2 GRIFFIN PL - BUILDING INSPECTION Commonwealth of Massachusetts C ( �
Sheet Metal Permit � PECR M ti
Date: I '—� 4 Permit
Estimated Job Cost: $ / Permit Fee:
Plans Submitted: YES— NO— Plans Reviewed: YES NO—
Business License# I LN ('00 Applicant License#
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Business Information: Property Owner/Job Location Information:
Name: t l l `� ��I✓5 Name: 1- %C L P r ib% S C o l r, — �� L L C
Street: 2L Oh eL S Street: 2 (-?0 n1,f PQ" 9'
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City/Town: �1�p 0 tt,6 c�� /`� � City/Town:
Telephone: Telephone: ! b'— z
Photo I.D. required/Copy of Photo I.D. attached: YES NO
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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— Retail— Industrial— Educational
Institutional Other
Square Footage: under 10,000 sq. ft. --'— over 10,000 sq. ft.— Number of Stories:
Sheet metal work to be completed: New Work:_ Renovation: _
HVAC Metal Watershed Roofing— Kitchen Exhaust System—
Metal Chimney/Vents— Air Balancing—
Provide detailed description of work to be done:
tx1( NQ 01,efi
INSURANCE COVERAGE: /
q 1 have a current liabilityinsurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes J[J No❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy 12/ 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
�V'V Check One Only —/
Owner ❑ Agent
Signature of Owner or Owner's Agent
By checking this box❑,1 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.
Duct inspection required prior to insulation installation: YES NO
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By ElMaster
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Title
❑ Master-Restricted
Cityrrown
oumeyperson Signature of Licensee
Permit# f _
❑Joumeyperson-Restricted License Number: �L� W
Fee$ ❑
Check at www.mass.gov/dpi
Inspector Signature of ermit Approval
LICEN E
NONE
83 38 2012 How S81347878
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BOARD OF
SHEET M€TAL WORKERS
ISSUES THE FOLLOWING l�GENSE AS A
.IQURNEYPERSON-UNRESTRICTED
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- Technician TYPE UNNERSAL
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2247670 3/1712005
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