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HomeMy WebLinkAboutBuilding Permit #441 - 181 KARA DRIVE 11/30/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: V" IM ORTANT:Applicant must complete all items on this page LOCATION r 1 Print PROPERTY OWNER n eus Unit# ' Print MAP NO:99PARCEL: ZONING DISTRICT: Historic District yes62) Machine Shop Village yes 100 year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ' ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ®ISeW'ell i �F1`oodp a Wetlari'cls # VWatersh�edst%t _-- � � �a ® - ..�_ DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) O'VN NER: Name: Phone: Address: `Breiinanr DGA- CONTRACTOR Name: r Phone: _ fa 70 r Address: bcz�r r5 i� �. ' n License: Afg k/ZUn)Re,1krlckc�'_xp. Date: Home Improvement License: Exp. Date: 20 — 12— ARCHITECT/ENGINEER Phone: j Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: FEE: $ l d IICheck No.: Receipt No.: '1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si�natureofAgent%Ownere _. y .: _ , Signatureofcontractor I. . J Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application r Doc: Doc.Building Permit Revised 2008mi i f i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ i Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS 1 i I 1 CONSERVATION Reviewed on Si qnature i i COMMENTS HEALTH Reviewed on Signature COMMENTS �y Zoning Board of Appeals: Variance, Petition No: —ZoningDecision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Siqnature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use i I I' ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location y No. Date TOWN OF NORTH ANDOVER � 1 Certificate of Occupancy $ , 7 tr�iwi� 4 S CMusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24844 Building Inspector Job: Addition to 181 Kara Dri Aw&m s*4wA(rd Project Summary Date: Nov 28,2011 Entire House By: Warren Estes Brennan Cooling & Heating 31 Gfenside Avenue,Billerica,MA 0, 4 0-0 in N Ow For: John&Dolores Cusack 181 Kara Drive, North Andover, MA Notes: Nii-Al Weather: Boston, MA, US Winter Design Conditions Summer Design Conditions Outside db 12 QF Outside db 88 of Inside db 70 of Inside db 75 of Design TD 58 of Design TD 13 oF Daily range L Relative humidity 50 % Moisture difference 27 gr/lb Heating Summary Sensible Cooling Equipment Load Sizing Structure 17371 Btuh Structure 15851 Btuh Ducts 869 Btuh Ducts 0 Btuh Central vent(0 dm) 0 Btuh Central vent(0 dm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 18240 Btuh Use manufacturer's data n Rate/swing multiplier 0.93 Infiltration Equipment sensible load 14678 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Best Fireplaces 0 Structure 1756 Btuh Ducts 0 Btuh Heating Cooling Central vent(0 cfm) 0 Btuh Area(ftJ 1584 1584 Equipment latent load 1756 Btuh Volume(ft3) 13874 13874 Air changes/hour 0.30 0.20 Equipment total load 16434 Btuh Equiv.AVF(cfm) 69 46 Req.total capacity at 0.70 SHR 1.7 ton Heating Equipment Summary Cooling Equipment Summary Make American Standard Make American Standard Trade FREEDOM 95 COMFORT R Trade ALLEGIANCE 15 Model AUH2B060A9V3VA* Gond 4A7A5030E1 AHRI ref no.2016714 Coil 4TXCB036BC3 AHRI ref no. 3431746 Efficiency 97AFUE Efficiency 12.5 EER, 15 SEER Heating input 60000 Btuh Sensible cooling 19600 Btuh Heating output 58000 Btuh Latent cooling 8400 Btuh Temperature rise 56 oF Total cooling 28000 Btuh Actual air flow 933 cfm Actual air flow 933 cfm Air flow factor 0.051 cfm/Btuh Air flow factor 