discipline:
Name: DANIEL R STEVENS
Business Name: DBA Name:
https://elicensing.state.ma.w/CitzenAccess/General PropertyticerreeDetail.aspx?LicenseeNumber=11567&License Type=Sheet°/20Metal%20Master 1I1