26 FOREST AVE - BUILDING INSPECTION (4) C -mmonwealth of Massachusetts $ 2
Sheet Metal Permit
Date: / / / Permit#
--Estimated Job Cost:$ Permit Fee:-$
Plans Submitted: YES_ooNO Plans Reviewed: YES— NO
Business License# b Applicant License# j
j Business Information: Property Owner/Job Location Information:
F
Name: To On Xy- C)S&-fe n S JJVC- Name:Street: i -5 - Ma,04- (S''C►'t�et Street: �
Cityfrown: C6Y1J �'e . �, 4 i l 3 City/Pown:
�f
Telephone: f7 R 77-7 " -7 19 Telephone:
Photo I.D.required/Copy of Photo I.D.attached: YES& NO_
smata+fot
J 1/l�-i rresh-icted license
3--2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. &/2-stories or less
Residential: 1-2 family Multi-family_ Condo/Townhouses. Other_
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under T0,000 sq. R ✓over 10,000 sq. &_ Number of Stories:
Sheet metal work to be completed: New Work:_ Renovation:_
HVAC ✓ Metal Watershed Roofing_ Kitchen Exhaust System_
Metal Chimney/Vents_ Air Balancing_
Provide detailed description of work to be done:
Sr i a Lzi�ro arl2=ai2 �i err /ter 2L r—
E!�lis�YlCr
. 1
1`1 A t t�,y� ►� Z2 I C
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Ye;xNo❑
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 signet on this permit application waives this requirement
Check One Only
Owner ❑ Agent
r
Signature of Owner or Owners Agent
ey checking this bo 1 reby certify that all of the details and Information 1 ha submitted(or entered)regarding this application are true and-
accurate to the ba of M he ve 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
Tine ❑Master-Restricted
Cityrrown
❑Joumeyperson Signature of Licensee
Pemmt# ❑Joumeyperson-Restricted
License Number.
Fee$ ❑
Check at www.mass.gov/dpi
( Lo tC,e
Inspector Signature of Permit Approval
The Commonwealth efMassachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Ao'plicant Information Please Print Legibly
Name(Businesatorganirstion/Individual): ec, /T/Y' J iy Ae-1;'y[5
Address:
City/State/Zip:_��llyers; 1�4 671f,23 Phone C/ 9d( 9 Q 9 — 9G�
Are you an employer?Check the appropriate box. Type of project(re4uired):
I.® I am a employer with /y . 4. El I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hued the sub-contractors d Remoe 7. Remodeling
2.El I am a sole proprietor orpattaer- listed on the attached sheet t g
ship and have no employees These sub-contractors have 8. ❑Demolition
working 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.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers' comp. c. 152,§1(4),and we have no 12.M Roof repairs
insurance required]t employees.(No workers' 13. Other YVA C
comp,insurance required.]
*Amy applicant that cheeks box#1 must also fill out the section bdow showing their workcre compeosadon policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
tContractors that check this box must attached an additional sheershowing the nmoe of the and theirworkers'comp.policy informauun.
lam an employer that isproviding workers'compensation insurancefor my employees Below is thepolicy andjob site
Information,
Insurance Company Name: UY4it/e--e -
Policy#or Self-ins.Lie.#: /�90 Expiration Date:
Job Site Address: /—r�/t��/ ✓e City/State/Zip:
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 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 d pen ofpcdury t the information provided above is true d co rect.
Sigilature: Date:
Phone#: 7 7 9 2 —
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 Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
CERTIFICATE OF LIABILITY INSURANCE r
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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns
and conditions of the policy,Certain policies may require an endorsement.A statement an this Certificate does not corder rights to the certificate holder
In lieu of such endorsements.
PRODUCER CON EACT CLIENTCONTACTCOTgE '
FEDERATED MUTUAL INSURANCE COMPANY "ONE FAX
HOME OFFICE: P.O.BOX 328 (AID.No Ert:888-333-4949 FAID tw:5074464664
OWATONNA, MN 55060 wo'A ess:C ENTCO TACTCENTER FEDINS.COM
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935
INSURED 366-239.2 INSURER B:
TECH-AIR SYSTEMS INC INSURER Q
156 MAPLE ST INSURER o:
DANVERS, MA 01923
INSURER Et
INSURER F.