0.059 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.90 Calculations approved by ACCA to meet all requirements of Manual J 7th Ed. 2011-Nov-28 16:49:22 IQ- + wrightSOft' Right-Suite®universal 8.0.18 RSU15053 Page I Projecti.rup Calc=MV Front Door faces: N a Aw&,w Shy Component Constructions Job: Addition to 181 Kara Dri... Date: Nov 28,2011 Entire House By: Warren Estes Brennan Cooling & Heating 31 Glenside Avenue,Billerica,MA =.8.vim r • 6e4 ,4 -�z P' „. For: John&Dolores Cusack 181 Kara Drive, North Andover, MA Location: Indoor: Heating Cooling Boston, MA, US Indoor temperature(°F) 70 75 Elevation: 16 ft Design TD(°F) 58 13 Latitude: 42°N Relative humidity(%) 30 50 Outdoor: Heating Cooling Moisture difference(grAb) 24.4 26.6 Dry bulb(°F) 12 88 Infiltration: Dailyrange(°F) - 15 ( L ) Method Simplified Wetbulb(°F) - 72 Construction quality Best Wind speed(mph) 15.0 7.5 Fireplaces 0 Construction descriptions or Area u-value Insul R Htg HTM Loss Clg HTM Gain fP BMflF--'F ft'-°F/BM Bluhr Btuh BM/W atuh Walls 12MO:Firm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2"gypsum 1155 0.037 27.0 2.13 2466 0.75 863 board int fnsh,2"x6"wood frm I Partitions (none) Windows Window 031 U-value 028 SHGC:1 glazing,clr glz,mtl no brk frm mat, n 14 0.310 0 17.9 250 9.31 130 1/8"thk;NFRC rated(SHGC=0.28) a 105 0.310 0 17.9 1878 30.3 3184 s 21 0.310 0 17.9 376 15.4 324 all 140 0.310 0 17.9 2504 26.0 3638 Door-Glass-Energy Star Rated:2 glazing,Gr low-e outr,argon gas, a 119 0.320 0 18.5 2197 37.1 4409 insulated vinyl frm mat,clr innr,1/2"gap,1/4"thk;NFRC rated s 21 0.320 0 18.5 388 18.4 387 (SHGC=0.35) all 140 0.320 0 18.5 2585 34.3 4796 Doors (none) Ceilings 18FO:Rflclg ceiling,asphalt shingles roof mat,firm cons,1/2" 783 0.035 30.0 2.02 1581 1.42 1113 gypsum board int fish,12"thkns,r-38 ceil ins Floors 22AO:Bg floor,light dry soil,prrn ext ins cov,on grade depth,r-3 ins 82 0.810 0 46.7 3832 0 0 .� IfVt'i � � 2011-Nov-2816:49:21 ..,� gft� Right-Suite®Universal 8.0.18 RSU15053 Page 1 .�IGCA Project1 up Calc=MR Front Door faces: N Job: Addition to 181 Kara Dri Aw1&,N SAN&d Building Analysis Date: Nov 28,2011 Entire House By: Warren Estes Brennan Cooling & Heating 31 Glenside Avenue,Billerica,MA For: John&Dolores Cusack 181 Kara Drive, North Andover, MA Location: Indoor: Heating Cooling Boston, MA, US Indoor temperature(°F) 70 75 Elevation: 16 ft Design TD(OF) 58 13 Latitude: 42 ON Relative humidity(%) 30 50 Outdoor: Heating Cooling Moisture difference (grAb) 24.4 26.6 Dry bulb(OF) 12 88 Infiltration: Dailyrange(OF) - 15 ( L Method Simplified Wetbulb(OF) - 72 Construction quality Best Wind speed(mph) 15.0 7.5 Fireplaces 0 Component Btuh/R2 Btuh %of load– Wal uct Walls 2.1 2466 13.5 Glazing 18.2 5089 27.9 nfiftration Doors 0 0 0 Ceilings 2.0 1581 8.7 Floors 2.4 3832 21.0 Infiltration 15.7 4403 24.1 Gla2J_ Ducts 869 4.8 Piping 0 0 Humidification 0 0 Flom Ventilation 0 0 Ceilings Adjustments 0 I Total 1 18240 1 100.01 F711'77 —Component Btu htft2 Btuh %of load Walls 0.7 863 5.4 Walls Glazing 30.1 8434 53.2 Doors 0 0 0 Internal Gains Ceilings 1.4 1113 7.0 In Floors 0 0 0 Infiltration 2.3 641 4.0 Ducts 0 0 Ventilation 0 0 Internal gains 4800 30.3 Ga2i Infiltration Blower 0 0 ngo Ceilings Adjustments 0 I Total 1 1 158511 100.01 Latent Cooling Load= 1756 Btuh Overall U-value=0.059 Btuh/ft2LOF Data entries checked. 