31C-035 (9) Commonwealth of Massachusetts
DE' - 7 2015 Sheet Metal Permit
DerNOr.cR't tr N Lis )..zits Permit# 50-A"29
L.
Estimated Job Cost � Cil.+.� Permit Fee: $' "Lc— 1.130q
Plans Submitted: YES NO Plans Reviewed: YES NO
Business License# Applicant License# i"n 53
Business Information: Property Owner/Job Location Information:
Name: z.,1?,&S IN\L r-rtG- Name: p€GC)Y CO - -
Street: p0 qO9 Street: IA m'os ' s C Cr i7 F1Q 4 LU3 L)
City/Town: AG-flv rn MA. OM l City/Town: 1"�ORS'I)i.Pinfivri 1144-
Telephone:
f4Telephone: L4Y3 ` )f- 1 a tiu Telephone: 3 `1 VI--
Photo
I Photo I.D. required/Copy of Photo I.D. attached: YES NO
Building Type:
Residential: 1-2 family I/ Multi-family Condo/Townhouses
Commercial: Office Retail Industrial Educational Institutional
Building Cubic Footage: under 35,000 cu. ft. f over 35,000 cu. ft.
Sheet metal work to be completed: New Work: Renovation:
HVAC Metal Roofing Kitchen Exhaust System Chimney/Vents
Provide brief description of work to be done:
�. CG' Pik. OikZ' .Z4 RUL. -OW FlOiti FLrs
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes 7No ❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy [7 Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
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 checking this boxdhereby 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.
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By Ni Master
Title 5,,
❑ Master-Restricted 11,1�,
CityrTown EJourneyperson
Signature of Licensee
Permit#
❑Journeyperson-Restricted Mt J 3
License Number:
Fee$ ❑
Check at www.mass.govldpl
Inspector Signature of Permit Approval