208 ESSEX ST - BUILDING PERMIT APP 5
Commonwealth of Massachusetts
. Sheet Metal Permit
Date: D �a �� permit#
1
Estimated Job Cost: pto. Permit Fee: $ 7
Plans Submitted: YES— NO— Plans Reviewed: YES— NO—
Business License# 5a3 Applicant License#
Business Information:p Property Owner 1/Job Location Information:
Name: N A(9 V\m() QL- . Name: ;Lgt c
Street: 4 Street: �o v� FS�iIc
City/Town: M- 6 ._k P / �i A City/Town:
Telephone: Telephone: 5-S
Photo I.D.required/Copy of Photo I.D.attached: YES_ NO_
smttWti'l
J-1 /M-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-family_ Condo/Townhouses_ Other
Commercial: Office_Z Retail_ Industrial_ Educational_
Institutional/® Other
Square Footage: under 10,000 sq. ft. V over 10,000 sq.ft._ Number of Stories:
Sheet metal work to be completed: . New Work: '✓ Renovation:_
14VAC Metal Watershed Roofing_ Kitchen Exhaust System_
Metal Chimney/Vents_ Air Balancing
Provide detailed description of work to be done:
INSURANCE COVERAGE:
I have a current liabilityinsurance policy or its equivalent which meets the require ments of M.GL Ch.N2 Yr L� No❑
If you have checked Yes indicate the type of coverage by cheGdng t w:
appropriate box below
A liability insurance policy EJ 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 taws,and that my signature on this pemdt application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this box[].I hereby cerMy that all of the details and mfomeabon I have submitted for entered)regarding tds application are true and
accurate to the beat of my knowksdge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent pion of the 1111assachuseffs Building Code and Chapter 142 of the General Laws.
Duct inspection required prior to insulation installation:YES NO
Proeress Inspections
Date Comments
Final Inspection
Date Comments
T�yp/e of Ucerrs:
By L�M W
Title ❑Master-Restricted
city/Town ❑downeyperson Sign Licensee
P $ ❑Journeypersa*Restricted License Number a 60�
F
Check at itU'tSiW.iY18S3.90Lidri
�wL.N
inspector Signature of permit Approval -