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32A-148 (2) Current code language: Any building containing less than 35,000 cubic feet of enclosed space, measured to the exterior surfaces of walls and roofs and to the top of a ground supported floor, or in the case of a crawl space, to the bottom surface of the crawl space. In the case of basement floors or levels, the calculation of enclosed space shall include such spaces. For additions to existing buildings, the volume of enclosed space shall include the entire existing building and all proposed additions. 101.5.4.0 Investigation and Evaluation. For any proposed work regulated by this code and subject to subsection 107.6 of the International Building Code 2009 with Massachusetts Amendments (780 CMR 107.6) as a condition of the issuance of a building permit the building owner shall cause the existing building (or portion thereof) to be investigated and evaluated in accordance with the provisions of this code. This may include, but not be limited to: evaluation of design gravity loads, lateral load capacity, egress capacity, fire protection systems, fire resistive construction, interior environment, hazardous materials, and energy conservation. The investigation and evaluation shall be in sufficient detail to ascertain the effects of the proposed work on the work area under consideration and, the entire building or structure and its foundation if impacted by the proposed work. The results of the investigation and evaluation, along with any proposed compliance alternatives, shall be submitted to the building official in written report form. 6th edition language: 1. Any building containing less than 35,000 cubic feet of enclosed space, measured to the exterior surfaces of walls and roofs and to the top of a ground supported floor, or in the case of a crawl space, to the bottom surface of the crawl space. In the case of basement floors or levels, the calcula -tion of enclosed space shall include such spaces. w7 Lull Iu; JORM rrw r I VVV 1•VV t1 VYV • VV.. t JOB NAME tk t1 Vro -A rc+ LOCATION ,7'i --. 9 w �l .e-asaO-V - 51. i PURCHASER ORDER NO. ENGINEER, SUBMITTED TO FOR: Reference Approval Construction SUBMITTED BY DATE_ _ 1 UNIT DESIGNATION: Schedule N. MODEL NO. 1 \` RETURN AIR DVCTOPENING �,� 1,' � 1 III 1 0 V.t RETU NR Ot1CT J SIDE RETURN AIR DUCT APPLICATION DOWN SHOT RETURN AIR DUCT APPLICATION • / t i 6.676 DAMPER MDUNTNG PANEL NTT7I PROTECTIVE =nom oAMPER BLADE (1 PC& PER UNIT) (I PCS_ PER UNIT) i � ` +5.676 ouTSma!<IR su _ A(1 DJUSTMENT // PC6 PER GNI1') / . / •.�.: DAMPER SERI uvttll£ •::::!!!:•L ) /' 17.750 '� � (1 PC3. PER UNIT) DAMPER MOTOR UNIY DA _ - I (1 KA PER UNIT) TERMINaL6 MOTOR LEADS Q FAN S11PPa WO 0 - . I', � . ) •AMPER .. •,. r —.HQOp ASSEMBLY a M t is PCS. PER UNni ___.•''..