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60 WASHINGTON ST - BUILDING INSPECTION (7) is Commonwealth of Massachusetts V g� I Sheet Metal Permit $1 SA c,- 19 g 31 Date: �,2 Permit# Estimated Job Cost: $ 7, Q Permit Fee: $ Plans Submitted: YES_ NO X/ Plans Reviewed: YES— NO— Business License# g Applicant License# 3) q 9 Business Information: Property Owner/Job Location Information: Name: �;/, A�r Svs�f'//Y1S Z?C . Name: � G ZL)e SX)Wf�y � Street: ISe I�Qt2/e S�/-e� Street: 9 /01 -/- __ )Dan)D n yP r-5 r city/Town: .SG /[`/,)I i Telephone: 9?r- 97 / / 4toJ Telephone: 9o2 -GG�QG Photo I.D.required/Copy of Photo I.D.attached: YES_& NO Staff Initial J-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_ Multi-family_ Condo/Townhouses— Other— Commercial: Office_ Retail Industrial— Educational— Institutional Other Square Footage: under 10,000 sq.ft X 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_ "y Provide detailed description of work to be done: /,YPCTG r "LS S V NZ ddY gl9l S30IA83S lNNOI!33dSNl Tech-Air Systems, Inc. l HVAc service&Installation Peter Zagorskl Humidification Air Filtration&Ductwork President Maintenance Policies / 156 Maple Street C(rj6 I '^� Danvers,MA 01923 �S a � (978)468-1687 Etta O q� (978)777-7669 Et 3 (978)777-7689 FAX techair@tech-airsystems.com www.tech-a:irsystems.com F COMMONWEALTH OF MASSACHUSETTS ~; SHEET METAL A BUSINESS ISSUES THE ABOVE LICENSE TO: PETER M ZAGORSKI TC.CH-AIR SYSTEMS INC HA MAPLE ST Q DANVERS MA 01923-0000 82 10/14/14 258090 �y,.v�a,vrvuvwnvvrr�un yr mHJJMWnVJG11J y:; R HE-EtEA G W r , SSA fi 0 �� IS54ES T E FOLLOWI1 EN5E ERA 359�AS;BU 1= � S���ONr kM 10 01982 ;ljo�� �` 'T 81884692 '.`PEER N' I;S .1A HA SBUflY STr,1�4'� - �. MILTOL{'lLA� �� _ _.r=t.� • ,, INSURANCE COVERAGE: I have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yep<No❑ If you have checked Yes,Indicate the type of coverage by checking the appropriate box below: A liability irsurance 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 is permit application waives this requirement. Check One Only �* �f- Owner ❑ Agent�51 SignatureofOwne r Owner's Agent , By checking this bo I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the be of nowledge 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 Progress Inspections Date. Comments Final Inspection Date Comments Type of License: By Master Title ❑ Master-Restricted City/rown ❑Joumeyperson Signa ure of Licensee � Permit# ❑Journeyperson-Restricted License Number: Fee S Check at www.mass.govldpl Inspector Signature of Penult Approval The-Commonwealth of Massachusetts Department oflndustr'ia!Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):•�]�ch /7/r 6',,S4-n?,q /j r Address: n/ec City/State/Zip: ntl -frs' , MH �J973 Phone#: 9121' 9— Are you an employer? Check the appropriate box: Type of project(required): LL0 I am a employer with_u 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition worldng for me in any capacity. workers.'comp.insurance. 9. ❑Building addition (No workers' comp,insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required_)t employees. [No workers' 13X Other • 11A(' comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and thm,hire outside contractors must subrnit a new affidavit indicating such. tConuzctors that check this box must attached an additional sheetshowing the name of the subcontractors and their workers'comp.policy inforrration. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. �J Insurance Company Name: I ��rJk C12af-lif r / rl (�' I At — Policy#or Self-ins.Liic.#:�G�iSir� �� farr L/ Expiration Date:�N�Il Job Site Address: /� �Q_ �J/))�f 7 r�tY eP / City/State/Zip: Sal e n-) , /%A o/9/70 Attach a copy of the workers' compensa on policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signatu�n n>d . t�7 n �r7�/Li�..l��iL� Date Phone#: `�/ /O / 2 / " / 1� � Official use only. Do not write in this area,to be completed by city or town of-ciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: �Boarb of 3aegi�aration of 4&beet Aetal lVorhm; 3Eqabing ,'ati,qfieb the requiremento. of Mae; aw juoett5 0eneral Raw ClOpter 112, &.ection 237 tbrougb 251 i!6 berebp granteb tbfi� certificate no. 62 aq; ebibence to practice a5 a *beet on tbig; 14111 bap of (October 2010 In Te5stimonp Vbereof, i5 r)ereunto affixeb the name of the (ftecutibe :Director of the -Aoarb .wrY wniyny . (October 21, 2010 QExecutiUe irectn� i Mate cAS11LA WASTE SERVICES 79 INVOICE PEABODY DMSION 295 FOREST ST SERVICE ADDRESS PEABODY MA 01990 156 MAPLE ST CUSTOMER NUMBER 79-07766 1 PAGE 1 of 1 INVOICE# 1979159 TECH AIR SYSTEMS BILLING INQUIRIES(800)445-1318 DANVERS MA 01923 INVOICE DATE 6/O l/13 An updated f iel/oll/enviro table is now available at our website. Please visit www.Caselia.com/fueVoiVenviro for more details. DATE DESCRIPTION QTY. RATE TOTAL 5/31/13 FUEL/0IL/ENVIR0 FEE - - - .79 5/31/13 8YD FL EOW TRASH 4 P/U: 01 1.00 171.89 "Spring is here" Call us for`a roll—off box - - 652306A FOR SERVICE DURING JUNE PAY THIS AMOUNT $172.68 I 1 INOMIEI®IMMIBMISMEN ._ Certificate of Product Ratings AHRI Certified Reference Number: 5924411 Date: 4/24/2014 Product: Split System: Heat Pump with Remote Outdoor Unit-Air-Source Outdoor Unit Model Number: SSZ14042W Indoor Unit Model Number:AVPTC48D14A* Manufacturer: GOODMAN MANUFACTURING CO., LP. Trade/Brand name: GOODMAN,JANITROL,AMANA DISTINCTIONS, EVERREST,ONE HOUR AIR CONDITIONING AND HEATING, ENERGI AIR Series name: SSZ14 Manufacturer responsible for the rating of this system combination is GOODMAN MANUFACTURING CO, LP. Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent,third party testing:_ .�®-T�--���. _. t L paclty_(Btuh): 415g00 — I (Cooling). 12.$0 �ng(Cooking): �- 15.00pacity(Btuh)@47F:HSPF Rating(Heating): 9.00* Heating Capacity(Btuh)@ 17"F: 23000 ' m Ratings followed by an asterisk(')indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized aRerotion of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahrldlrectory.org. TERMS AND CONDITIONS D This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; entered Into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's Individual, personal and confidential reference. AIR-CONDRIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The Information for the model cited on this certificate can be verified at www.ahrldlrectory.org,dick on'Verify Certificate"link x,e make lifebentr­ antl enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right �- ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 130428145046991503