SMP-85060 fs
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Commonwealth of Massachusetts
Sheet Metal Permit
Date: Mai 1"j Permit# J3/e--)oei
Estimated Job Cost: $ 1(k)0 , t) (5 Permit Fee: $ 3 S , c v
Plans Submitted: YES NO 0 Plans Reviewed: YES NO
Business License# Applicant License#
Business Information: Property Owner/Job`Location Information:
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Name: I �feht' 1
I n cd,cr Name: e r(y `Ro c�. et s
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Street: (pp 'b �p � e I�G• Street: il�'j t,ac z 1.,&AA _
City/Town: ca.- ar 1p :0
l, '� h City/Town: gin'
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Telephone: Jr��` d�a Telephone: —lilt- 45 it to 4.8
Photo I.D. required/Copy of Photo I.D. attached: YES NO
Staff Initial
J-1/M-1-unrestricted license
J-2 -2-restricted to dwellings
3-stories or-less-and commercial up to 1 U,D00aq. ft./2-stories or less
Residential: 1-2 family f( 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 K Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney/Vents Air Balancing
Provide detailed description of work to be done:
540 (L I c=e e fax; ri,oce -' A/
•Rv.,,, 0.10.60 'ilt4(0.4-"4" / 1)Cilki All 4 ti,e_5
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INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes 0 No❑
If you have checked Yes•indicate the type of coverage by checking the appropriate box below:
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWS INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
M ssachuse eral Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner Nif Agent ❑
ignature of Owner or Owner's Agent
By checking this boxD,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 Inspections
Date Comments
Final Inspection
Date Comments
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Type of License:
By (Master
1 (...... ? .
Title
❑Master-Restricted
City/Town
❑Journeyperson
Signature of Licensee
Permit#
❑Journeyperson Restricted License Number: v)�cc y(r.
Fee
El
Check at www.mass.gov/dpl
- A d c A'Cr
1 e of Permit Approval PRI n i N IglY1 r
( ) TOWN OF DARTMOUTH BUILDING DEPARTMENT RECEIPT 6 UU
PHONE: 508-910-1820.- FAX: '8-910-1838 ;
N s'`‘ � f r r d
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Name: r ��' d L Property Owner:: Date''` ,/
6 f f
Job Locati t: 1 q' / /7 47/,"' {... Map: . Lott—�-----
Description General Ledger#'s Ref. # (� �• ount
Building & Building Misc. 01'000-44105 i, A ,..c'. ,X. „
Electrical 01000-44106 �4 ,'
Plumbing & Gas 01000-44107 Q �y y
Trench Safety 01000-44129 I
OW
Other Department Revenue 01000-42420 ?
/ -----'-
White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received B. .. ,,;
THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS