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2 SALT WALL LN - BUILDING INSPECTION Commonwealth of MassachusettsREIVED Sheet Metal PermihPECT ONAL SERVICES Cr, to u IS Date: k !'t- Estimated Job Cost: ga� �/3 Permit I ' S p0 S Plans Submitted: YES NO Plans Reviewed: YES N Business License # �� Applicant License # 1 Business Inf rrmmatiion: �y��c��N1L8�1 Property Owner/Job Location information: Name: COr' Ir R 1 Q1Jl l�L Name: 0 1) N Q Street: C �ea , ( Wft�)q Street: o� S(31 fi QYi�1� L1V; City/Town: (ION mq• dq� ` �� City/Town: _ � , t,' IR • � I� Telephone: ?a I ` (� 1 ( Z Telephone: Photo I.D. required/ Copy of Photo I.D. attached: YES NO_ J-1 l- mrestricted 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. tt:>� over 10,000 sq, ft. _ Number of Stories: Sheet metal work to he completed: New Work: Renovation: I-IVAC� Metal Watershed Routing_ Kitchen Exhaust System Nletal Chimney 1 Vents Air Balancing Provide detailed descrikion of work to be done: ToyR'� qf INSURANCE COVERAGE: :'.'y _.. --IIfl- I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes?& No❑ �F •r; � t _ rn , If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy C. Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 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 smOwner ❑ Agent O 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 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 Proeress Inspections Date Comments Final Inspection Dote Comments Type of License: By �Waster Title ❑ Master-Restricted CltyiTown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: ) _ Fee S Check at www.mass.govlJpl Inspector Signature of Permit Approval The Commonwealth of Massachusetts Department oflndustrfalAccidents l Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia vivorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information C' ry� ('+ ease Print Legibly Name(Busine(sss/Orgamzatitiongndiv'idlual): 1�c`S� 1'I�r {�1G�� \0 N S j `. Address:_ 1 6 `\6 ±1 ) City/State/Zip: l�N . m 05 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.�I am a employer with_employees(full and/or part-time). 7. ❑New construction 2.0 I am a sole proprietor or partnership and haw no employees working foJh any capacity.[No workers'comp,insurance required] 8. ❑Remodeling t 3.❑1 am a homeowner doing all work myself[No workers'comp.insurance9. ❑Demolition 4.❑Isms homeowner and will be hiring contractors m conduct all work on 10❑Bulldtng additionensure tlut all contractors either Aare workers'co ation insorence I wiliproprietors with no employees. 1I.❑Elechical repairs or additions 12.❑Phnnbing repairs or additions I am a general contractor and I have hired the subcontractors listed on theet.These sub-contmmms have employees and haw workers'comp mnamc13.❑Roof repairs+,6.❑We am a corporation and its officers have exemsed their right of exemptic. 14.�Otber y (/152,§l(4),and we have no employees.[No workers'comp.imsmaoce req 'Any applicant that checks box#1 must also fill out the sermon below sho wing their workers'compensation polity information. t Homeowner$who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ,Contractors that check this box must attached an additional sheet showing the name of the sub-conbacmrs and state whether or act those entities have employees. If the sub-contractors have employes,they must provide their wodcus•comp,policy number. I am an employer,that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: ^7 C Policy#or Self-ins.Lic.#: f q (Q 6 A g 3� r Expiration Date: Job Site Address:a SJ,� " h � City/State/Zip:S� e Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 fore of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby - I under the pains andpenahies ofperjury that the information provifelf J above is true and correct Suture: Q �p rp TJ))r-n Date t V Phone#: 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 on 1.Board of Health 2.Building this 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person• _ Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,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 is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing 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 than 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,§25C(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,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfomtance 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 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(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 Town 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 thepemtit/license number which will be used as a reference number. in addition;an applicant that must submit multiple perrnit/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 home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. r The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-7274900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Universal Mechanical Contractors, Inc. 9 Devlin Way Lynn, Ma. 01905 Phone 781 -595-9222 Bringing Quality and Comfort to families for over 30 years. 