COVERAGES CERTIFICATE NUMBER:4 REVISION NUMBER:0
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 CONDITION OF ANY CON
TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCECE 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 OL SUBR POLICY EFF POLICY E%P LIMITS
TYPE OF INSURANCE I S POLICY NUMBER MID IVY IDDI
EACH OCCURRENCE $1,000,000
GENERAL LIABILITY
DAMAGE TO RENTED $100,000
X COMMERCIALGENERALUABIUTY ISES ocsuneel
OCCUR MED EXP(Any p Person) EXCLUDED
CLAIMS-MADE
A - N N 99D4602 D4/29/2015 04/29/2016 PERSONAL S ADV INJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GEN'L AGGREGATE UNIT APPLIES PER: PRODUCTS-COMPIOP AGO $2,000,000
X POLICY JECT lAC
AUTOMOBILE LIABILITY COMBINED SINGLE UNIT $1,000,000
no
X ANY AUTO BODILY INJURY(Per person)
ALL OWNED SCHEDULED
A AUTOS AUTOS N N 9904604 04/29/2015 04/29/2016 BODILY INJURY(Per actlaentl
NONOWNEO PROPERTY DAMAGE
HIRED ALITGB AUTOS tPer 2r no
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EEKCESS LIAB CLAIMS-MADE AGGREGATE
DED I RETENTION
WORKERS COMPENSATION X WC STATUS CEN
WC
LIMITS ER
AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $500,000
ANY PROPRIETORIF I TNERIEXECUTIVE ❑NIA ' N 9904603 04/29/2015 04/29/2016
A OFFICEMMEMBER EXCWDEO? E.LOISEASE-EAEMPLOYEE $SQQ,000
(Mandatary In NMI
It Yes.Easy be under E.L DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS Mi.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks SOredule,it more space is repuired)
CERTIFICATE HOLDER CANCELLATION
366-239-2 40
CITY OF SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CI
CI OF L - THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
EST
SALEM, MA 019TD-3623 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1
0 1988-2010 ACORD CORPORATION.All rights reserved
ACORD 25(2010I05) The ACORD name and logo are registered marks of ACORD
e OMMONWEALTH OF MA
03.Z.. BPOF
SHEEl,''AE—'U "WORK ERr
yy
ISSUES,THE FOLLOW ICENS ;
<Fv 5 'AS A BUS,,I,NESS
PLTEf M ZAGORSKI
TECH—AIR SYSEj>i5 INC
156 MOWN s �i
b RVE ht11 01923
�lU/L4/� 999 x
SHEE1
41SSUES F[ E, —TMU'
• '� ;`"� 5` ERA • �
x G RSKI r � 's rye,- 3
3 �'ASB' 1� : '•� '�
r
`PETER N• J.
'1 i 1 of 31kr '1 : ' . ` o 1: 6-beet A r i' t ::: A k.r : i
*i 1 1 i 1 ' requiremento1 faWatbuOtto 6eneral i 11
i &-ection 237 tbrou1
Terb - Rir oy.5tem'q Snc
' " '
1 ,. 1 c 1 zertificate o $ i' ebibence1 practice i i
'JUrew6clu ect Octal N'u.5t'nc.5.q
on tbio 141blay 1 (e 1 1 '
t r✓�'1
Ali:�.i ii .i4fp;9[iy�V;l
CASELLA WASTE SYSTEMS,INC INVOICE
er ti PO BOX 1372
WILLISTON,VT 05496.1372 SERVICE ADDRESS
156 MAPLE ST
CUSTOMER NUMBER 79-07766 1 PAGE 1 of 1
INVOICE# 2392570 TECH AIR SYSTEMS
BILLING INQUIRIES(800)"6-1318 DANVERS MA 01923
INVOICE DATE 2/01/15 An updated NeVoillenviro table is now available at our website.
