230 GOOD CIR - BUILDING INSPECTION �1J
Commonwealth of Massachusetts
Sheet Metal Permit
Date: A� o/j Pen„it tt 717i-ly, .J -
Fstintatcd Job Cost: 5.--_ /� Permit Pce: ..S (J�
Pins Submitted: YF.S _ NO _ Plans Reviewed: YES NO
Business License 11 0 "JAI S Applicant License # C(
13usinesS Intbrn,ation: Property Owner/Job LocationInformation:
Name: XI _z,, L Name: t [tti[ dC ? ��v W(71J Gj.� L
Street: ""�q Street: DS0 6oad C4
City/Town: iy,,/jtV.jtgan Ak, City/Town: - � �2��
Telephone: �? 7 (�`���f� Telephone:
Photo I.D. required/Copy of Photo LD. attached: YES -4 NO
J-1 : (-1-u restricted license s„rr edu3i
J-2 -restricted to dwellings 3-stories or less and commercial up to 10,000 sy. It. / 2-stories or less
Residential: 1-2 family / Nluhti-family_ Condo/Townhouses— Other_
Commercial: Office_ Retail_ fndustrial Educational
Institutional_ Other_
Square Footage: Under 10,000 sq. tt. 4---over 10,000 sq. ft. _ Number of Storles: _
Sheet metal work to he completed: New Work: Renovation:
11VAC_ Metal Watershed Routing _ Kitchen Exhaust Systen,
`fetal Chimney/ Vents_ Air Balancing
Provide detailed description ofwork to be done:
rA
INSURANCE COVERAGE:
I 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 th pe of coverage by checking the appropriate box below:
Other type of Indemnity El Bond ❑
A liability Insurance policy YP
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 chocking this box❑.I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
ons perfored under the prmit
in compliance with alltpmy knowlede and that ertinent prow sion of all shoot metal work and
Building Cods alnd Chapter 112 of he Generuad for this application will be
al Laws.
Duct inspection required prior to insulation Installation: YES_NO
Progress (nsuectiolls
Date Comments
Final luspection
Date Comments
Type of License:
Y aster
p M n `
Nis — ❑ Blaster-Restricted \`{, 1, I� �—a
i
ria:•:n -___ ❑Journeyperson Signature of Licensee
Penml x __ ❑Journeyperson-Restricted
a�
License Number: I
Pea i L ----
- - - - - ------ -- Check at ,r•.v v. n.t;s ..iov"IL
I
I
Impactor Signaturo of Permit Approval