___ - . ` - - IQ • lJ � i r i mima i • NOTE; . The 0.50% motorized outside air system is designed to place over the return air side connection. No drilling on the unit is required. This unit incorporates a 2- position control motor that opens the intake damper when the indoor blower is energized. The amount of alr is controlled by an outside air slide plate. The intake panel is fully insulated. The damper doses on power loss. • S u b j e c t t o c l o v e without mtge. Panted In die U. S. A. MOTORIZED FRESH AIR DAMPER . FORM 530.46S015Y (297) MODEL 2FA08700124 Supersedes: 530,46 -SD15Y (1195) (0% thru 50% capability) J :. Heating and Air Conditioning YO - IP - 111 11 Iu :JGnm r4VNr' •�" " °'•"" ' "' pJM NS!ONS - INCHES UNIT DIMENSION SLZE - A - '_ 024 THRU 036 33)S 18%. 042 THRU 060 4114 23% VENT AIR OUTLET HOOD BLOWER "---` SERVICE ACCESS COMPARTMENT PANEL - f/ j ` � \ CONDENSER COIL GAS SUPPLY 1X' DIA. HOLE .-- -- ` Mgo: -' WO ()4- f N1 CONNECTION) t �- � ii A UNIT CONDENSATE 1 � / 1111110 � I � i 2% (OVERALL) CONNECTION 1: NPTF B.,,- I i � (TRAP RECOMMENDED) ''ti, tI r 1 . *i alp `� 0 ' ii, I i " 1' 3% \, } II' � f HIGH vOLTAGE CONN, 2) REFRIGERANT 1N DIA REFRIGERANT . j CONNEGTioNS HIGH VOLTAGE CONK. s t •: ` COMBUSTION AIR %i OIA KNOCKOUT �1�, " �� INLET LOUVERS GAS SUPPLY 1) DIA KNOCKOUT ,x ' ��5 )i .i FRONT og NPTF CONNECTION) 2% 12% 49R Low VOLTAGE CONN. �47r sS (OVERALL) 135 DIA. KNOCKOUT xV' VOLE (OVERALL)\ GAS/ELECTRIC CONTROL SERVICE ACCESS HIGH VOLTAGE 834 COMPARTMENT PANEL � � 1 911 CONN.1)52 n DIA. 1 a r 11/a, :Y. FRONT KNOCKOUT i� ' - s GAS SUPPLY 13e DIA KNOCKOUT it.,,„, �. E `'1? (J4' NPTF CONNECTION) /� ';. I III; I LOyy VOLTAGE CONN. 1 //�� '� �hl�, P; DIA. KNOCKOUT SIDE SUPPLY o \ �.-� � � AIR OPENING `w f��: // 4% r 28N A\ \ ` . /f I I 4 14X SACK `�)",� s.< CONDENSER l�I + ! �� COIL �llll��llilll I ��{ \ 3% . '` 11 IIIIIII 1! I \,� CONDENSATE BOTTOM SUPPLY SIDE RETURN \ /( �� 11 11 II 11- 1 AIR OPENING !lllll�llll!I 11i'1 , III (1 DRAIN NPTF AIR OPENING 111r ,11114111111j11111111 ji 1 � ki �i� iiill' '} / �' I \/ \\ fi ` `` 15 �4Y. is � x'15 = � 1;r 4 %,\ 1x BOTTOM RETURN 3X AIR OPENING • Subject to change without notice. Panted in U.S.A. z88797 YSD-!}1009 Copyright 0 2009 by Johnson Controls, Inc. All rights reserved. Supersedes: 288797 YSD -C-0409 Johnson Controls Unitary Products SO05 York Drive Norman, 01(73069 • •1 , rnvm • 333•91 -Y1G -G -0211 Electrical Data 0NZ024 -060 Gas Heat 00 Fan Sv(3ply Max Compressor. z ! Sire Motors Blower Fuae (Tons) Volt teach) (owl) Moter � ) Broaker3 Size � ON2 CSI®CE1111Z11 (Amps) 024 2001230 -1.60 01�� 17.1 25 • ' (2.0) 030 208/230 - *� 1.3 -,0 23.7 30 . (2.5) 209 30 8.8 1111 1.3 6.0 18.1 25 460 440 4.5 0.75 X 1.0 6.6 15 OM 205235 -100 14.7 1.3 6.0 25.7 35 (3.0) F4.r$ ?, ". 11311111011111MINIM 6.0 16.7 4604-60 Ezi Iffill111111WIN 3.0 9.4 15 i 042 208/230 -1 -50 15. - 1.7 6.0 � ss ("- ( 3.5) 205 `• 9.3 1. 6.0 19.5 25 pa 480 -3.50 5.1 H 1.0 3.0 10.4 15 AS 048 2091230 -3-60 16 120 ® 40 (4.0) 440.3 - 60 _ 7.7 um 1.0 me 0 O50 206/130 -1 -60 28.2 2.3 s0 (5.0) 206/230.3 -60 wznaummutum 7.0 MM. 40 IICIEitL111iE11 1-3 3.8 MUM 1. Minlmu n Circuit Ampacity_ • 2. Maxlrnurn Over Current Protection per standard UL 1995. 