1 /1 8/2016 Page 1 of 4 Proposal Submitted to: Julie Breskin Phone: 781 -589-3100 2 Saltwall Lane Email: jbreskin@comcast.net Salem, Ma. 01970 jmgrossl@gmail.com Job: 2 Salt Wall Ln. Salem, Ma. 01970 Estimate Submitted for: the installation of up to 3, Trane, 1 .5 ton, central a/c systems with a SEER rating of 14 or 17. Kitchen/family rooms: This system shall be located above the garage with ducts run through the garage/laundry room ceilings and through the family room partition. NOTE: Installation of these grills will require removal of the decorative woodwork on this wall. Removal and repair of this woodwork boxing in of P � 9 garage ductwork is not included in this proposal. 2 supplys and one return shall be installed in this partition. One supply and one return shall be installed in the laundry room. The outdoor unit shall be located on the end of the home. Phone 781 -595-9222 Email peter@getair.org Fax 781 -595-9643 Page 2 of 4 The air handler will be suspended from the roof rafters with an emergency drain pan and safety switch. Installed price: 14 SEER $ 7,175.00 q1SEER:$ 8, 9:5.00) 5V3 First floor: spare bedroom, therapy room, foyer and dining room. The air handler shall be located in the basement below the spare bedroom. The outdoor unit shall be located in the rear of the home. 5 supplys and two returns shall be installed. Installed price: 14 SEER $ 8,895.00 1 CSEER $ 10,250.00 nf,� 2nd floor bedrooms: The air handler shall be located in the attic space with an emergency pan and safety switch installed. The outdoor unit shall be located in the rear of the home. 5 ceiling supplys and one hall return filter grill shall be installed. Installed price: 14 SEER $ 7,995.00 7 SEER $ 9350.00 All return box and unit plenums will be lined with acoustical insulation. All attic ductwork will be sealed and insulated to R-8 per code. 3 of 4 Return and supply ducts shall be flexible round with a volume balancing damper installed in each supply take off. A digital, programmable Honeywell room thermostat shall be installed on each system. Exposed Freon and drain lines shall be enclosed in Fortress line hide. 14 SEER equipment: M# 4TTR3018 - XR13 SEER outdoor unit M# TEM3AOB1 8 - air handler with standard fan motor System ratings: 14 SEER - 12 EER AHRI # 7918133 17 SEER equipment: M# 4TTR6018 - XR16 outdoor unit M# TAM7A0A24 - variable speed air handler with high efficiency ECM motor System ratings: 17 SEER - 14.5 EER AHRI # 8625055 Rebates: 17 SEER systems are eligible for a $ 250.00 rebate for National Grid customers. NOTE: Universal Mechanical does not guaranty rebates as programs may change without notice. Home owners must verify and apply for these rebates personally. 4of4 i Warranty : Two years all parts and labor Ten years Trane functional parts. Five years on room thermostat. Routine maintenance must be performed to validate warranty. Price does not include: electrical wiring, moving landscape plants for installation of outdoor units, removal and repair of woodwork in the family room, boxing in exposed garage ducts. Price includes: equipment, materials, labor, permits and sales tax. If in agreement, please circle and initial desired option(s), sign and return proposal for our records and permitting process. Submitted by: Peter Lyon Date: 3/29/ 16 Accepted by: Pricing valid for 30 days Phone 781 -595-9222 Email peter@getair.org Fax 781 -595-9643 -" OMMONW L7H OF MA 'AtFiSF S Of SH€ET CAL, WORKERS f 'ISSLcS;,TH'k FOLLOW IhlN L1'CENSE U{� tSTR Marcia Kirkpatrick From: karen <karen@getair.org> Sent: Monday, April 04, 2016 10:42 AM To: Marcia Kirkpatrick Subject: FW: 2 Eclipse Hi Marcia, Just faxed over page 2 for the work being done at 2 Eclipse Lane in Salem. If you did not receive the Copies of the License's or page 2 signed let me know. We were asked to submit approval from the condo association that it was ok to do the work. Below is an email stating it is fine to have the work done. This approval was sent to the homeowner and then forwarded to us. Any questions please give us a call. Sorry for the mistake and thank you so much for your help! Karen Lyon Universal Mechanical Contr, Inc. 781-595-9222 From: Katherine HEALEY [mailto:markhealey@comcast.net] Sent: Friday, April 01, 2016 3:43 PM To: Mark Healey Cc: karen@getair.org Subject: Fwd: 2 Eclipse Begin forwarded message: From: "Jill Fama" <Ifama(5crowninshield.com> Subject: RE: 2 Eclipse Date: April 1, 2016 at 3:40:11 PM EDT To: "'Thomas St. Pierre"' <tstpierre(cDsalem.com> Cc: "'Katherine HEALEY"' <markhealey(a)comcast.net> Good Afternoon Mr. St. Pierre, The owners of 2 Eclipse Lane at the Green Dolphin Village will be replacing their furnace and a/c unit. They will be using Universal Mechanical out of Lynn, MA. The Condominium Association does not object to this work and have no problem with them pulling a permit. Please let me know if you need anything else from my office. Thank you in advance and have a great weekend. t �1 UNIVE-1 OP ID: LS ACORO` CERTIFICATE OF LIABILITY INSURANCE DAM(MWDDIYYYY) `/ 03/28/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. 