0006-0008 CLIFTON AVENUE - BUILDING PERMIT APP 13- t �1 - 1� 15 u< 15OG
RECEIVED Commonwealth of Massachusetts RECEIVED
INSPECTIONAL SERVICES INSPECTIONAL SERVICES
Sheet Metal Permit
101' aZpv cl A 1014 NOV 19 P 1. 41
Permit #
Estimated Job Cost: y -2_wd Permit pee: S_s���"�
Plans Submitted: YES _ NO Plans Revicwcd: YES _ NO
Business License # Applicant License #
Business Intormation: Property Owner/Job Location Information:
Name: Z� \ -c- SDk G' He,.�� Name: S o-e N�-\a CL\ V
MStreet: / o c91 Cwi Jcr Street: �Q— N-r'y Sl
\V/ City/Town: pJo City/,rown:
'relcphone: c'{7`c— -ns--`tcls7- Telephone: 7�5
Photo I.D. required/Copy of Photo I.D. attached: YES_ NO
Sluff lnillal
J-I : l-I-u restricted license
J-2 / M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 3-stories or less
Residential: 1-2 family_ Multi-family ✓/Condo/ Townhouses_ Other
Commercial: Office Retail Industrial Educational
Institutional her
Square Footage: under 10,000 sq. tt. 1z over 10,000 sq. ft. _ Number of Stories:
Sheet metal work to be completed: New Work: _ Renovation:
I IVAC _ Metal Watershed Rooting _ Kitchen Exhaust System
Metal Chimney/ Vents_ Air Balancing_
Provide detailed description of work to be done:
-,C
'`� �U Crv�-�✓G�� Sir �L �'d o
INSURANCE COVERAGE:`
I have a,current liability Insurance policy or its equivalent which meets the requirements of M.G.L.Ch, 112 Yes❑ No❑
r _
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❑,1 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
Glie_ ❑ Master-Restricted
Cily:Town ❑Jaurneyperson
Signature of Licensee
Permit z
❑Jaurneyperson-Restricted License Number:
Fee s _ ❑
�� Check at:v�;r.v.m hL d:is.�lovl y,
J 'te-wa �� �
Inspector Signature of Permit Approval