3. Fuse or HACR circuit breaker size Installed at factory or field Installed. • NQ024.060 Gas Heat Co OD Fan Supply = , Motors blower use / flops) (each} (sash) What Breaker DNt] ®� IM FlA Amps) (2-8) �CI� 1,4 � 20 030 EL✓' #T QLa IIIM� 25.6 35 208/230440 tt230.3.80 I z� I 19.3 25 2 -1111'Src'NEis 95 15 00) 2001730.3.616'111aBOUIIIIII5 19.5 25 -0 LICIIy]Q 0.0 3.4 MON 15 209(230 -1.60 LID VAII. *-11111WAII 38.1 50 (3.5) FF-r - IMAM 22 �7llUNIE:LIN 35 '• 0.940 _rain= 10 0.9 1 Nam 13 15 049 lrm 120 � 1.7 L� 45 0380 ® 50 ® 0.6 4.6 MEM 20 A 08/230.140 25.0 E:.� 9.1 gum" 60 urTy31 p 2. 40 . 60 52 110 1.4 e 9,1 4.6 15.' 2 1. Minim urn Circuit Ampac)ty. 2. Maximum Ovet Current Protection per standard UL 1995. 3. Fuse or HACR e8cuk breaker size installed at factory or field installed. 5 • Johnson Controls Unitary Products 55 U0 - 14 - 0,11 110•04MM rnvm 1 YV V I • YY7/ YYY 1 VV.. 2 2 -4r 1 7 Q 2 > 333491 YTG-G -0211 Physical Data DNZ024 -060 Single Stage Gas Heat •+•� -� Modets component DNZ024 1 0E2030 DN2038 0142042 l oNZ049 DNZ060 Nominal Tonnage 2.0 2.b 3.0 3.5 4.0 6.0 AR(�OoLtNG PERFORMANCE Gross Capacity (3 ARI A point (MBh) 24.7 ' 301 35.0 { 43,0 50.0 59.5 ARI net capacity (M8h) 24.0 30.0 34.2 f 41,5 48,0 57.5 EER 11.6 11.5 11.1 11.6 11.1 10.9 SEER 13.2 13.2 13.2 13.4 13.4 13.0 Nominal CFM 850 940 1200 1300 1540 1600 System power (1(W) 2,1 2.7 3.2 3.6 4.4 �_ 5.3 R efrigerant type R-410A R-410A R-410A R-410A R-410A R410A ReMgerant charge (lb-oz) 3.10 4-0 4-0 4-14 4-0 5.2 ARI HEATING PERFORMANCE Heating modal N058 14056 NO38 N056 NO35 14056 N072 N085 - 14090 N005 N090 _ N110 1 14065 N090 N110 Hew input (K tu 45 70 45 70 45 70 90 50 108 50 106 135 80 106 135 Heat OutPut 1K Btu) 36 56 ' 30 56 30 56 72 64 87 84 87 109 84 97 107 AFUE 3/4 80.0 80.0 80.0 60.0 80.0 ' 60.0 80.0 80.0 80.0 80.0 60.0 80.0 80.0 80.0 80.0 - Steady state efficiency (bb) 60 50 90 BO 80 80 a0 80 60 e0 80 50 80 80 60 No. burners © 3 2 3 2 3 4 3 1 3 4 5 3 4 5 I No. stages 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Temperature Rise Range (sF) 25.55 - 3060 25-55 30-60 25-55 25-55 3040 25-55 45-75 25.55 35.65 46-75 25-55 35-65.. 45-75 Gas Limit Setting (`F) 140 160 140 160 140 160 , 160 150 175 150 175 , 160 150 , 175 180 Gas piping connection (In.) in 1 /2 1/2 1/2 1/2 1/2 DIMEN$10NS (inches) L811910 451/8 49118 49118 491/8 401/8 49118 Width 471/4 471/4 471/4 47114 471/4 471/4 - Neigh 331/2 331/2 331/2 411/2 41 411/2 OPERATING 551'. (Ibe.) 378 398 402 460 _ 485 480 COMPRESSORS Typo Reap 1 ' Reap 1 -spd ' Rep 1 -spd - Recap 1-sp0 Scroll 1 -spd Scroll 1dpd Quantity 1 1 1 1 1 1 CONDENSER C01L DATA Facie area (Se. Ft.) 11.9 11.a 11.9 15 15 j 15 rums ' 1 1 1 1 1 1 Fins per InCl1 23 23 23 23 , 23 23 Tube altimeter (in.) 0.71115 0,71/18 r 0,71/18 0.71/18 _ 0.71/15 0.71/18 Circuitry Typo 2 -pass Miero-Cliannel EVAPORATOR COIL DATA Face area (Sp. Ft.) 3.4 34 3.4 4.4 4,4 4.4 Rowe 2 3 3 3 3 4 Fins par inch 15 13 _ 13 16 16 13 Tube diameter _ 3/8 3/8 3/6 318 3/8 3/8 Circuitry Type Imerlaead Interlaced Interlaced !madame interfaced InicdaCed Re ,erantcontrot Orifice OdOce Orifice Orifice