Please visdwww.Casella.comtfueVoiVenviro for more details.
DATE DESCRIPTION QTY. RATE TOTAL
1/31/15 FUEL/OIL/ENVIRO FEE
1/31/15 8YD FL 1 X MTH TRASH ;# P/U: 01 1.00 95.00
1/31/15 LATE FEE - 3.00
G52°G6A
FOR SERVICE DURING FEBRUARY
jFPATYTHIS AMOUNT
$98.00
'1
Adtek Software Co Richard Dion
105 S Main St-Toluca, III 61369 26 Forest Ave.
815-452-2345 -sales@adteksoft.com Salem, MA 01960
Sales Consultant: Peter Z 978-604-0142
Job#: 1888
Date: 01/19/2016
System l (Average Load Procedure)
Design Conditions
Location: Gloucester, Massachusetts Elevation: 11 ft Daily Range: Low
Input Data: Outdoor Dry Bulb Indoor Dry Bulb Latitude: 420 N Design Grains: 25
Summer: 94 75 Heated Area 884 Sq.Ft.
Winter: 0 70 Cooled Area 884 Sq.Ft.
HeaVLoss Summary (July Heat Load Calculations)
Gross Sensible Latent
Area Loss Gain Gain
Walls 960 6090 2482 0
Windows 120 5460 6106 0
Doors 42 1146 576 0
Ceilings 884 1980 990 0
Skylights 0 0 0 0
Floors 884 0 0 0
Room Internal Loads 0 1380 1230
Blower Load 1707 0
Hot Water Piping Load 0 0 0
Winter Humidification Load 0 0 0
Infiltration 5536 788 641
Approved ACCA
Ventilation 0 0 0 MJ8 Calculations
Duct Loss/Gain EHLF=0.077 ESGF=0.071 1556 804 139
AED Excursion n/a 0 n/a
Subtotal 21768 13833 2010
Total Heating 21768 Btuh 7 kw of electric heat
Total Cooling 15843 Btuh 42 Linear ft. of Hydronic Baseboard
*Calculations are based on the ACCA Manual J 8th Edition and are approved by ACCA.All computed calculations are
estimates based on building use, weather data, and inputted values such as R-Values,window types, duct loss, etc.
Equipment selection should meet both the latent and sensible gain as well as building heat loss.
Adtek Accul-oad Report Version 6.0.1 Page 1
Adtek Software Co Richard Dion
105 S Main St-Toluca, 111 61369 26 Forest Ave.
815-452-2345 -sales@adteksoft.com Salem, MA 01960
Sales Consultant: Peter Z 978-604-0142
Job#: 1888
Date: 0111912016
System l
AED Curve — DAL — 1.3 — 1.5
8000
7000
6000
5000
L
4000
m
3000
2000
1000
0
8 9 10 11 12 13 14 15 16 17 18 19 20
Hour
AED Excursion: 0 btuh
AED Status: System has Adequate Exposure Diversity.
AED Flag: No AED Flag.
Hours are listed in 24-hour format: 8 is 8am, 20 is 8pm.
Adtek Accul-oad Report Version 6.0.1 Page 2
Adtek Software Co Richard Dion
105 S Main St-Toluca, III 61369 26 Forest Ave.
815-462-2345 -sales@adteksoft.com Salem, MA 01960
Sales Consultant: Peter Z 978-604-0142
Job#: 1888
Date: 01/19/2016
System I Breakdown
Item Name U-Value
/SHGC Net Area Htg. HTM. Clg. HTM Sens. Htg. Sens. Clg. Lat. Clg. Total Clg.
Construction Type
8vstem I 0 1707 0 1707
Room 0 1380 1230 2610
Ceiling 0.032 884 2.24 1.12 1980 990 0 990
Ceiling Below Roof Joists (Spray Foam)jDark or Bold Color Asphalt ShinglesINAIR-34 Closed Ce
Joist Cavit
_
---....-.._...... ---- --------------- l-------------- --- --- --
Floor 0 884 0 0 0 0
Floor Over Conditioned SpaceINAINAINAINAINAINAINA
South Wall 0.109 163 7.63 3.11 1244 507 0 507
Frame Wall/Partitionj NA]NAIMetallR-151NonelNAISiding or StuccoINA
--- — — ---- --._...-------------------- ------------------..-._......_.. ----- ------ ._..._....._.._...._...
