239 WASHINGTON STREET - BUILDING INSPECTION The Commonwealth of Massachusetts
Department of Public Safety
(µ+r' 1;. \Lasachusrtls Slaty Building Code(780 CNIK)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(Phis Section For Official Use COIN)
Building Permit Number: _ Dale Applied: (f Building Official: _
SECTION 1: LOCATION (Please indicate Block B a d Lot p f r locations for which a street address is not available)
No.and Street City/I'urrn Yip Code Name of Building(if applicable)
SECHON 2:PROPOSED WORK
Edition of NIA State Code used It NPN Construction check here or Check all that apply in the two rotes below --
Existing Building I Repair❑ Alleralion Addition❑ 1 Demolition Please fill out and submit Appendix 1)
Changv of Use ❑ Change of Occupancy Other ❑ Specify:_
Are building plans.lnd/Or crmstrticlion drxvn1011S being supplied as part of this permit application? Yes No 'O
[Still Independent Structural Engineering Peer Review required? Yes ❑ Nj+JW
Brief Description Of Proposed Work:
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SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOIN ENO A'ftON, DTr10N,OR
CHANGE IN USE OR OCCUPANCY
Check here dart Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ `
Existing Use Group(s): I Proposed Use Gruup(s): —_
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Flours/Stories(include basement levels)&Area Per Fluor(sq. ft.)
Total Area(sq. ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4 ❑ A-5❑ B: Business NO E: Educational ❑
F: Facto F-I ❑ F2❑ H: High Hazard H-I ❑ H-2❑ H-3 ❑ H-a❑ H-5❑
I: Institutional I-1 ❑ 1.2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-:i❑ R4 ❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑, IIA ❑ IIB ❑ ILIA ❑ IIIB ❑ 1 ;IVY❑ 1 VA ❑ VR ❑
SECTION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details an each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check if Oulsido Ilona 7_unr O hulic.ue municipal ❑
A Irenckwill not be Licensed Disposal Site❑
required ❑Or trench or specify:________
Privy tc❑ or indentifv Zone: or nn site system ❑ permit is enclosed O
Railroad right-of-way: Ilazards to Air Navigation: �I l i........ . .,,um,.,,,
Nut Applicable❑ Is Structtve within airport approach area? Is their rev iv%% iomplelod.'
or COnsent to Build VIR'losed ❑ 1es❑ Or No❑ YrS❑ No ❑
SFC"I'ION 8:CONTENT OF CERTHICATE 01:OCCUPANCY
i
Edition of Code: ..... L'sr Group(s): IN'pe OI Construe lion'. ___ _ Occup,nit Ladd per Ilour.
-
Our s the building contain an Sprinkler Svslem?. __.e._ .__Special Stipulations.
SECTION Y: PROPERTY OWNER AU'I'IIORIZA-1 ION
N,unc and Address ul Property(hcncr "R
-- L 6----- ---
Name(Print) Nu.and Stre -- City/Town Zip
Property Owner Contact Information:
I ille Telephone No. (business) 1elephone No. (cell) a-mail address
If applicable, the property owner hereby authorizes .
Name Street Address City/Town 'State Zip
to act on the property owner's behalf, in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less thin 35,10)cu.ft.of enclosed s pace and or not under Construction Control then check here O and ski+Section 10.I
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
PC'f4C�o_� ) - ((�efie 1111-1
Company Name U
7 74s
Name of Person Responsib a for Construction y ' License No. and Type if Applicable r
q") l (Ii ` SG (e-, 114A Clgi`zG
Street Address City/Town nn State n Zip n
? S l jl` q�-sw D�c6`q C4�. ( v A11�cv� It .ye _
Tole t one No. business Telephone No. cell a-mail address UUU---
SECTION 11:1Nol,,K iliR t-im11'I 1 it �\ IAA:F_U_r.A.A(j AIIII7,vV1f M.G.L.c.152.§ 25C6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the dental of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes O No 13
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item b)_$
1. Building $ -
Buildbrg Permit Fee=Total Construction Cost x_(Insert here
'_. Electrical $ appropriate municipal factor)_$
3. Plumbing $
4. Mechanical (HVAC) $ Note: Nlinimmnn fee=$ (tact nmu 9palily)
5. Mechanical Other $ Enclose check payable N bG
a.Total Cost $ (contact municip,dtty)and write check number sere
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering n»• name below, I hereby attest,under the pains and penallies of perjury that all of he inhumation contained in [his
applii anion is true and accurate le the best of my knowledge and under standin .
