65 MARGIN ST - BUILDING INSPECTION Commonwealth of Massachusetts
Sheet Metal Permit
r' s
Estimated Job Cost: S � Permit Pe
GfC 240)
Plans Submitted: YES NO_ Plans Reviewed:
Business License 4 '1 7l �3 Applicant License f/ 1
Business Information: Property Owner/Job Location hh formation: Jo�j Si7 e'•
�2�.091 9�l z /� ��� Name: lee �QC ( 7� �`�S ZJ�QPP f
Name:
street: C/ �GL /yr/� Ppr' Street:
City/Town: /�G/%/yc /t i-cq d��,r-y�f� 0/AeVyrrown: Pe62 Z0-WC G�111 4
Lulephoner`/7O7 — SOS Telephone: 9T0 /^ �JOO
Photo I.D. required/ Copy of Photo I.D. attached: YES_ NO L/
J-1 / Di-l-unrestricted license V Staff Initial
J-2 / M-2-restricted to dw,elliinngs 3-stories or less and commercial up to 10,000 sq. ft. / 2-stories or less
Residential: 1-2 family v Multi-family_ Condo/Townhouses_ Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. V-�O-ver 10,000 sq. ft. _ Number of Stories:
Sheet metal work to be completed: New Work: _ Renovation: t>�
I IVAC— Metal Watershed Rooting_ Kitchen Exhaust System
Metal Chimney/ Vents_ Air Balancing
ProViildo detailed description of work to be done:
INSURANCE COVERAGE:
I have a current liability Insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below: 1/
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.
Check One Only
Owner ❑ Agent I�
Signature of Owner or Owner's Agent
By chocking 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 Insnection
D;ug Comments
Type of License:
By. ❑ Master
flue _ ❑ Master-Restricted
Cirpimvn ❑Journeyperson
Signature of Licensee
Pennd z.
❑Journeyperson-Restricted License Number:
roe$ _---- -----
❑- -- Check at .v+v:v.m.lss;lovhlul
nspector signature of Permit Approval
i
CITY OF S;U.ENI, NWSACHUSETTS
t� BUILDING DEPARTMEVT
4 a xiLc r 5+ 120 WASHNGTON STREET, 3w FLOOR
T E.L (978) 745-9595
F.sir(978) 740-9846
K)\(BERL.EY DRISCOLL
,NLAYOR THoi\tAs ST.Pt;F_uE
DIRECTOR OF PUBLIC PROPERTY/BUILDNG COMMISSIONER
Workers' Compensation Insurance Afrdavit: Builders/Contractorv/Electricians/Ptumbers
A a tlicant Information / Pfease Print Legibly
V;Intt.'(BusincssOrganiralion,'Individual):
Address: (
City/State/Zip✓k'/'"' 0/Vn 114 01fd"7Phone It
Are you un employer'!Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4• ❑ I am a general contractor and I 6. ❑New construction
employees((oil and/or part-time)." have hired the subcontractors
2.❑ lama sole proprietor or partner- listed on the attached sheet.; 7. remodeling
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. insuranco 5. We are a corporation mid its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.❑ I tun a homeowner doing oli 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.Q Roof repairs
insurance required.) t employees. [Nis workers' l3.[]Other
cutup. insurance required.)
;Anv opplieunt ilia!diec4s box A I most also fill out ohe fedian baow showing their wodtan'cumpeneatiun policy intunnadun.
'I lomeuwtwn oho sstbmit this ufldnvit indicating'hey arc doing all work and then hire outside cantmctorx must suhmit a new air-davit indicvting such.
$'n tm-tors shut cheek this box most mwchal an additiuttul abut showing thu mune of the subeamnctan and their wnrkerr'camp,policy inromalion.
l one can employer that is providing workers'coerpeasadon insurance for my employees. Below Is the policy rnld job rite
inforarraion.