Door-3x7 0.39 21 27.3 13.71 573 288 0 288
WoodlSolid CoreiNo Storm
Window-3x4 0.65/0 12 45.5 30.42 546 365 0 365
OperablejNormal WindowlHeat AbsorbingJ2 PanelMetal with Break
Window-3x4 0.65/0 12 45.5 30.42 546 365 0 365
OperablejNormal WindowlHeat AbsorbingJ2 PanelMetal with Break
West Wall 0.109 236 7.63 3.11 1801 734 0 734
Frame Wall/Partition I NAI NAI Metal I R-1 51 Nonel NAISiding or StuccojNA
------— —---- - --- -- - ------— - ----- ----- --- - ......_............
Window-3x4 0.65/0 12 45.5 53.83 546 646 0 646
OperablelNormal WindowlHeat AbsorbingJ2 PanelMetal with Break
Window-3x4 0.65/0 12 45.5 53.83 546 646 0 646
OperablelNormal WindowlHeat AbsorbingJ2 PanelMetal with Break
Window-3x4 0.65/0 12 45.5 53.83 546 646 0 646
OperablejNormal WindowlHeat Absorbing12 PanelMetal with Break
East Wall -- --- 0.109 —_— 236 ---- 7.63 --- 3.11-------1801 —-- 734 - —0 -----734 ---
Adtek AccuLoad Report Version 6.0.1 Page 3
Adtek Software Co Richard Dion
105 S Main St-Toluca, III 61369 26 Forest Ave.
815-452-2345 -sales@adteksoft.com Salem, MA 01960
Sales Consultant: Peter Z 978-604-0142
Job#: 1888
Date: 01/19/2016
Frame Wall/Partition INAINAIMetallR-151NonelNAISiding or StuccoINA
Window-3x4 0.65/0 12 45.5 53.83 546 646 6 646
OperablejNormal WindowlHeat AbsorbingJ2 PanelMetal with Break
_._..
Window-3x4 0.65%0 12 45.5 53.83 546 646 0 646
OperablelNormal WindowlHeat AbsorbingJ2 PanelMetal with Break
Window-3x4 0.65/0 12 45 5 53.83 546 646 0 646
OperablejNormal WindowlHeat AbsorbingJ2 PanelMetal with Break
North Wall 0.109 163 7.63 3.11 1244 507 0 507
Frame Wall/PartitionINAINAIMetalIR-15INoneINAISiding or StuccoINA
------Door-3x7 -------0.39 21 —- 27.3 13.71 573 288 0 288
WoodlSolid CorejNo Storm
Window-3x4 0.65/0 12 45.5 20.83 546 250 0 250
Operablel Normal Windowl Heat Absorbing 12 PanelMetal with Break
Window-3x4 0.65/0 12 45.5 20.83 546 250 0 250
OperablejNormal WindowlHeat AbsorbingJ2 PanelMetal with Break
Adtek Accul-oad Report Version 6.0.1 Page 4
. Adtek Software Co Richard Dion
105 S Main St-Toluca, III 61369 26 Forest Ave.
815-452-2345 -sales@adteksoR.com Salem, MA 01960
Sales Consultant: Peter Z 978-604-0142
Job#: 1888
Date: 01/19/2016
System I CFM
Dud sizes and velocities based on settings selected in the setup screen.
*Dud sizes calculated using this CFM. Winter Summer Winter Summer
Return Supply Calculated Calculated System System
Item Name Velocity RA Duct Size Velocity SA Duct Size CFM CFM CFM CFM
System I 0 0 396 —629 _ 0 *0
----- -- - - --- --- --—-- --- -.._.. --------- - -
Room 0 0 396 629 0 * 0
Adtek Accul.oad Report Version 6.0.1 Page 5