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�° ;, SHEET METAL PERMIT ZO
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I(:. ,, igCommonwealth of Massachusetts
" """`" Town ofYarmouth BuildingDepartment
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Date: /0 // Permit#:
Estimated Job Cost:$ 94goo Permit Fee:$ 4040
Plans Submitted: YES/ NO' Plans Reviewed: YES/NO
Business License# 219 Application License# i a 797
Business Information Property Owner/Job Location Information
Name: Zed/.c 54,-e>4 Ale 14.,/ Name: OPT 1 l.l.C. 'yaw ou/h kp,1at, 5
Street: ioo/� Lila y+No uth 61- Street: ,a t Ns'n ir,r r-t' go cage c99
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City/Town: edderp t Mil City/Town: %Q a.//A am MA jar s'tk 44 it
Telephone: in- 871- .Soo) Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES/NO Staff Initial:
J-1/ M-1 unrestricted 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-familyCondo/Townhouses_ Other
Commercial: Office Retail Industrial Educational Institutional Other
Square Footage: under 10,000 sq. ft._over 10,000 sq. ft. t./Number of stories: 02
Sheet metal work to be completed:
New work ‘i Renovation:_HVAC:_ Metal Watershed Roofing:_
Kitchen Exhaust System:_Metal Chimney/Vents:_Air Balancing:_
Provide detailed description of work to be done:
cinccw'ork- For hoc*//IG el et .1.7t3./ G--6'he{u•574- .4'.y Ani5 t .
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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 ,. No
If you have checked Yes indicate the type of coverage by checking the appropriate box below:
A liability insurance policy V 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. •
�VCheck One Only
Owner Agent L/
Signature of Owner or Owner's Agent •
•
By checking here—) ♦/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 installation 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.
Inspections shall be called for prior to insulation installation.
• Duct inspection required prior to insulation installation: Yes No
Date: Comments:
Date: Comments:
•
Type of license: •
By: Master
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' Title: Master-Restricted t Signature of Licensee t
City/Town: Journeyperson
Permit ft: Journeyperson-Restricted License Number:
Fee: $ Check at www.mass.gov/dpi
T Inspector Signature of Permit'1`
of Permit Approval
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