232 GOOD CIR - BUILDING INSPECTION caa cv/ �
j Commonwealth of Massachusetts
i
Sheet Metal Permit
I Dater 1113 Permit
Fstimated Job Cost: S�[p Permit Fee: S La
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License # ' "1 D14 3 t{S6 C7 6S Applicant License # ` 99
Business Information: Property Owner/Job Location Information:
Name: 0-om't n1(, 1C ZZJ�u 1nt-Tbgk vCA—
street: )Q �Q1 Street: _�?-,a ( a, Cp lg
City/Town: Lt�t��lt,i�c`[Y}A, City/Town: �A gf,-4
fclephone: �(,7 6 �JJ I "(O/� Telephone: c17� 3 r?9'7S
Photo I.D. required/Copy of Photo I.D. attached: YES NO
lturrtniam
J-t / 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 Retail Industrial Educational
Institutional _ Other_
Square Footage: under 10,000 sq. tt,2�\-- over 10,000 sq. R. Number of Stories:
Sheet metal work to be completed: New work: Renovation:
I IVAC _ Metal Watershed Roofing_ Kitchen Exhaust System
IMktal Chimney/ Vents_ Air Balancing
Provide detail
''ed deseriptiun of work to be
done: A
�-;Lt4 - A -1;0r(e[[ )Accr L9\ CQ 1T
I/* — --
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Ye9�A No Cl
If you have checked Yes, indicate the type of coverage by checking the appropriate box below: V
A liability Insurance policy�9(— 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 1 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.
required prior to Insulation Installation: YES_NO
Duct Inspection q P --
Proeress Insnections
Date Comments
Final Insuection
Date Comments
Type of License: /�
a ster 1 `
nue_ 1\ �� ❑ Master-Restricted l/\X' Y, A n
talyJau.%n \ JOurneyperson
\ Signature of Licensee
Pennn x rNJourneyperson-Restricted
License Number: 1—
Fce$ _ ❑ _—_
Check at:r,v.v.nwss.;lovi�iL �
Inspector Signature of Permit Approval
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