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15 CLEVELAND AVE - BPA - NOT A CITY ADDRESS Commonwealth of (Massachusetts / Sheet Metal Permit Date: / //p �-- Permit l# -,(—�—� -- Hstimated Job Cost: S � Permit Pee: S Plans Submitted: YES NO— Plaits Reviewed: YES NO 13usincsS License # S Applicant License ## &y� -- Business Inlimnation: Property Owner/Job Location information: (SiL� J Name: ry a T �lN GtcU Namr. street: 1-l1I3 Street: city/Town: �I»Jt� m.7 c2,F�?l City/Town: An 'telephone: 22e I'rn f-S/tJ© Telephone: I)Jr— ow- Photo I.D. required/Copy of Photo I.D. attached: YES;Ik NO_ Starr Initial J-t / DI-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-ramify_ condo/ "Townhouses_ lOther_ Commercial: Office_ Retail_ Industrial _ Educational X Institutional_ Other_ Square Footage: under 10,000 sq. ft. _ over 10,000 sq. tt. X Number of Stories: Shect metal work to be completed: New Work: _ Renovation: X IIVAC ifetal Watershed Roofing_ Kitchen E.ellaust System a Metal Chimney i Vents_ Air Balancing Provide detailed -, ription or work to be done: X, n z -_4Z - fQ _fit r�rzL � FP-0 " _ - INSURANCE COVERAGE: I have a current liability 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_ Proeress Inspections Date Comments Final Inspection Date Comments Type of License: By _ ❑ Master nue_ ❑ Niaster-Restricted Coy,To l — ❑Journeypersorr Signature of Licensee Pennit z �J )/� ❑Journeypersan-Restricted License Number: / Y Fee 7 -- ❑ --- Check at.w.w.v.m.iss, 1001Ilrl hi specter$IrJ fah of P rnii Aµ ppp V