200 FORT AVE - BUILDING INSPECTION (2) s
Commonwealth of Massachusetts
Sheet Metal Permit
Date: a7 l�L
Permit #
Estimated Job Cost: Permit Fee: $3�
Plans Submitted: YES _ NO — Plans Reviewed: YES _ NO _
Business License# Applicant License # ® r
Business Informatio : Property Owner/ Job Location Information:
Name: ame: C�l�M S c tb`t f
Street: V-/O Cll L S'] Street: _ cam, F R7— �
Citylfown: Ul City-frown:
Telephone: "� a-a1k6 32dKj6 Telephone:
Photo I.D. required / opy of Photo i.D. attached: YES _ NO Co ✓✓l`
J-1 /M-1-unrestricte license StaffInitial
J-2/M-2-restricted Id dwellings 3-stories or less and commercial up to 10,000 sq. ft. 12-stories or less
Residential: 1-2 family _ Multi-family _ Condo/ Townhouses
_ Other _
Commercial: Office — Retail Industrial
— Educational _
Institutional Other_
Square Footage: unc cr 10,000 sq. ft. _ over 10,000 sq. ft. _ Number of Stories: _
Sheet metal work to be completed: New Work: t/-�—
Renovation: _
HVAC_ Metal Watershed Roofing _ Kitchen Exhaust System
tat Chimney / Vents_ Air Balancing_
Provide detailed descri tion of work to be done-
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INSURANCE COVERAGE:
1 have a current liabili Insurer ce policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No❑
If you have checked Yes,Indicate the t Pe of coverage by checking the appropriate box below:
i
A liability insurance policy . Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am awaro 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 appllcatlon waives this requirement.
I
Check One Only
Owner [] Agent ❑
Signature of Owner orOwner's Agent i
By checking this box ,I hereby certify that all of the details and Information I have submitted for entered)regarding this application are true and
accurate laths best of my knowledgeand that all sheet metal work and installations performed under the permit Issued for this application will be
In compliance with all pertinent prov slop 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 Comments
Type o1 License:
By
aster
Title
❑Master-Restricted �y
Gtyrrown
❑Journeyperson
Permit - Signature of Licensee i
❑J ourneyperson-R eslricted
Fee S License Number:
Check at MaA ma_ g��dol j
I
Inspector 9lgnature of Permit Approval
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�JAMES�RTSTEWART b �R �
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! 200 FORT AVENUE 619-14
GIs# i372 COMMONWEALTH OF MASSACHUSETTS
Map: 45
Block: CITY OF SALEM
Lot: 0089
(Category: Sheet Metal
Peat# 619-14 = BUILDING PERMIT
Project JS-2014-001578
Est. Cost $8,000.00
Fee Charged: l$93.00
Balance Due: $.00 ? PERMISSION IS HEREBY GRANTED TO:
Coast. Class: _
Contractor: License: Expires:
Use Group: Scott Sheet Metal Company Inc.
Lotnge(sq.ft.): 762300 Owner: SALEM CITY OF, SALEM WILLOWS PARK
Zoning:
Units Gained: A '; Applicant: Scoh Sheet Metal Company Inc.
Units Lost: AT: 200 FORT AVENUE
Dig Safe#:_
ISSUED ON: 25-Feb-2014 AMENDED ON: EXPIRES ON: 25-Aug-2014
TO PERFORM THE FOLLOWING WORK:
619-14 KITCHEN EXHAUST HOOD &VENTILATION FOR THE CLAM SHACK
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Building
Umfirground: Underground: Underground: Excavation:
S'eiivice::: Meter: Footings:
Rough: Rough: Rough: Foundation:
Final: Final: Final: Rough Frame:
.a Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter: Oil:
Final:
House# Smoke:
Treasury:
Water. Alarm: A$$e5$Or
Sewer: Sprinklers: Final:
THIS,PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
'RULES AND REGULATIONS.
Signature:
lt- `: Fee Type: Receipt No: Date paid: Check No: Amount:
-� -Sh16ET METAL REC-2014-001588 25-Feb-14 21327 $93.00
GeoTMS@ 2014 Des Lauriers Municipal Solutions,Inc.
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