231 GOOD CIR - BUILDING INSPECTION Commonwealth of iA/lassachusetts
\� Sheet Metal Permit
Date: �I Pen„it # —1,?
Estimated Job Cost: s Usz>zp Permit Fee: S� w
Plans Submitted: YES NO_ Plans Reviewed: YES_ NO
Business License # Applicant License # y ---
Business Intiormation: ff Property Owner/Job Location Infrrmation:
Name: � � �(a,A� N� Name`�Jrowi�n� 2�1�f) i7 . ( •lC
Street: Lk 1 �Q _ Street: _a'� CoA Ct/2
City/'Town: City/Fown: �JPyQ(,�-,
Telephone: Sq? U-S, ���� Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES K.NO
J-1 4I- nrestrictcd license Staff 1,11dal
J-2/ AI-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. It. / 2-stories or less
Residential: I-2 Family Multi-family_ Condo/ Townhouses Other
Commercial: Office_ Retail _ Industrial_ Educational
Institutional _ Other_
Square Footage: under 10,000 sq. ft. over 10,000 sq. it. _ Number of Stories:
Sheet metal work to be completed: New %Vork:424,, Renovation:
I IVAC _ Metal Watershed Roofing_ Kitchen Exhaust System
Metal Chimney/ Vents_ Air Balancing
Pr— i
ur%iide detailed description of work to be done:
INSURANCE COVERAGE: �J
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes,l X No❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below: I��
A liability Insurance policy Other type of indemnity El Bond ❑
OWNER'S INSURANCE WAIVER: l a----m 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 box0,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
Proirress Inspections
Date Comments
Final I llsoCeti011
Date Comments
Type of License:
By _ Master
nne i ❑ Master.Restricted F-IL
CilyiTuwn ❑JOurneyperson
Signature Of Licensee
Permd x, q —
❑Journeyperson-Restricted License Number: c7'
Pea S
-- - --- Check at'n-w-v.m.t:,s, Iovhll/l
Inspector signature of Permit Approval