Please print and sign name -----.---_ __— .Fitle Telephone No. Dale _.
Sheet Address Cih'/llren Slate _—Lip
Municipal f i pector to fill tint this section upon application approval.:
c Dale
i
0.0
Commonwealthiof Massachusetts
� Sheet Metal Permit Date: g 3 1 ) q Permit #
1 Estimated Job Cost:S ( � b Pernit fee:
Plans Submitted: YES_ NO �e i Plans Reviewed: YES_ NO_
Business License I Applicant License# 3
Business Information: Property Owner/Job Location Information:
CO)N�Nan e: U u z v Lp 4 J1� 1 t�C Gi Sq 1\S �C FF\ I Name: S ('`J (�¢� IJ Uj 1g1CS
"VA
Street: I 'Q.�4x �3�`' I Street:
City/Town:�hh• ��J IV City/Town: S)9)
Telephone:7 ri ) ^TJ O i 5?�'a I Telephone: 7g
Photo I.D. required/Copy of Photo I.D. attached: YES_ NO_
J-1 M- unrestricted license
I
J-2/M-2-restricted to dwellings 3-stories or less find commercial up to 10,000 sq. ft./2-stories or le
Residential: I-2 family_ Mulfi-family� Condo/Townhouses Other—
Commercial: Office_ Retail_ Industrial_ Educational_
Institutional Other_
Squure Footage: under 10,000 sq.ft. over it0,00,0/sq. ft.` Number of Stories:_
Sbeet metal work to be completed: New W rk: t
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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I
r Universal Mechanical Contractors, Inc.
9 Devlin Way Lynn, Ma. 01905
Phone 781 -595-9222
Bringing Quality and Comfort to families for over 25 years.
7/28/11 Page 1 of 3
Proposal
Submitted to: lob Location:
Mr. Steven Banks 3rd floor
14 Bay View Dr. 14 Pratt St.
Swampscott, Ma. 01907 Salem, Ma. 01970
Email: stevenbanks@byu.net
Proposal Submitted for: the installation of one, 80%, gas fired, Trane
furnace located in the attic for the 3r floor apartment.
The furnace shall be a M# TUD1 B060 with a capacity of 60,000 btus.
cooling coil M# 4TXC B031 will also be installed.
2.5 ton co ,
A 9
The unit shall sit in an emergency drain pan with a safety switch installed.
One return filter grill will be installed.
Six ceiling supplys will also be installed.
One programmable room thermostat will be installed.
Phone 781 -595-9222 Fax 781 -595-9643
Page 2of3
The furnace will be vented up through the roof with metal B-vent chimney.
The roof flange will be installed by the roofer contracted by others.
OPTIONAL: Completion of the a/c system at this time.
We shall install a Trane, 2.5 ton, 13 SEER outdoor unit M# 4TTB3030.
This unit shall sit on the ground in the rear of the building on a poured
concrete pad.
The Freon, drain line and electrical will be run exposed down the side of
the house covered with Fortress line hide.
Price includes: cutting holes, materials, equipment, labor, sheetmetal
permit, removal of debris from the job site.
Price does not include: patching, painting ceiling, electrical, gas piping,
roofing.
Furnace & a/c coil: Complete a/c system a $ 2,827.50
Sales to 140.63 122.50
Total $ 5,995.00 $ 2,950.00
Page 3 of 3
Warrant one year p
r all arts and labor
Five years equipment parts
Ten years on compressor
Twenty years on heat exchanger
If in agreement with proposal: circle and initial desired options, sign and
return one copy of proposal to Universal, keep one copy for your records.
Payment: $ 3,000.00 on day of delivery of equipment and start of work
followed by progress payments.
Submitted by: Peter Lyon Date: 7/28/1 1
Accepted bv: Date:
Universal Mechanical Contr, may withdraw this proposal if not
accepted within 30 days.