TXV TXV CONDENSER FAN DATA _ Quan0ty 1 1 1 1 1 1 Fan Comelier (inch) 22 22 22 22 22 22 Type Prop Prop Prop Prop Prop Poop Drive typo Direct Ol eCt Direct Meet Direct Direct No. speeds 1 1 l 1 1 1 Number of motors 1 1 1 1 1 1 Wow HP each 1/4 1/4 1/4 1/3 1/3 _ 1/2 RPM 1100 1100 1100 1120 1120 1090 NO/Nnat total CFM 2400 2400 2400 _ 3200 3200 3200 DIRECT DRIVE EVAP FAN DATA Quanta/ 1 1 1 1 1 1 Fan Site (Inch) 10x 8 10 x 8 1 1 810 11x 10 11 x 10 11 x 10 Type ' Centrifugal 0entlfugal Centrifugal Centrifugal Centrifugal Centrifugal Motor HP each 1/2 3/4 3/4 3/4 1 1 RPM Vat8ble Variable Variable Variable Variable Variable Frame size 48 _ 48 t 46 46 48 _ 48 FILTERS Otrantity -S24 1- 20x2051 ] 1- 20820x1 1 1- 20820x1 i 2- 20x121r1 1 2- 20«12x1 1 2- 20412x1 Johnson Controls Unitary Praducts 7 vee ev — evie e v•vvnm envm .�. .... ... ... SUBMITTAL DATA SHEET ggiyoRK ...______. AFFINITY"' SINGLE PACKAGE AIR CONDITIONER GAS /ELECTRIC (13 SEER, R -410A) 2 - 5 TON Heating and Air Conditioning MODELS: D_NZ024 thru 060 `` JOB NAME: p �l Y l' tr ? - 1 k LOCATION: a " PURCHASER: I AL'lm Dt`) cA tY .1 .1J c. • ORDER NO: ENGINEER: SUBMITTED TO: FOR: REF: APPROVAL: CONSTRUCTION: SUBMITTED BY: 3 \P - t i t DATE: UNIT DESIGNA1 iON: 0 i SCHEDULE NO. MODEL NO.13lj ?.„ oaq COOLING PERFORMANCE STANDARD FEATURES q • R�10A Refrigerant TOTAL CAPACITY (Nth actIBH • Low and high pressure switches on all products. SENSIBLE CAPACITY (NET) a/p001ABH - Condenser coils are constructed of Micro-Channel aluminum tube, OUTDOOR DESIGN TMP. q5 •F DB/WB aluminum fins for long lasting durability and efficient operation. TOTAL SUPPLY AIR CFM • Evaporator coils are constructed of highly efficient rifled copper tubes with TEMP. OF AIR ENTERING enhanced aluminum fins. EVAPORATOR COIL S •F DBIWB - Internal compressor protection (temperature and pressure). POWER INPUT REQ. — KW • Standard cooling operation down to 45• F (Low ambient kit to 0° F (LESS BLOWER MOTOR) available). EATING PERFORMANCE • Refrigerant system strainer. N - Single or two stage gas heat. GAS FIRED HEAT EXCHANGER - Blow thru heat exchanger design with aluminized steel tubes. INPUT /OUTPUT CAPACITY -- 70 IAIDABH • Induced draft "POST-PURGE" gas Control logic. • SUPPLY AIR BLOWER PERFORMANCE Reliable spark to pilot ignition. - Ignition control provides a red LED for diagnostic error codes. TOTAL SUPPLY AIR _CFM • Compact size cabinet with single footprint. TOTAL RESISTANCE EXTERNAL • Bottom and /or side electrical and gas utility connections. TO UNIT L NYG • Top discharge condenser air design With flush mounted grille guard. BLOWER SPEED (Circle)- • • • - () LOW - Full perimeter, removable base rails with built in rigging and shipping MOTOR RATING HP provisions. POWER INPUT REQ - - - - - - - - - -- -'- WATT - Heavy gauge galvanized steel cabinet with a paint finish which has industry leading 1000 hour salt spray rating per ASTM43117 federal test standards. ELECTRICAL DATA - Easily field convertible from side to bottom discharge. No other accessory POWER SUPPLY alai_! /..1Q