42-179 SHEET METAL rz-
Commonwealth of Massachusetts � E C�~
Sheet Metal Permit APR 6 2020
Date: I —�— ��'b Permit# �S�<j ,,r. sFFcrIoNs
_.-.N.h1A01or'o
Estimated Job Cost: $ y 0 0 Permit Fee: $
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# 172 Applicant License# 267
Business Information: Property Owner/Job Location Information:
Name: M.J. Moran, Inc. Name: NG6�1,�&t F0( tkan7
Street: 4 South Main Street Street: //S--
City/Town: Haydenville City/Town:
Telephone: 413-268-7251 Telephone: y/3
f
Photo I.D.required/Copy of Photo I.D.attached: YES M-1 NO
starrrn[n8�
J-1 nrestricted 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:
✓&7t5
atvhA V�'n9
w
INSURANCE COVERAGE:
I have a current liar insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes D0 No❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy X Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee dnP_ not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waive this requirement.
Check One Only
N/A
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxX,I hereby certify that all of the details and information I 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 inspection,
.Date CoLumpats
Final Tnsnectinn
Date Comments
Type of License:
By DQ Master
Title ❑ Master-Restricted
City/Town ❑Journeyperson
Signature of Licensee
Permit#
❑Jou rneyperson-Restricted
License Number:
Fee$ ❑
Check at vow mace gnv
Inspector Signature of Permit Approval