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293 JEFFERSON AVE - BUILDING INSPECTION
. ,T��' l `-f.-� �O �1 '3 Z Commonwealth of �lussachusctts �--K. �F I Z l � Sheet �fe��,����L SERVIGES � u;,tc: .-`Z�-�---�-- �'�i,»it a_------- 101U HAY -b A II� 54 � , I?slint;rtc� Jab (bst: S_ / ODU . �O Pcrtnit l�e�: 'S 1----- Plan, Submill�J: YES � YO _ Plans Rcvic�vcd: YES _ �O �_- Bu,incss Liccnsc # Applicant Liconse 1# ���.2� 13usincss Inlbrmation: Property Owncr/ Jub Locatiun Intittmation: N.ime: /�nP �/I I/'Gi�ilu�-i�„✓ Numc: l7V4nP cS�4in�/Ie!- -- 5tr��t: (X l_ tP9, /�cL Sll'��L o� 'rl� "1�!-Y� �sn i A�_ Ciry/"Ibwn: � G��s%Ol, /�I/-� c�ryi�r����,: c�o.. ,�A fulephone: �p/7� � U/ 7�/ 7�-- Telephone: - Phuto I.D. required/Copy oFPhoto I.D. attached: YES� NO _ .��rr i��w:�i I J-1 I `l-l-unrestricted license I J-2! �[-2-restricted tu dwcllings J-storics or Icss and commercial up to 10,000 sy. ft. / ?-sturics ur I�,s Residentlal: I-2 fumily_ Multi-fumily_ Cbndo/1'ownhouses_ Other_, Commercinl: OFtice_ Retail_ Industriul_ Educational _ lnstitutionai Other 'X ��TiavR-r�*�� � Square Footage: undcr 10.000 sq. ft. � uver 10,000 sq. tt. _ Nwnber of Storics� Shect mctal �vork to he completctl: New �Vork: _ Rcnovation: _ INAC i�[ctul 1Vutcrshcd Ruuling_ Kitchcn Grhaust Systcm� `(cWl Chinuwy i V�nts_ Air 13alancing — 1'ruvidc dctailc� �Ic;criptiun uF��urk to be done: � ln t'�ll �il.l� < <�rl Cr-�IX�YY�2�r� �i �� � Cv C���r —���� �__�Lj���"'„� ---- _ - - -. .. ._ � �'L(— W 4-1�1J �-�"I�.Dvj � ('� � �G��( (o _ � �Ti' �o I"1 -- ZO l — `1 a Z Z e . INSURANCE COVERAGE: �, r 3�� . I have a current liabili insuranca policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes❑ No❑ .If you have checked Yes, indicate the typa of coveraga by�checking the appropriate boz below: . � • 'i , v . �uS A liabilily Insurance polfcy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am awara that the Ifcensee does not have the insurence coverege required by Chapter 112 of the Massachusetts General Lawe,and that my signature on this permit applicatlon wafvea this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By chocking thla box❑,I hareby eertlfy that all o!the detalla and Informatlon I hays submltted(or entared)regarding thi�applicatlon ara lrue and accurota to the 6eat of my knowledge and tha!all sheet matal work and Installatlons parformed undar the pe�mlt iesued!or Ihif applleallon w111 ba I In compllance wllh all partinent provlalon a!tha Maasachusalt�BUIlding Code and Chaptar 112 of the Genanl laws. Duct inspection required prlor to Insulatlan Inatallatlon: YES NO Proeress Insocctlons i Date Comments Final Insocctiuu ������ Comments 1 TyUe o(License: �Y- ❑Master r�ne — . ❑ M1laster-Restiicted cryirawn _ �Jaumeyperson Signature of Licensee Pernut x -- �Joumeyperson-Restricted r-ea i — License Number: I - -- ---- ❑ -- CheCk at:v,;r.v in.iss.�iuvhlL I � � Inspaclor Signaluro of Pcrmit Approval I ._...—___- � � --___—__—_'___ __J � 4vr ONWEALTH OF MASSACHUSETTS = `': �,eC,a,e„te�c-�e c-fl°� E � � • _, � ' ' HC-000260 � SHEET METRL WORKERS = i ' , ISSUES THE FOLLOWI�1Gst�ICENSE ;, HoodCleaningCertifioaSeofCompetency �. ,r � - ` AS �A'"MASTER-UNRESTRICTED ' '< ��'� , � Scott J Mcauade ' � !