2 DEVEREAUX ST - BUILDING PERMIT APP JACKET --� -, H : 32 BCD 14
Commonwealth of Massachusetts 2-1
3 Sheet Metal Permit
Permit#
Estimated Job Cost: S Permit Pee: $
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Plans Submitted: YES NO�� Plans Reviewed: YES NO
Business License # Applicant License#
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Business Information: !DjW/ _0 iZ.LPIi"WProperty Owner/Job Loccation,h_i form ation:
Name: ���n G� C4� Na.ne:
Street: 5 LIiSS//i1 e� �Tt' et: l
City/Town: City/Town: '. �.(A
Telephone: Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES NO_
Starr i nitiai
J-1 %M-1-unrestricted license
J-2/ NI-2-restricted to dwellings 3-stories or le7ondo/
' mmercial up to 10,000 sq. ft. / 2-stories or less
Residential: 1-2 family_ Multi-family Townhouses Other
Commercial: Office_ Retail_ Industrial Educational
Institutional Other_
Square Footage: under 10,000 sq. ft. t/ over 10,000 sq. ft. _ Nmnber of Stories:
Sheet metal work to )e completed: New Work: Renovation:
HVAC Metal Watershed Rooting_ Kitchen Exhaust System
Metal Chimney/ Vents_ Air Balancing
Provide detailed description of work to be done:
INSURANCE COVERAGE:
1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes 0 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 l/
Progress Inspections
Date Comments
Final Inspection
Date Continents
Type of License:
By ❑ Master
Title ❑ Master-Restricted .�
City/Town 'tlourneyperson _ UNCE% Signature of Licensee
Permit#
❑Journeyperson-Restricted License Number: ' Z-
Fee S ❑
Check at www.massxIov/dpl
Inspector Signature of Permit Approval