187 LAFAYETTE ST - BUILDING INSPECTION (2) Commonwealth of Massachusetts
\� Sheet Metal Permit
Estimated Job Cost: Permit Pre: $__��
PLm, Sabmi(ICd: YF.S _ NO l/ flans Reviewed: YES No
Business License !R Applicant License ft
l3usiness Information: Property Owner/Job Luruion//Information:
Name: J2 /jGaO� ,v�,QG Name: ✓d�/� �KO/
Street: yC5�VIZet; I✓1f Slreet: /zn
city/town: city/Town: / 7
'telephone: 79/ !� k - '1r,7°Z Telephone: rSOf- J p
Photo I.D. required/Copy of Photo I.D. attached: YES NO
s„rr uuu:d
J-1 �!- nu•cstrictcd license --
J-2/ M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. It. / 2-stories or less
Residential: 1-2 tamily_ Multi-Family ✓ Condo/ Townhouses Other
Commercial: Office_ Retail_ Industrial Educational
Institutional _ Other_
Square Footage: under 10,000 sq. ft. over 10,000 sq. A. _ Number of torics:
Sheet metal work to be completed: New Work: _ Renovation:
I IVAC_ -le(al Watershed Roofing_ Kitchen E.ehaust Systcm
`fetal Chimney i Vents_ Air Balancing
I'rovidc detailed description of w%mk to be done:
r , �
INSURANCE COVERAGE:
1 have a,current ilabilit Insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yeallo❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
Other t El Bond ❑
A liability Insurance policy type of indemnity
nsee does not have the Insurance coverage required by Chapter 112 of the
OWNER'S INSURANCE WAIVER: I am aware that the lice
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 chocking this boxl],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
ons perfored under the
Iaccurate to the best of my knowlede and that n compliance with all pertinent provision of the all
Massachusetts Building Cad*aind Chapter 112 or he General nLawsit ue r this application will be
Duct Inspection required prior to insulation Installation: YES_ NO
Progress htsacctions
Date Comments
Fhtal inspection
Date Comments
,f
Type of License:
By Master
one — ❑ Aiaster-Restricted
i
cdy:ra,vn _ ❑Journeyperson Signature of Licensee
I''-rm"I° - -- ❑Journeyperson-Restricted I
License Number:
rod .--- - -- - - — ❑ ----------
Check at'.v•.v_�.ui.lsS.,luv:,ILI
C I
In speclor ignalure of Permit Approval
E ; COMMONWEALTH OE MASSACHUSETTS
SHEET METALWORKERS
AS A.MASTER-UNRESTRICTED
ISSUES THE ABOVE LICENSE TO • 4
_JOSEPH W BLOOD
285 FOREST AVE
SWAMPSCOTT MA•' 01907-2246
14 1
14.58 11/28/13 696 x
�n —