1 KERNWOOD ST - BPA B-15-94r
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Commonwealth of Massachusetts
Sheet Metal Permit RECEIVED
Sh
„t INSPECTIONAL SERVICES
Date: Yl g /,�r Permit,,, „u 2b A 11: LL1
oc'7
Estimated Job Cost: $ y fX 0 — Permit Fee: $ _5� 2, °=o
Plans Submitted: YES -46'3 Applicant
_ Plans Reviewed: YES_ NO_
V') Business License# -4, / 3 Applicant License#
I Business Information: Property Owner/Job Location Information:
r� Naive:�/������� f7/62 ,�VG Name:��,t2 Lr�(b�J ��OlJ6U7/4 t/�GU(j
I� Street: �(6D5 ZZA1 :5 T #A--; Street: / e�_-Xlllwow 57-,
City/Town: /O /E/ t MA &�ff3 City/Town:&4 i EGLf/ "fif 0/ 0
Telephone: 7 / —d rZ 2/ Telephone: !? 7 X- 7y,S—XOL
Photo I.D.required/Copy of Photo I.D.attached: YES_ NO_
st.rcin;iial
J-1 M-3-unrestri�,�
J-2/M-2-restricted to dwellings 3-stories or less andcommercial 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 {%eclr c a tlDvl a l din/H �urlcYlDi/
Square Footage: under 10,000 sq. ft._ over 10,000 sq. ft. x Number of Stories:
Sheet metal work to he completed: New Work:_ Renovation:
HVAC Metal Watershed Roofing_ ; Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
16/21ac e 3 e xi rpt y h e , e;1600lac.&a /JI/21 t
1611-617 3 4_F_1&) uvti6
lua�� L(3
INSURANCE COVERAGE:
I have a curront'jiabliity insurance policy or Its equivalent which meets the requirements of M.G.L.Ch.112 Yes VNo❑
If you have checked Yea,indicate the type of coverage by checking the appropriate box below:
A liability Insurance policy 10 Other type of Indemnity ❑ Bond ❑
OWNER'S!INSURANCE WAIVER:I am aware that the licensee does not haverthe Insurance coverage required.by Chapter 112 of the
Massachusetts Gsneral Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent
Sl a of Owner or Ownees,Agent
By checking this:box ,I hereby:certify:that:all of the debits and Information 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 eompgance wgh-ag pertineM:provislon of.the:Massachusetts Building Code and Chapter 112 of the'General Lon.
Duct Inspection required prior to insulation Installation:YES_NO
Prouess Inspections,
Date Comments
Final Inspection
Date Comments
Type of License:
sy Master
Tme -�'
❑Master-Restricted
Cgyrrown ❑Joumeyperson
Signature of licensee
Peimp-k / 7
❑Joumeyperson-Restricted License Number:110,3 3
Pee$- ❑
Check at www.mass.aovfdpl
Inspector Signature of Pemilt Approval