needed. TOTAL UNIT AMPACITY a / Asa's • Attractive cabinet design with single piece - watershed" top cover and drip MINIMUM WIRE SIZE AWG edge to extend cabinet life and deter water collection. MAX. OVER ORRENT DEVICE • Factory Installed, attractive protection condenser coil grille. • Foil face insulation which does not emit fibers into air stream. _ FUSES v `- CIRCUIT BREAKER - t�Q AMPS • Permanently lubricated condenser and evaporator motors. UNIT WEIGHT -1a • Slide out blower assembly with multi speed (5) direct drive motors on ail TOTAL UNIT WEIGHT (operational). 5* LBS models. • Non corrosive condensate pan internally sloped to meet strict requirements r . CLEARANCES of ASHRAE 62 indoor Air Quality standard. FR ONT 36 .. • Ridged mounted, protected refrigerant access ports externally accessible. BACK 0° - Both numbered and colored wires. LEFT SIDE (FILTER ACCESS) 24" • All three phase models have built in filter rack with cleanable filters and 75 RIGHT SIDE 12" VA transformer with reseltabie circuit breaker. BELOW uNIT1 p" • Warranties on all product applications: 2 • it) year single phase compressor warranty and 5 or 10' year limited \ABOVE UNIT d6" warranty on parts_ 1. Units may bo installed on combustible Soots ooSoots made • To from wood or pass A. B or C roof covering melodic qualify for the extended 10 parts warranty, the unit must be 2. Unita must be 'mashed outdoors. Overnanainy strw registered online at www upgproductreaistration.com within g0 days of tures or shrubs should not obstruct condenser air install. discharge outlet • 5 year 3 phase compressorwarranty and 1 year limited warranty on parts. - 20 year gas heat exchanger warranty. NOTE: . • A 1' clearance must be provided between any combustible material and the supply air duct work. - The products of Combustion must not be allowed to accumulate within a confined space and recirculate. • Refer to the Technical Guide for unit specifications. • Unit may be installed on combustible floors made from wood or class A, B or C roof covering material. - Units must be installed outdoors. Overhanging structures or shrubs should not obstruct air discharge Outlet. Johnson Controls Unitary Products 288797 -YSD -D -1009 SUBMITTAL DATA SHEET igi AFFINITYTM SINGLE PACKAGE AIR CONDITIONER GAS /ELECTRIC (13 SEER, R 410A) 2 - 5 TON Heating and Air Conditioning MODELS: D_NZ024 thru 060 JOB NAME: - r �� LOCATION: a4 ?IDA iL ...4 \ . PURCHAS r a ORDER NO: ENGINEER: SUBMITTED TO: FOR: REF: APPROVAL CONSTRUCTION: - SUBMITTED BY: J r I. DATE: UNIT DESIGNATION: -- 0 — - SCHEDULE NO: MODEL NO. 1:)Jtf3 y COOLING PERFORMANCE ''s\ . 