34 BELLEVIEW AVE - BUILDING INSPECTION Commonwealth of Massachusetts
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Sheet Metal Permit Pt ,G� d�1t
Date: 'Z� Permit# 10(6 SEP 28 A (Q 53
Estimated Job Cost: $ lids® Permit Fee: $ A, l,- 3 1
Plans Submitted: YES NO Plans Reviewed: YES NO_
1 Business License# 47 1 Applicant License# U �7
Business0 N V£z.,,,L Property Owner/Job Location Information:
Name:11)F-Ct1'nNtcRL. Q3 01C+) lgrill +L Name: iy2 fttri e-W , ioDe1
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Street: q � A N t L / Street: 3 ,1 1RkN-'4) `w 1�
City/Town: Ly NN City/Town: �1
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Telephone:�81 ''S�S ����� Telephone: (l ( - V)
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. over 10,000 sq. ft. _ Number of Stories: oZ
Sheet metal work to be completed: New Work:jy Renovation:
HVAC >( Metal Watershed Roofing_ Kitchen Exhaust System
Metal Chimney /Vents Air Balancing
Provide detailed description of work to be done:
c,,fi c v woc� o seat �� pol oos
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M At 1—D TD C-4 G 10 ILA
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 YesX 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.
^ �Q �, ` , , Check One Only
I { . �n�yv r ` Owner ❑ Agent $k
Signature of of Owner or Owner's Owner's Agent
By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES_NO_
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By 'Master /^/
Title E] Master-RestrictedQ\ AA IR ,
City/Town ❑Joumeyperson
Signature of Licensee
Permit# 11.5
❑Joumeyperson-Restricted License Number:
Fee$ ❑
Check at www.mass.uov/dpl
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Inspector Signature of Permit Approval
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COMMONWEAL.TH OF. MAS�US S a
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BOAAG OF
SHEET(1AETAI WORKERS
ISSUES THE FOLLOWING Lk iVSE�A �.
y c6ASTER UNRESjR1CT.ED
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a PETER A LYON .`_ �
a �91EVLIN WAY ,� ` +�
LYNN 1YIIA Q1905 1749 z A.'"'
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115/ 3 w'x ,y `I�`31c8/2018 $4347 .'�
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The Commonwealth of Massachusetts
Department of Industrial Accidents
� - — OlBceoilnlfestlgatlons
600 Washington Street, 7th Floor
,yo f Boston,Mass. 02111
Workers'Compensation Insurance Affidavit: Buildingv_ umbing/Electrical Contractors
Applicant information: Please PRINT leeibly
name: P L riN
address: -I N •'ky (� (�']
cityL�N 1J Lt 1 stater�� , zi :0) Vg_ hone#
work site location(full address):3-r�t-\��-V)oW '(T\y t �x e� 01� ( 0
❑ I am a homeowner performing all work myself. Project Type: ®New Construction®Remodel
❑ I am a sole proprietor and have no one working in any capacity. ❑Building Addition
I
❑ I am an employer providing workers' com ensation for my employees orking n this job.
companyname: V N�1V'Q,f S ` �C (Z /,�N�
address: {„ W�)
ci : 41� V� hone#:
insurance co. policy# _
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers'compensation polices:
company name:
address:
city phone#•
insurance co. policy#
company name:
address:
city phone#:
r
insurance co. Policy#
Atmch additional sheet if necessary
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$1500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DLA for coverage verification.
I do hereby cerci under the pain an`d penahies ofper)ury that the information provided above is true and correct
Signature Q6 VW s �s(�. �+Vf'l - Date
Print name 1 )QC rl . ��� � N Phone#
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(retisei S,t.2003)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", 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 section 25 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, 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. Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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.
City or Towns
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. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you 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 Imleaganons
600 Washington Street,7"'Floor
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617)727-4900 ext. 406
Universal Mechanical Contractors, Inc.
9 Devlin Way Lynn,Ma. 01905
Phone 781-595-9222
Bringing Quality and Comfort to families for over 30 years.
September 14, 2016 Page 1 of 3
Proposal .
Submitted to: Matt Beane Phone: 617-817-7743
34 Belleview Ave. Email: mbeaneconstructin@gmail.com
Salem, Ma. 019
Estimate Submitted for: the installation of a 2.5 ton, hydro air heating
system with a/c.
Option one. ADP hydro air attic unit with a Trane outdoor ac unit.
ADP M# BCRMB56363SN3 — 120 volt air handler with standard fan motor.
50,000 btus at 2 gpm and 180 degree water.
Trane M#4TTR303 - - 13 SEER outdoor unit.
Installed price• $:11:90:00-00
Option two. Trane 220 volt air handler with variable speed ECM fan
motor with hot water coil and Trane outdoor unit.
Trane air handler M# TAM7AOB30
Trane hot water coil M# BAYWVBB07SC — 40,000 btus at 6 gpm and 180
degree water.
Phone 781-595-9222 Email peter@getairorg Fax 781-595-9643
Page 2 of 3
Trane M# 4TTR3030G -13 SEER —2-5 ton outdoor unit.
Installed price: $ 12,100.00
Option three: Same Trane air handler and hot water coil with a Trane, 16
SEER outdoor unit.
Trane M# 4TTR6030J — 2.5 ton — 16 SEER unit.
System ratings : 17 SEER— 1.4 EER AHRI # 8626299
Installed price: $ 12,700.00
This system qualifies for a $ 250.00 electric rebate and a $ 300.00 tax credit
if customer is eligible.
The air handler will be suspended from the roof rafters with an emergency
drain pan and safety switch.
We shall install 11 ceiling/wall supplys.
Two 14 x 14, ceiling return filter grills will be installed.
Unit plenums will be lined with acoustical insulation.
The main supply duct shall be an extended plenum.
All attic ductwork will be sealed and insulated to R-6 per code.,
Return and supply ducts shall be flexible round with a volume balancing
damper installed in each supply take off.
Page 3 of 3
1j
A Honeywell programmable room thermostat shall be installed.
The outdoor unit will be located on the left side of the home with the Freon
and drain lines run down enclosed in Fortress line hide.
Rebates: Universal Mechanical does not guaranty rebates or credits. Please
check with your service provider for program availability and requirments.
Warranty : Two years all parts and labor
Ten years Trane functional parts.
Five years on room thermostat.
Five years on ADP functional parts.
Price does not include: hot water piping, thermostat and electrical wiring
Price includes: equipment, materials, labor, permit and sales tax.
If in agreement circle and initial desired option, sign and return proposal for
our records and permitting process.
Submitted by: Peter Lyonp Date: 9/14/16
Accepted bv_ }v1 �� (> cyhc_ Date:
Pricing valid for 30 days