2011-Nov-28 16:49:14 wrightsoft* Right-Suite®Universal 8.0.18 RSU15053 Page 1 Projecti.rup Calc=IVIR Front Door faces: N Load Short Form Job: Addition to 181 Kara Dri... Date: Nov 28,2011 Entire House By: Warren Estes Brennan Cooling & Heating 31 Glenside Avenue,Billerica,MA F � ; Y e ' a For: John&Dolores Cusack 181 Kara Drive, North Andover, MA F. L 0 Htg Cig Infiltration Outside db(°F) 12 88 Method Simplified Inside db(°F) 70 75 Construction quality Best Design TD(°F) 58 13 Fireplaces 0 Daily range - L Inside humidity(%) 30 50 Moisture difference(gr/Ib) 24 27 HEATING EQUIPMENT COOLING EQUIPMENT Make American Standard Make American Standard Trade FREEDOM 95 COMFORT R Trade ALLEGIANCE 15 Model AUH2B060A9V3VA* Cond 4A7A5030E1 AHRI ref no.2016714 Coil 4TXCB036BC3 AHRI ref no.3431746 Efficiency 97 AFUE Efficiency 12.5 EER, 15 SEER Heating input 60000 Btuh Sensible cooling 19600 Btuh Heating output 58000 Btuh Latent cooling 8400 Btuh Temperature rise 56 OF Total cooling 28000 Btuh Actual air flow 933 cfm Actual air flow 933 cfm Air flow factor 0.051 cfm/Btuh Air flow factor 0.059 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.90 ROOM NAME Area Htg load Cig load Htg AVF Cig AVF OF) (Btuh) (Btuh) (cfm) (cfm) B-Office/Bath 192 3148 1550 161 91 B-Playroom 320 2821 1763 144 104 B-Den 289 3806 2162 195 127 1-Office 240 3409 3719 174 219 1-Breakfast Area 288 2090 3132 107 184 1-Homework Area 255 2965 3525 152 208 Entire House d 1584 18240 15851 933 933 Other equip loads 0 0 Equip. @ 0.93 RSM 14678 Latent cooling 1756 TOTALS I 1584 I 18240 I 16434 I 933 I 933 Calculations approved by ACCA to meet all requirements of Manual J 7th Ed. W r f h0 2011-Nov-28 16:49:13 Right-Suite®Universal 8.0.18 RSU15053 Page 1 Projectl.rup Calc=MR Front Door faces: N NORTii ® Of Andover -. o , '� dover, Mass., Y O ^- LAKE I� COCMICMEwICK 7,p ADRATED V BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............ �.... ° ........... ... . s, ;. .1 ............................................................................. Foundation has permission to erect..........:.::.......................... buildings on l ..`......... r11110 ......� ....................... Rough Chimney to be occupied as.................#V.0,WM ���..�.�. . :.,w.................:. y .................. .......................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final- this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. -PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIS . Rough - .. Service .. .. . . ... ............... ....... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner -- Street No. SEE REVERSE SIDE Smoke Det. Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license V All sheet metal work being performed with proper joumeyperson-to- apprentice ratios C/ Equipment sized per heating/cooling load calculations V Duct work sized per manual "D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers V Ductwork/plenum connections sealed substantially airtight y Ductwork insulated by means of external covering or internal lining New/clean -properly sized filter installed (final inspection) Testing and Balancing report complete(final sign-off) OP ID:VG ACORO° DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11109/11 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER 781-729-2900 NAME: SCOW Insurance Agency,Inc. 781-729-9500 PHONE FAx 17 Mount Vernon Street A/c No Ext): A/C No): P.O.Box 1000 E-MAIL Winchester,MA 01890-8300 ADDRESS: PRODUCER BRENN-1 Michael R SCOW CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Timothy P.Brennan INSURER A:The