209 JEFFERSON AVE - BUILDING INSPECTION Commonwealth of Massachusetts
\� Sheet Metal Permit
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1 1):ilc: -� Permit 4
FMimatcd Job ('ost: .S_- ZsoO- 00 Permit Fee: S
I'I:ms Submitted: YF.S _ NO i1 Plan, Reviewed: YES -- NO
Business License # _ Applicant License /# Nfa f ---
Business Information: Property Owner/Job Location Information:
7—
Name: Name:
Strcc1: 1z 44,11441 ciorlC Street: �g ��/YO�✓ ��
City/Town: /moo/`h �N�vs� 174 City/Town:
telephone: Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES /--' NO
Burr uan:d
J-1 / M-1 unrestricted license
J-2 / AI-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. 11. / 2-stories or less
Residential: 1-2family / Multi-Iamily_ Condo/ Townhouses Other_
Commercial: Office_ Retail _ Industrial Educational
Institutional/_ Other_
Square Footage: under 10,000 sq. ft. L liver 10,000 sq. ft. _ Number of Stories: 2—
Sheet metal work to be completed: New Work: _� Renovation:
IIVAC Metal Watershed Routing _ Kitchen Exhaust System
`fetal C'hinmcy / Vents_ Air Balancing
Pr06LIC detailed description of work to be done: /J
Jf
INSURANCE COVERAGE:
1 have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes kNQ ❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
�, / Other type of indemnity ❑ Bond ❑
A liability Insurance policy Lt' yp
ensee does not have the Insurance coverage required by Chapter 112 of the
OWNER'S INSURANCE WAIVER: I am aware that the I(c
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner LY Agent ❑
Signature of Owner or Owner's Agent
By checking this box❑,I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
shoot metal work and tions
under the
Iaccurate to the beat n compliance with of my knowledge and pertinent provision of at allthe Massachusetts Building Codeaand Chapter 112 of he General Lawsrmit uad for this application will be
ll
Duct Inspection required prior to insulation Installation: YES_ NO
Progresslnsoections
Date Comments
Final 1115UCCti011
Date Comments
Type of License:
By ❑ Master
ntie Master-Restricted
C'ly,ru:•:n .___. - ❑Journeypersan Signature of Licensee
1 I
❑Journeypersan-Restricted License Number:
❑
Check at ••�:ry �n.c,s ,luv:�IL
I
I
Inspector Signalura of Permit Approval
COMMONWEALTH OF MASSACHUSE7TS {
1 . 4I
1
SHEET, METAL WORKERS " r ,
AS A ►VASTER UNRESTRICtED
I UES THE ABOVE LICENSE TO i !!
VICTOR M -BUENDIA S > '
q" ° t
18 ANDREW CIR { i ¢` 4
NORTH_ ANDDVER MA 61845=52bD i.
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1i-68-2014 1tMS 1981
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