Loading...
16B-001 (16) Entire Holls& Equip, 9 u w (..a„err, cooling Printou certif..{" bt ACCA to meet ,3`' -e urta_-S". nls --,,f a ,... uai E .tOn Ed, b: EAp.HILL 2 By Load € r Form m .. w pause E � =M a �P..,�su�-�.�mda�,.�.�..��°.�r:. � �.` ����� � a�,y����4�w;� g `•Sd�.� k� � �;r .r�., ,s�s� a ,_ .,. � iSiuv iJ .� rye , Es D-3 t _wr CJEStua� c a °{. r1b) i E LlIp ENT COOLING HEATING � r Ond Tr� 4 Ai t} ' ' ,'iEms' f .....H�: Actual i u sue. 022 Cf 1 Static pressure 9 14� Ste_ "D BASEMENT 4 26 4� L0F i AREA fi� SUNR v v° �El H i ✓ V+ 11 `PS �_ 45-3C c !k 8 j v~ KMIFOYER 129,32 E v: E# 1 65 3" HALa S LOS ETS MASTER EEILDR00M, MSTETHI AUNALAV ?291 2748 �.0 ill . N.i �equ,ireme .:, k;.t �v4� f'°Jj _ B,1y`Ed m rN. C -60 -6 6t � ,e. 0 E C 2012 Project MMa � : En6re House For, A,rVA r� w� r n,tw`r L wgfE t outside db -r, '~`F Inside db 1� `'F Inside bb tr:pstgll f ID D rw" en ible C00jing Equiprnent Load Sizing Heating c r' ,actui e c uri 63594 Btu Esa E C3,, pas v—1 �Er ` ; A Sir,''h�r tUII Humidi C itJ ' cr1U c 3i vY§ ' ,so ur' 1 1i1u 'Ti IC i 6. '94 i EgUIP7u it 2I1.`;-� Git„'sY cp c{C:F iu3 EgUlPrr u, t Infiltr ti n Load Sizing mpIfle Latent �a�iif�c� Equipment rblethad T!,g Constru-ion, qua`Y Str;s^:ture E,tuh FsreplaCes Ducts E*uh, Central ve + � =r7 u r �t h Heattn Co011rl t 33, - �c9ulpar rzz air ! r a f t u VOlurne Otaf EglJ r r€ �I l 3 Air C?1r�t s(Ctour -)9 Req, tO-caa CcaPa it%' at quiv.4 cirr Coolirg Equipment SumrflarY Heafing Equipment SUmmarY Nlake Make bade I r ade tv a'. mcidel csil G MIS€ A F J E Pfr{ci ,., _ r EfficiencY i eatl£ttg input 0 B-`u �3 1t aIi 1 Heatir',O OUt U't r, 3t a t ,o irtM e 1E t"3tl�r rise A 3¢ uk :} ? ��M Actua! air frovi n; ±m it t'',r f1ovd�a 'Cl W r-it`fiL`L^` faCt,^.r A) i� 4-;�L;.+ ..rj ., .. ^F 1 -risible Space (.✓{15 L;d Ei�.to{�.${"L'^',�-..-.0 r:.i° rrt t. .:..Y 4<.._... .,,, ►- i � cnw N w < 30 X D N m Lrl o T ,T W 3 ....ZZ4 v m' • _ . . i ; m .: v� c ' m ►-�D = cm � -` DZr n ND _ r 0 O ZI^ M N 3 r cn* -n tn0 9 n Z m z 7C N m N c • ^ . o � Signaturey 1 1 10 fuu 0 +1 RR PAU w 7974 } v d k$ p J U70&sr9 7. x „ r+r IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25•S(2001108) Certificate 1155510 ACORD CERTIFICATE OF LIABILITY INSURANCE DAT0501/2012' TM PRODUCER Phone: (113)781-2410 Fax: 413.731-9539 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INSURANCE CENTER OF NEW ENGLAND INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1070 SUFFIELD STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O BOX 1230 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. AGAWAM MA 01001 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Central Insurance Company 20230 ACTION AIR INC !INSURER B: Commerce Insurance Company 34754 P.O.BOX 636 INSURER C: FEEDING HILLS MA 01030 - -- INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL TYPE OF INSURANCE POLICY NUMBER ` POLICY EFFECTIVE POLICY EXPIRATION OLI LTR INSRD DATE MWDDYY I DATE MWDoM LIMITS +,GENERAL LIABILITY CLP7978942 i 04/30/12 04130113 EACH OCCURRENCE $ 1,000,000 X i COMMERC WL GENERAL LIABILITY DAMAGE TO RENTED g 300,000 ' i PREMISES(Es oeourer $ CLAIMS MADE X` OCCUR MED EXP(Any one person) $ 5,000 A ' PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,0 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 i PRO- .. . __..._.. . _ ._._ POLICY PRO- LOC I AUTOMOBILE uneam YM3030 04/30/12 04130/13 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 I ALL OWNED AUTOS I BODILY INJURY ''' X i SCHEDULED AUTOS (Per person) $ B X HIRED AUTOS I !BODILY INJURY X i NON-OWNED AUTOS ( (Per accident) $ I PROPERTY DAMAGE $ i (Per accident) - GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY CXS7978943 04/30/12 04/30/13 EACH OCCURRENCE $ 2,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 2,000,000 A $ DEDUCTIBLE $ RETENTION$ 0 $ WC STU- WORKERS COMPENSATION AND WC797894416 04/30/12 04/30113 X TRY uM TS OTHER "i EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNERIEXECUTIVE - E L.EACH ACCIDENT $ 500,000 OFFICERIMEMeER EXCLUDED? E.L DISEASE-EA EMPLOYEE $ 500,000 U yes."emi"unaw SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS TO SHOW EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE FOR VERIFICATION OF INSURANCE PURPOSES ONLY TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT$AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE Attention: tephen Gallagher ACORD 25(2001108) Certificate# 62630 ©ACORD CORPORATION 1988 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statue, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the forgoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees,However the owner of a dwelling house having not more that three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer". MGL chapter 152 section§25(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152 section §25(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s),along with their certificates(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the Members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towns Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 phone#: (617)727-4900 ext. 406 or 1-877-MASSAFE fax#: (617)727-7749 Revised 11-22-06 www.mass.gov/dia Department of Industrial Accidents Office of Investigations 600 Washington Street . .. . ... .:. Boston,Mass. 02111 www.mass.gov is Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): (�(� Address: 3 �.P City/State/Zip: Phone#: e4l Are ou an employer?Check the 1p box: Typegf project(required): 1. I am an employer with_ 4. 