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'�°`"_"1 SHEET METAL PERMIT
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(9 f ' .. )i Commonwealth of Massachusetts [._ MAR 08 2023
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`a -r•rM:,,,eKF; :`' Town of Yarmouth Building Department
.,,.�-'"' .fir BUILDING uEPARTMENT
Date: Permit#: 3L SI'(1 -2.7j— vu(-98-J
Estimated Job Cost: $ 511' Permit Fee: $
Plans Submitted: YES/ NO Plans Reviewed: YES/ NO
Business License# 6-66'�' Application License # -5a,pe/
Business Information Property Owner/Job Location Information
Name:,4 r�s / 1ieG d1 Y ` Name: PiKe_ Ctifr,c,
Street: ii' c ,e,e( r' Street: S0 Pcjr. k &vv-
City/Town: pfid 'L'79 -kr/1I City/Town: u/e -t Ygrw,ouLl M tk
Telephone (7/ Sf2 _q'Z- Telephone: 617 tf t+ "b 65
Photo I.D. required/Copy of Photo I.D. attached: ;`"YES NO Staff Initial:
-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 V Multi-family Condo/Townhouses_ Other
Commercial: Office Retail Industrial_ Educational_Institutional Other_
Square Footage: under 10,000 sq. ft.V over 10,000 sq. ft. Number of stories:
Sheet metal work to be completed:
New work Renovation:_HVAC: Metal Watershed Roofing:
Kitchen Exhaust System:f'Metal Chimney/Vents: Air Balancing:
Provide detailed description of work to be done: /A1,%% '01'1- d' G" be''e'l�
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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 1-7/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
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:
Type� of license:
By: V Master
Title: Master-Restricted 'IT Signature of Licensee IN
City/Town: Journeyperson /
Permit#: Journeyperson-Restricted License Number: 'j_6� 67(1
Fee: $ Check at www.mass.gov/dpl
1` Inspector Signature of Permit 1'
of Permit Approval
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,.,...,i;..:f..(.. COMMONWEALTH OF MA:SACHUS ,.,SM:-I
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......„,..-,:,. SHEET METAL WORKERS 1-::•;,'::.. ........ ...,.....1:„.„:.:,.,.„.
•,.:::,,..,:,,,,,,::",. ,.:::: ISSUES THE FOLLOWING LICENSE 4,1'..!::':,,,i,k1.1:-•
MASTER-UNRESTRICTED
., g-'''. ',,.:,..•:,.,.,':i,.':-'".. ''.'::
MIKHAIL ELBRUS
29 COPELAtilck,Br',,:',:.:'
WATERTOWN,'''MK-024731601'''"V.
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5604 24 307948 07128/20 ,..,,,,,,:,..,i'
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LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER
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