Hartford 22357 dba Brennan Cooling&Heating INSURER B: 31 Glenside Avenue Billerica,MA 01821 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE 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. IICY EXP LTRR ADDIL SUB TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE ENTM- A X COMMERCIAL GENERAL LIABILITY 08SBAPQ5465 05124111 05124/12 PREMISES Ea occurrence $ 300,00 CLAIMS-MADE FX-1 OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 11000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- 7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 (Ea acddent) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE A X HIRED AUTOS 08SBAP05465 05124111 05124112 (Per accident) $ X NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONX WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVEF—] N/A 08WECPD1852 05/24/11 05/24112 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 It Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION CIJSACKJ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN John Cusack ACCORDANCE WITH THE POLICY PROVISIONS. 181 Kara Drive North Andover,MA 01845-4834 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD -- - MBER `S66474887 0�-I$20f 15 0315a�19 C1AiS HEST MGT so 4 d e7 r'BRENNAN M TIMOTHY P. ; 31 GLENSIDE AV BILLERICA,MA'. 01821.5946 BOARD BOARD OF`SHEET-METAL W&kkRS SM AS A MASTER-UNRESTRICTED TYPE TIMOTHY P BRENNAN, M1 31 GLEN SIDE .AVE BILLERICA MA 01821-5946 . 799491 823 03/28/12 799491 Fully Insured BR, +,NNAN EPA Certified BrennanCooling-HcatingCComcast.net C, y 9� Design • = Service • Tim Brennan ,� Installations 978.804.2856 $'� rrr Residential 978.670.1265 Commercial • Billerica, MA i yTJ���O u�$s1 9b Nzoto AV 301SN310 M o a Au OWU " 'NVNN3HG 6 -5 '£0 SLUa'Ed% 4 Stq a L99VLV99 awn 3SN I SIL SMARD BASRA MASTER UNRES R CUTEDERS TYPE TIMOTHY P BRENNAN-, M1 31 GLENSIDE .AVE BILLERICA MA 01821-5946 . 799491 823 03/28/12 799491 s Fully Insured BRENNAN EPA Certified Brennancooling-Heatingo.comcast.net �C' & � 'V r ��► OO •4ft, Y-•`• $ '" VOA ' Design • `? Service • Tim Brennan Installations • 978.804.2856 �'i `tc�jt►ttltl �? '' +. r , _ Residential • 978.670.1265 Ma,. {YF Commercial Billerica, MA Commonwealth of Massachusetts Sheet Metal Permit Date: i l- 17- l Permit# Estimated Job Cost: Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# / ( (e V 3Z0 Applicant License# Z? Business Information: ` Property Owner/Job Location Information: Name• t'ey\V'k-AV C�`► rt- (� I Name: CAt"a. Street: i Street: City/Town. llt_r +c« City/Town: ®A �c � cusp Telephone: l-c 8 -6_�® - i Z..c S Telephone: 1 Photo I.D. required/Copy of Photo I.D. attached: YES NO , Staff Initial J-1 / vbnrestricted 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 X 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: 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: ee `l �•�'l E;t-1Cnt�L U�if� Q,y�. � /��c� �C.� 1��+,t�ltw� � �F— [INSURANCE COVERAGE: have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes,YV No E]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. Check One Only Owner ❑ Agent ❑ Signature of Owner or 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 f^ Title ( ` ❑Master-Restricted - City/Town ❑Journeyperson Permit# Signature of Licensee❑Journeyperson-Restriv cted License Number: p Z 3 Fee$ Check at www.mass.aov/dpi Inspector Signature of Permit Approval Cvi 7,u C� of S �v.n its C-- cx } tvi r vo ©X S AJ 5' D(1G.1 R kc,x� r2Ju ,,l- 1 x 2 OuL 12 o� ,7 l r i I