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71; aF Yf9+:: SHEET METAL PERMIT
-k Commonwealth of Massachusetts
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-,'.°!4, :F. Town of Yarmouth Building Department' _ _._. _ 1
Date: .9.-1 Permit#: Re�/�1V— �,0 ' Q7 c Sgii
Estimated Job Cost: $ ID, S Permit Fee: $
Plans Submitted: YES/ NO Plans Reviewed: YES/ NO
Business License # Application License# 366
Business Information //�1 Property Owner/Job Location Information
Name: H 1 qh ° - If r i-H- Name: A2vb�C &CA/ � � -7"�/ '
Street: 28- '€r:� -e- Street: �P / lfk--r�o i L
City/Town: n h�R,-,r. , 1'-t it City/Town: S CM.;'k yet"
Telephone: (Q 12—� S24 — 2-qg 3 Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES/ NO Staff Initial:
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-family Condo/Townhouses Other
Commercial: Office Retail Industrial Educational Institutional Other
Square Footage: under 10,000 sq. ft.po
ver 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:
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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 �tJ 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 here- ,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 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:
Tye of license:
By: Master
Title: Master-Restricted I Signature of Licensee 'f`
City/Town: Journeyperson S,
Permit#: Journeyperson-Restricted License Number: 3 PI
Fee: $ )) Check at www.mass.gov/dpl
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'I` Inspector Signature of Permit '1`
of Permit Approval
DIVISION OF PROFESSIONAL LICENSURE
SHEET METAL WORMERS
ISSUES THE FOLLOWING LICENSE
MASTER UNR TRfCTED
NHAN H NGUYEN
284 BRIDGE ST
RAYNHAM,.MA 027671975
3605> Ifl/Z81201:::` 733025
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBS'
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