0 I am a general contractor and I 6. w construction employees(full and/or part time).* have hired the sub-contractors 7.❑Remodeling 2. 0 I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance. $ 9. 0 Building addition required] 5.0 We are a corporation and its 10. 0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. 0 Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required] t c. 152,§ 1(4),and we have no 12. 0 Roof repairs employees. [no workers' 13. 0 Other comp,insurance required.) *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whetber or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'comp cation insurance for my emplo ees.Below is the policy and job site information. Insurance Company Name: n5� a Policy#or Self-ins.Lic.#: Lk-A2,--I C� L� —I I LP Expiration Date: 3® 13 Job SiteAddress:n gov C;,_ City/State/Zip; floc\e &9- al U0,A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pa' a d penalties of perjury that the information provided above is true and correct Sign ture 7 Date. o� Print Name: qeva ( Phone #: 13 = --)V1 3�J Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact person: Phone#: INSURANCE COVERAGE: 1 have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑. OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner Agent ❑ Signature of Owner or Owner's Agent. By checking this box I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best 1 my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Proaress Inspections Date Comments Final Inspection Date Comments Type of License- el By """ aster Title ///"❑Master-Restricted CitylTown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted �� License Number, Fee$ ❑ Check at www.mass.gov/dt)l Inspector Signature of Permit Approval I 1 Sheet a©ale m P cam.\5 �\ .fir' b2@2 Permit# e5M S0 CSC Dr- !7- EstiinateA Jo, Cost: $ sb� Permit Fee: $ (D5.Q� 3� Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# Business Information: Property Owner/Job Location Information: Name: 0&)0tl l �' Name: ti S C. v✓1 Street: *,_� plcx (o�J� Street: qV City/Town C\ X51)N City/TownX�CQ Y\0 S2 7 Telephone: ?,—� - ,C) Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO saa lniu.l 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 X 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 Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing %i de detailed description of work to be done: Sk ry-) File#SM-2013-0016 APPLICANT/CONTACT PERSON ACTION AIR ADDRESSIPHONE P O BOX 636 (413)789-9305 PROPERTY LOCATION 40 MARK WARNER DR-20 BRIDGE RD MAP 16B PARCEL 001 040 ZONE SR/URA/WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 5rn - Fee Paid Typeof Construction: INSTALL HVAC SYS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 375 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I FORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND/OR Special Permit with Site Plan Major Project: Site Plan AND/OR Special Permit with Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee P rmit Elm Street C ssion Permit DPW Storm Water Management Si e o Building O ficial Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of Planning&Development for more information. 40 MARK WARNER DR - 20 BRIDGE RD SM-2013-0016 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON IGIS#. 112142 Map: 16B Block: °°' - SHEETMETAL PERMIT Lot: 1040 „�..• Permit !SHEETMETAL III, Category: New Single Family House 1 Permit# SM-2o13-0016 PERMISSION IS HEREBY GRANTED TO: - - 01 - - - — 'Project-# JS-2012-001848 _ Est Cost: $12,500.00 Contractor: License: Expires: - - - ACTION AIR Sheetmetal 375 Fee Charged $25.00 - 05/12/2013 _ --- — --- Balance Due:$.00 Owner: 20 BRIDGE ROAD LLC #of Fixtures:! Applicant: ACTION AIR DigSafe# - AT: 40 MARK WARNER DR-20 BRIDGE RD �UseGroup IConstClass ISSUED ON: 27-Dec-2013 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: INSTALL HVAC SYS THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Sheetmetal REC-2013-000996 07-Sep-12 5139 $25.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov GeoTMS®2013 Des Lauriers Municipal Solutions,Inc.