� SGOT.,T J MCQUADE "` � R r ' ' � � 10 RobertS Street ' � ,, ,. •• .:� � ° � !, ��-� �.•� �uine MA'02169 � � i l� � � Y 277 (WAS�ilNC�TON ST > ° � f • '' xpi�r�ation Date . ' `, � \ � ,� � �`6871'Ji:+t'15 : aW�YMOUTH , , rtn oz188 1508 ` � StateFireMarshal _��q„�) � � 14121 ,;�F 03/28L,;15 ' 9120 a,� ,,,� �Y� . ..i.. —..,. i i i�I.� li —• � i i�����. �%k����� f 1 1� � ,1 6�� I �•,, . � �.. �� Massachusetts -Department of Pubiic Safety ,� + � Board of Building Regulations and Standards a . . � Canctructiun Supercisor 1+ . Certifimtian Num6er BC10910-09 Expires: 04LJT07$ � License: CS-091282 �►�� Scott McQuade \p—' i i, i,,, �3�nac . SCOT7'JMCQUApE '� '�, I�"�"S ' 1 Cali Venfilafion � e� I n�wastvxcTorrsT�;; y�7 Washington Str�et WEYMOUTHMA 02�88�� ; . ' %, �;� Weymouth, MA 02188 ' �.,�.,, llJ�� n n��a Expiration ' � � . . .. } . � Commissioner 03/15/2015 _ . , - � :1 � • � � I�• � • • � � :�� � - 'Q " 5 . . .. �,:. .,, • • � � ` ,.° CITY OF S.1I.E�,i, l�I��SS�ICHL"SETTS � BL'ILDI\G DEP.�RT�(E.`iT - � � 4 �' ��5+ 1�O C�V.ISHLYGTON ST2EET, 3�E'200R ��� � T�L (978) 745-9595 F.�X(9 i 9) 730-9846 KI�BERLEY DRISCOLL i�fAYOR Triont�.s ST.P7F.axs DIRECTOR OF PLBLIC PROPERTY/BI:A.D4\G CO\L11I55fONER 1Vorlccrs' Cumpensation Insurance AfTidavit: Buildcrs/Contractors/Electricians/Ptum6ers Applicant Infnrmrtinn Picase Print Leeibly V;IIIIC(13usincssOrganiza�ioro'Individu:J):�nP C.��1 �I d�,On "h�� IlOn, �j� (' Adtlress: �a� A �'� 2-c� City/Statc/Zip: Qc„�1�{. N� Phone it: �f�-ad l� �9 7 1, � Arc ynu un employer!Check the•rppropriate boi: 'Pype uf proJect(requlred): I.�I om a cmployer with 4• ❑ �:{m a gcncr�l contractor anJ I � employees(fult and/or pa�.• have hired Ihe sub-contracwrs 6. ❑New caiswction I 2.Q 1 am a sole proprictor ur p,utncr- lisiad on�he attached ehect.� 7. ❑ Remodeling � .hip and have no employccs These sub-contracrors have S. (] Demolition �wrking for mc in any capacity. workan'comp. insuranca. y. ❑ puilding ad�ition � . [No warken•'comp, insurance 5. Q Wa are a corpomtion mid its . , � rcyuircd.J of�icers have ezerciscd thcir «�� Electrical rcpairs or additions - �. 3.O 1 am a homcowncr doing all work . right of exemp�ion per MGL 1 I.❑ Plumbing rcpuirs or udditions . � myxlE [10 workcrs'cump. c. 152, 41(4).and ac have no 12.0 Raof rcpairs insurance reyuircd.J } employeey. [No workers' I3.�'Other '�70� Sv r1-�evf� cump.'insurance reyuircd.J --r 'A^y�pplic:ml du[checke burc pl mux�alsu fill uw tha amtion hlow thawing t�eir workrn'mmpensadun puliry inlLrmaiion. ��. . �I Luncuwncra nho w6mit�his�illclavit inJia�ing ihry a�s doing all work and ihcn hirC uuiside<omtactata miut auhmil a new oflidavit indialiny auch '� �G�mrxwo�hul ch�zk ihi�bux mw1 a�W.h.d an a�kliiiuwl.hµ1 showiny tlu mm�c of thc iubavmneton anJ ihel�workcre'cump.yulicy in(umu�ion, I am urt empluyer thaf ir praviding�varkrrs'conipm�sadun iieiuruime jor my eirrpluyees. !3elury!s flie polfcy ui�d Jub sile � � iuforn+ulinn. ,A + f 1 Inwrancc C:ortipany Vame: /"4/'T1/��_—..lLS.�L eR . . Policy i!or Self-ii�x. Lic. fl: I./ (� a-� 3� S ^ 3 �� 7O' O II a-Expiration Dntz: 10 'a-7 1 � ' IubSi�eA�ilress: OL'fl.� �.a,d7-etSooJ ��� '� CirylSta[e/Zip: Ss �e..