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). PRODUCER CONTACT A James Lynch Insurance Agency -NAME: PHONE 7815984700 ac No:781-599-0580 297 Broadwayy AIC.No.Eat): Lynn,MA 01YD4 E-MAIL Thomas R Ross ADDRESS: INSURERS)AFFORDING COVERAGE NAICp INSURER A:Arbella Protection Ins Company INSURED Universal Mechanical Cont. Inc INSURER B: Peter Lyon INSURER C 9 Devlin Way Lynn, MA 01905 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF INSURANCE ODL UBR POLICY NUMBER MM/LODYY MMIODWYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 MTM1­GE7Up1 11 TCLAIMS-MADE 'X, OCCUR 8600040425 0613012015 06/30/2016 PREMISES Ea occurrence) $ 500,00 MED EXP(Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,00 [ PRO- ❑ PRO JECT ❑ LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A ANY AUTO 1020001502 OW3012015 0613012016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON—OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS Peracciden[ UMBRELLA LIAB CU EACH OCCURRENCE $ EXCESSLIAB CL OCAIM:R-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE EORH A ANY PROPRIETORIPARTNER/EXECUTIVE Y/❑N 9109150608 06130/2015 0613012016 E.L.EACH ACCIDENT S 50 IM OFFICEREMBER EXCLUDED9 NIA(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 4 SO If yes,describe under 50 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT 4 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may Ee attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Julie Breskin ACCORDANCE WITH THE POLICY PROVISIONS. 2 Salt Wall Lane Salem, MA 01970 - AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Accela Citizen Access https://eiicensing.state.ma.us/CitizenAccess/GeneralProperty/Propert... Announcements I Reoisterfora Search... T Need Help? For technical assistance in using this web application, please call the ePLACE Help Desk Team at(844)733-75221Y@ or(844)73-ePLAC between the hours of 7:30 AM-5:00 PM Monday-Friday, with the exception of all Commonwealth and Federal observed holidays. If you prefer, you can also e-mail us at ePLACE helpdesk -state.ma.us. For assistance with non-technical issues, please contact the issuing Agency directly using the links below. Translation Information -Click Here Browser Compatibility: • For Application/Renewaldf your application requires a file upload, Microsoft Silverlight is required to do so. Please see the link below for instructions to download Microsoft Silverlight. Silverlight Download • File a Complaint:Instructions above apply for filing a complaint if you are uploading a file/picture. Home Manage Licenses, Permits & Certificates File &Track Complaints Check a Commonwealth Licensee Use Check a Commonwealth Licensee to see if a business or individual has a valid license or permit. Search for Licensee Licensing Entity: _ License Type:_ Board of Examiners of Sheet Metal Workers Sheet Metal Business T License Number: First Name: Middle Initial: Last Name: Lyon Peter - IA. Business Name: DBA Name:_ Universal Mechanical Contractors,Inc. City: State: Zip: Search Clear ONotice: Your search returned no results.Please modify your search criteria and try again. 1 of 1 4/4/2016 2:42 PM Accela Citizen Access https://elicensing.state.ma.us/CitizenAccess/GeneralProperty/License... Announcements Register for a [Search_. _ --- Need Help? For technical assistance in using this web application, please call the ePLACE Help Desk Team at(844)733-75221Y@ or(844)73-ePLAC between the hours of 7:30 AM-5:00 PM Monday-Friday, with the exception of all Commonwealth and Federal observed holidays. If you prefer, you can also e-mail us at ePLACE helpdesk(a)state.ma.us. For assistance with non-technical issues, please contact the issuing Agency directly using the links below. Translation Information -Click Here Browser Compatibility: • For Application/Renewal:If your application requires a file upload, Microsoft Silverlight is required to do so. Please see the link below for instructions to download Microsoft Silverlight. Silverlight Download • File a Complaint:Instructions above apply for filing a complaint if you are uploading a file/picture. Home Manage Licenses, Permits & Certificates File & Track Complaints Please refer to the Licensing Entity's website for additional information regarding the status and discipline information shown below. For DPL information,please visit the DPL website. For ABCC information,please visit the ABCC website. Information Pertaining To: Sheet Metal Master 1157 Licensee Detail License Number: 1157 Licensing Entity: Board of Examiners of Sheet Metal Workers License Type: Sheet Metal Master Type Class: MI License Issue Date: 05/26/2010 License Expiration Date: 03/28/2018 Status: Current Current Discipline: Other Discipline: Name: PETER A LYON Business Name: DBA Name: 1 of 1 4/4/2016 2:37 PM