323 HIGHLAND AVE - BUILDING INSPECTION (2) Comnfk�q rC�';ff l Bt iNlanachusetts
q A014
1$�t iAetal Permit
):uc: ember 28.2016 Permit#
Iislim: ted Job('ost: S 21,000.00 00
_ Perinit Fee: S 10�J —
Plans Submitted: YES V NO
Plans Re�iewcd: l'ES NO
Business License N 722
I Applicant License d 3070
Business fritbrmation: Property Owner/Job Location tnfimnatiun:
Name: Seabrook Air, Inc.
Name: Irving Oil
Street: 2 Caitlin Circle
Street: 323 Highland Avenue
City/Town: Salisbury, MA 01952
City/Town: Salem, MA 01970
I'c lep hone: 978-224-8132
Telephone:
Photo I.D. required/Copy of Photo I.D. attached: YES-aL NO_
J-1 / :,M-I-unrestricted license --
Staff 1au,i
J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. It. /2-stories or less
Residential: 1-2 family_ Multi-Tamil
Y_. Condo/Townhouses_ Other_
('ummercial: Office Retail
— Industrial_ Educational
Institutional Other_ —
Square Footage: under 10,000 sq. tt•� over 10,000 sq. tt._ Number of Stories: 1
Sheet metal work to he completed: New Work:
Renovation:
IIVAC'_ Metal WAcrshcd Routing_ Kitchen Exhaust System
Metal ('hinutey/ Vents_ \ir Balancing
I'rovide detailed description of work to be done:
furnish and install all sheet metal duct, equipment and accessories necessary for a complete
Installation. --
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Piease visit our web site at http://www.mass.gov/dpi/boards/SM
GARY SEE
SEABROOK AIR ISM)
2 CAITLIN CIR
SALISBURY,MA 01952-0010
Fold,Then Detach Along All Perrordtlons _
'r.a COMMONWEALTH OF M/1SS46H6SETfS
' a1 i 1 ralma:f• •
.;BS)ARDQ 1
SHEET METAL WORKERS -
13SUES THE FOLLOWING LICENSE AS A
BUSINESS—
SEE �y MIN" o
;SEABROOK AIR A',-
2 CArruk CIR r
SAUSBURY,MA-01952. . h
722 ' 12/3072017, z, 13077
CTTY OF S-�N4 .NAXSS.ACHLSETTS
BUILDING DEPARTMENT
120 WASHLNGTON STREET,3'n FLOOR
TEL (978)745-9595
FAX(978)740-9846
KINCBERL.EY DRISCOLL
MAYOR THOMAs ST.PtERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING CO%L,IISSIONER
1Vorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(eusine Orsaniz tiotvindividuat): Seabrook Air, Inc.
Address: 2 Caitlin Circle
City/StatelZip: Salisbury, MA 01952 Phone k: 978-224-8132
Are you an employer?Check the appropriate box: Type of project(required):
1.(0 1 am a employer with Five(5) 4. Q 1 am a general contractor and 1
employees(full and/or part-time).• have hired the subcontractors 6. El New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.: 7. (2 Remodeling
ship and have no employees These subcontractors have 8. Q Demolition
working for me in any capacity, workers'comp.insurance'
q, Building addition
[No workers'comp, insurance 5. Q We area corporation and its 10. Electrical required.) officers have exercised thew repairs or additions
3.Q 1 am a homeowner doing all work right of exemption per MGL I LQ Plumbing repairs or additions
myself.[No workers'comp. C. 152,§10),and we have no 12.Q Roof repairs
insurance required.]t employees.[No workers' 13.❑Other
comp. insurance required.]
;Any applicant that ehcoke box an
mutt atw fin out the seciien below throwing thou wmkas'compensaion policy inlomtatim
1 I haaownen who submit this affidavit indicating airy are doing all work and then hire outside corttmcton most submit a now affidavit indicating wok
:Cuntractan that cheek this tax most attached an additional sheet showing the name of are sub.commctm and their workers'comp,policy infamtstios.
I ant an employer that Lr providing workers'compensation insurance for my employees. Below is the pollay and fob site
injormafron.
Insurance Company dame: Gensis Insurance
Policy k or Self-ins.Lie.f/:WCC-500-5014645 Expiration Date: May 6, 2017
Job Site Address: 323 Highland Avenue City/State/Zip: Salem, MA 01970
Attach a copy of the workers'compeosadon 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 ofcriminal penalties ofa
fine up to S 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 he forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pulas and penahies ojperfury that the infbrasonan provided above is true and correct.
Stenature Date Nn h
28 2016
Phone ti: 978-224-8132
OTIciad use only. Do not write in this area,to be completed by city or town ofc1oL
City or Town: Permit/I.iecase#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person:
12/1/2016 Randalemail 20161201-033616.pdf-Seabreok Air,Inc.-Permit Page-Acrobatcom
S `b�Air,Inc. Randalemail_20161201_033616.pdf
SENT BY
Randal Boughton
SUBJECT& MESSAGE
Seabrook Air,Inc.- Permit Page
INSURANCE COVERAGE: Please find attached the missing
I have a current liability insurance policy or its equivalent which meats th signature page as requested.
please note that the original is
If you have chocked Yos. Indicate the type or coverage by checking the a also being mailed out this
morning to your office.
A liability Insurance policy Other type of Indemnity
Thank you,
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not h Randal Boughton
Massachusetts General laws,and that my signature on this permit appal Seabrook ug, Inc.
I
DATE SENT
8:17 AM
Signature of Owner or Owners Agent
Type Adobe PDF(.pdf)
ey checking this boaQ;I hereby certify that all or the details and information I ha pages 1
accurate to the best of my knowledge and that all shut metal work and lnslallilk
In compliance with all pertinent provtaton of the Massachusetts Building Code an Size 69 KB
Duct inspection required prior to Insulation
Download
Nroeress Ins
Date — Report Abuse
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12/7/2016 Randalemail 20161201 033616.pdr-Seabrook Air,Inc.-Permit Page-Acrobat.com
S b ir,Inc. Randalemail—20161201-033616.pdf
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By chocking isle boa�;1 hereby certify that all Or the details and Information 1 have submitted(w entsred)regarding this al
Compliance
rate t the beat
with of pay knowledge
le and
o1 at all
shoot Massachusetts Bk And code Installatand Chapterions performed2 of he Gener ued tot
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in
ldirl
Duct inspection required prior to Insulation Installation: YES
NO
Prearess Insnectiaufl
Date Convncnts l
Filial lus section
I):Itr:
Comments
Type of L+tense: �—
fiy O rvtaster t
(Vhlaster-Resiricte
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❑Journepper son.Restricted License Number; 3(17n
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lnepe�mr S41jn4tura of Permit Approval
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