� - I. ,lttrcb a copy uf the�vorlcers'compensatloo pulicy declaration page(shawing the pullcy number and explretlon date). h'ailure w snure c�verage:u mquireJ under Section�SA uf MGL c. 152 can IeaJ ro Ihe impovieion ofcrintiwl penalties of a finc up m SI,SOO.UO und/or one-year imprisnnmen4 as wcll ae civil penalties in thu lorm u1'u STOP WORK URDER anJ a line af up[o S_'50.00 a J�y against iht vio�a[or. 13e advised th�t a cnpy uf this statemenl may�: furw�rd�d to the Oftice of Invesiigmions ul'ihe DIA for insuronce coverage verilicaliun. I /du hrreby rrrrijy iu� er dir puinr und pe�iu/tirs ujprrjury dm�dir injunuullou provideJ aGuvr ix trur and c�rrecL . Si�,�n��qir�.r-'� / � Datut � Phone;!' (�l/)•�f/_��7�- OfJicia!use anly. Do no1 iuiile irt!lri.s a�ru.[o be cox+pl�ted by city or torva n/JleiuL � . City nr'fnwn: . _._._.. Pcrmit/i.lmnyc# , . �I . . . .__ ---_._—. ._----_. . ._...._-- � I�suing.\ulhurily(cirde unc): , � �. I. 6uard uf Ileallh 2. Ruilding Dep�rtment J.Cily/furvn Clerk A. F.Iectric�l luspector 5. Plumbing Inspeetur 6.Oihcr � Contacl Pcrson: . Phonc B: , __ . _. —_____..— -- I . � —_— I - i REVISIONS BY 3 �°x z'� ��L`��i�r�r�-�ot� �oNd�' '� �� �o��Jo��js `I-f{eGUc�-h� N Ia�r,�-� ��C�. �,�cr�..�c� � u ,�, . � ,� � . � �� ; P� Fc� � r� I li�---_ . h�o� ' 1 � x� H�VY �u-�� . � � � �� � c'"`�_-.�` i�u � �I �►fi- � o�J�-,�,gbJF � . ,4�� �1� � � � p ', I� s/ D� . —�-b,� � � � � , I � � �- f(�y�cl�"� �p �` � � � �' �- . �dcl��n I � �� Su��. � � D��-fv I_ -� �" _ - - - �tv ��--� � _ _ _ � � / �° ` 1------ -- i��CT LE- �L� �I J ? ,o cJ � Y1�bd4�I -- '=� � �300 -(YL��l.l �12E.c ct�,"�� N� �� riC���—� � � 5�-- � . �-� '�Ys�M � � ;�I N � �� Ila�l[�� , —t�rv"KlfvvS�cV` �b I�U-���s���IED ) � Q 'I _.. � I c�.�. � I � `'--�«-- b�1��t-� o�.� }'? o o - � c�� --- . . �' -�---- �,-o � � �- I'L o �'��,��2j C�� \��q���,�c 1� � � K � O � i � �i _.. voD ��D -Xi�.�.ct5 �,�QGuc� _ --� - ---- ---- - ___ � I I S�t.p����' �{ �IZ D t.(. � �. � ' P��`�i.�L j=L��R ��11>�J: �Ci�Ic1� �� �-��D�/��}-�l.a-��u� �r� D `��R� ��+ ��•r�SS�o�lg����`'I S� p I I � � � � � I I * � _..___._.-- _.. --� 5!, � I i �� � : � �=1 -0 � I s : o-�L�i N t-r:s S �"��L �� �. _ - �a ' � �_ � � � � y-�. � C--rFt�E�� L ��j{-�t, � c� �' � I b—p � , �_ � �S tiv�'llor � � ' 6.0.- C � - - 6 ��-cl�s� �� �D � � C -f (� � ' �5 �D I o M I�{� r�� �� I N �' � � -�-v ,� -� � 2ov � >, .�, �L u�� � ��16LL on�����1 �t �� � '� . _ , _ ___ - -- _ _ _ _ _ _ __ �` � r_� _ . � �" I� �'N�< ��iIW��� �dJ�- �f�p�s, � G. � � ,�� s�.+.� �.. _ ., I� � C. ��-c}J,� I a (_-cap�. �� , , , . xl(,S�P � , . � � ,, , ��� .�,� t�c�k� C�- �.M. � -�� r�,u-� ���, �1�� , �r �� I�. ��1'��� �: _-� !�.�a � � �i �-HT, �� ; , . �-M�.�CI�(�R6c�"F � �.., �_ � ! s"c r, � � .� 6� ���" � � �'J P -[, ._. � -.. \ , . ��• J�`��� � ( ��> GO 'V��£C.� in.� �U -f���r�� � j� �� rj -I � �� � � . ii ` � � . � � � I ` I � : � �� � � —: � = l -� io --9 �1(i, > .� — -- . �� �c St�h , - ...,, wr-�. + - - R� � �M � , _ , ;__. - ---. � I - t i �. ��--- j . - �.�.,�.r -i �� ���� � f ; .�-�--. -..._ - L_ ll( �'' + �-' 2�" � ' - - S��} ,gU rNT • �nzpP�Y ce�l��o � S�u�c� : ,�. �. �- � ? � i .,� —_� L-�d �j�6.5� _ _ _ , I - � ., , - �r�� s-i.������s� o lrJ �v.c. �� � . 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