53 CHARLES ST - BUILDING PERMIT APP Commonwealth of Massachusetts
�i Sheet Metal Permit
1
1� Date: Vat I I)- Permit#
Estimated Job Cost: $ K Permit Fee:� $ .73
Plans Submitted: YES_ NO> Plans Reviewed: YES_ NO X
Business License# a Applicant License# y 6 ?
Business Information: Property Owner/Job Location Information:
Name: Cen+-cLj CocIinpHen,}�r,,0 .Tnc. Name: L �f+ TiLYCs cY�
Street: 5 NArij, )a .S-ire Street: 4Y,3 CjAP-t,CS' S-V
City/Town: 1 i t 4,trn, Mig Q 1'Fo/ City/Town: Sfi L'�M
Telephone: 7?1-933- $ � 8F Telephone: ct72'745-93= ,
Photo I.D. required/Copy of Photo I.D. attached: YES_>C NO_
Staff bimal
d-i-/ I-1 unrestricted license
+a;4-2 restricted to dwellin s 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. v over 10,000 sq. ft._ Number of Stories: J
Sheet metal work to be completed: New Work: _ Renovation:
HVAC Metal Watershed Roofing_ Kitchen Exhaust System
Metal Chimney/Vents_ Air Balancing
Provide detailed description of work to be done:
SLOLA-UE 3 `5�9P(:Y 1144c_T5 1rJ VASIIMGPQ�
INSURANCE COVERAGE:
I have a current liabili 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 ® 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 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/Town
❑Joumeyperson Signature of Licensee
Permit# - p
oumeyperson-Restricted License Number: y (�
Fee$
,r ❑ Check at www.mass.aovIdol
Inspector Signature of P Approval