245 DERBY ST - BUILDING JACKET �y Commonwealth of (Massachusetts
Sheet Metal Permit
Uate: f as i 3_ Permit #
i oo —
Estimated Job Cost. y 9 J`O Pcrmi[ Fee: 'S
PLuts Submitted: YES _ NO_� Plans Reviewed: YES NO
Business License # Applicant License #
Business Intbrnwtion: //�� /�JJ-- Property Owner/Job Location Information:
Name: C5se-V- Uturi�rlllClY/5i'Y1e17 Name: sscm7CA kl mm _
Street: 60 Ward V Street: Jys / h/7 S-
City/Town: � ezn Al City/Town: ` 6M 1-14
rclephone: 9 . 7YS foc2 ? Telephone:Q:rT • qy/• a yya
Photo I.D. required/Copy of Photo I.D. attached: YES NO
— si,rndn,i
J-1 / hl-l-unrestricted license
J-2 / Y1-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 2-stories or less
Residential: 1-2 family— Nlulti-family_ Condo/Townhouses— Other_
Commercial: Office Retail industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq. tt. _ Number of Stories: /
Sheet metal work to be completed: New Work: — Renovation:
IIVAC `detrl Watershed Roofing— Kitchen Exhaust System_
`fetal Chimney/ Vents_ Air Balancing—
Provide detailed description of work to be done:
ot/e t t!i c�i/Lq I1Pa-� and 41C S/Lkm Old /iCW
INSURANCE COVERAGE:
1 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 an 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 Continents
Type of License:
By_. ❑ Master
fine ❑ Master-Restricted
r
l ily/io`.vn
� ❑Jaurneypers°n Signature of Licensee
Permit R
❑Journeyperson-Restricted License Number:
Foe S
-- — ❑ - -- Check at-w-w-v.mass,,tav:niLl
Inspector Signature of Permit Approval 7 �'�
245 VEBY STREET 49-12
COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
GIS# 1s79 r
Map ' 34
. . . 7!
Laoek _ "' SIGN PERMIT
Lot: � � 0438 ,� � �
Pemut ;?Sign
s
Category: 'SIGN
Perrmt# °,'as 1z IS HEREBY GRANTED TO:
Project# �'jS-2012-000171
Est Cost ;_$100.00 € ; Contractor: License: Expires
Fee Charged:$0 00 �jug ,� Gary lernegan
Balance Due:S.00 „ , ;, , Owner., SALEM CITY OF
#of Fixtures ? Applicant: Gary lernegan
DigSafe#
AT: 245 DERBY�S TREET
UseGroup tS7 i
ISSUED ON: 20-7ul-2011 AMENDED ON. EXPIRES ON: 20-Aug-2011
TO PERFORM THE FOLLOWING WORK:
SIGN PERMIT AS APPROVED FOR(SCRATCH KITCHEN)
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF
ITS RULES AND REGULATIONS.
Signature:
Fee Type: 'Receipt No: Date Paid: Check No: Amount:
BUILDING REC-2012-000186 20-Jul-II x $0.00
GeoTMS®2011 Des Lauriers Municipal Solutions,Inc.