Insunince Company
Policy 8 or Self-ilm Lic. 0: Expiration Date:
Job Site Address; City/State/Zip:
Attach a copy of the workers'compensation pulley declaration pale(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ot'MGL c. 152 can lead to the imposition oferiminal penalties of a
line up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to SM.00 a day against the violator. Ile advised that a copy of this statement may be funvarded to the Office of
Ineestigatiuns of the DIA for insurance coverage verification.
[,to hereby rrrrifi of the pains and penollies of er' that the infurotation provided above I's tr a andcorrect
Date.
Phone : T 1 70�— S pS7
Of iciul use mdy. Do sot write in thi.v area,to be conrpleled by city or town gI/cial
City nf'fuu'n: Pormitil.lccnscN
Issuing,\Wlmrily (circle arse): -_— " --- ._—
I. Board of Ilcallh 2. Building Dep;rrlinvot i.Cityirrnwn Clerk 4. Electrical hospector 5. Plumbing Inspector
6. Other
CuntuU 1'crsnn:_ __ Phone 't:
� 66/19/2011 04:29PM 9786583353
DRAGON AIR PAGE 01
t
DRAGON AIR HVAC, Inc.
` Yevgeniy Livshits
Licensed and Insured
Contract
6 Summer Street
Wlimington, MA Oi887Y -
Phone: 781-704-5057
1 Fax: 978-658-3353
E-mail: airstreamhvac@yahoo.com
{ "The Red I Realty Trust"
Cornelia Holt)er Trustee "t 50 Barstow.St. Phone #:(617)849-2286
Salem ,MA 01970 Date: 3f3/2014
system and 20d floor line-
remodel Job Name: Cool
� - - _ .
i
Location:Same
i
We hereby submit specification and estimate for: We propose to install
-j cooling equipment on existing heating system12.5 ton air condenser,model #
l _ PA13NA030 and cooling coil,brand nAne °payne",wittit, a!i recessa �.- __ _ _ -
! ducts,pipes(sealed and insulated R-6 and R-8 insulation su 1
t ), PP Y .
t boots,registers,refrigeration and drain line,pressurized and vacuumated syste-m.l0
'l years warranty for equipment.Permit cost is included.
Work will be performed as:Installation of equipment,sealing and wrapping
basement trunks 1st part,pipes and boots for 2nd floor after frame work will be
done.
TOTAL INVESTMENT FOR THIS JOB: $4,700.00.
If there will be possibility to
Install additional return from master bedroom price
•011 04:29PM 9786583353 DRAGON AIR
PAGE 02
will be:$5,000.00.
1 Year Warranty On Labor.
Any replaced part under warranty has to be paid for labor and
delivery(if distributor doesn't stock it).
}` Payments will be made as:$2,350 up front(down payment), $1,350.00
after basement work be done$800 after 2nd floor done and rest of
i the sum upon completion. _
Ail materials are guaranteed to be as sp iec fled A II work to be
-- _ ,
1 completed in a professional manner according to standard a
practices.Any alteration or deviation from
above involve extra cost will be executed only upon written order
and will become an extra charge over and above estimate.Title to
equipment to remain with "DRAGON AIR
I
HVAC,Inc." until final payment is made.
Authorized Signature: <�
j Refrigeration Certificate ID #010300023;Sheet Metal License Master-
s - _ Unrestricted'#11793 _ -y-
i Yevgeniy Livshi , HVAC Tech.
i Client Acceptant of ontract:The above prices,'specifications and Conditions
9 are satisfacto
j Signature Date
cepted.
Signature Date x
I
I
I
i
tl
i
1
i
MM NWEALTH OF MASSACHUSETT
SHEET METAL WORKERS
AS A-MASTER-UNRESTRICTED.
YRV9eliiy V Livshlts - ISSUES THE ABOVE LICENSE TO:
�y3 has been certified as a
Type-IlType-III YEVGENIY V LIVSHITS'
technician as required by 40 CFR Part 82,Subpart F. 6 $U M M E R S T
y
° ID#
WfLMINGTON — MA .01887-3802
CURSES Program
EPA Program �:
Educational Foundation Appro�al:9/30/93 11793 01/28/15 327853
I of 1 5/6/148:47 PM