410A Refrigerant STANDARD FEATURES TOTAL CAPACITY (NET) BM �( - Low and high pressure switches on all products. SENSIBLE CAPACITY (NET) BH • Condenser coils are constructed of Micro - Channel aluminum tuba, OUTDOOR DESIGN TMP- 90 °F DBMS aluminum fins for long lasting durability and efficient operation. � TOTAL SUPPLY AIR _ _v_ CFM • Evaporator culls are constructed of highy efficient rifled copper tubes with TEMP. OF AIR ENTERING enhanced aluminum fins. EVAPORATOR COIL ( °F DBNVR • Internal compressor protection (temperature and pressure). POWER INPUT REQ. - - - - KIN • Standard cooling operation down to 45' F (Low ambient kit to 0' F (LESS BLOWER MOTOR) available). HEATING PERFORINAI�CE • Refrigerant system strainer. • Single or two stage gas heat. GAS FIRED HEAT EXCI{ANGE&. • Blow thru heat exchanger design with aluminized steel tubes. INPUTIQUTPUT CAPACITY • - 17.-/ 11� BH • Induced draft "POST - PURGE" gas control logic. • SUPPLY AIR BLOWER PERFORMANCE Reliable spark to pilot ignition. • Ignition control provides a red LED for diagnostic error codes. TOTAL SUPPLY AIR 1300 CFM • Compact size cabinet with single footprint. TOTAL RESISTANCE EXTERNAL ` - Bottom and/or side electrical and gas utility connections. TO UNIT • b nun • Top discharge condenser air design with flush mounted grille guard. BLOWER SPEED (Circle) ISM ED kOW • Full perimeter, removable base rafts with built in rigging and shipping MOTOR RATING •:�y HP provisions. POWER INPUT REQ. WATT • Heavy gauge galvanized steel cabinet with a paint finish which has industry leading 1000 hour salt spray rating per ASTM -5117 federal test standards. ELECTRICAL QATA • Easily field convertible from side to bottom discharge. No other accessory POWER SUPPLY 21/ / I needed. TOTAL UNIT AMPACETY 1' AMPS • Attractive cabinet design with single piece "watershed" top cover and drip OaNIMUM WIRE ZE AWG edge to extend Cabinet life and deter water collection. max ENT DEVICE • Factory installed, attractive protection condenser coil grille. FUSES ✓✓ ✓CIRCUIT BREAKER - &5_ AMPS • Foil face insulation which does not emit fibers into air stream • Permanently lubricated condenser and evaporator motors. UNIT WEIGHT • Slide out blower assembly with multi speed (5) direct drive motors On all TOTAL UNIT WEIGHT (operational) - Yik LB!! models. • Non corrosive condensate pan internally sloped to meet strict requirements CLEARANCES of ASHRAE 62-89 Indoor Air Quality standard. FRONT se" • Ridged mounted, protected refrigerant access ports externally accessible. BACK p" • Both numbered and colored wires. LEFT SIDE (FILTER ACCESS) 24" • All three phase models have built in filter rack with cleanable filters and 75 RIGHT SIDE 12" VA transformer with resettable circuit breaker, BELOW uNIT 0- • Warranties on all product applications: `ROVE UNiT - - - - - - - - - - • - - - - 36" • 10 year single phase compreSSSOr warranty and 5 or 10° year limited 1, Units may be instated on oombuso'ble flews noon - To warranty on pans. tram wood or Class A. a or C roof cwcring materiel. To qualify for the extended 70 year parts warranty, the unit must be 2. unite must be instated outdoors. Overhanging woo- registered online at www.uocorociggirettptratIon.corn within 90 days of twos or shrubs should not obstruct condenser air install. disrtraree Outer • 5 year 3 phase compressor warranty and 1 year limited warranty on parts. • 20 year gas heat exchanger warranty. NOTE: - A 1" clearance must be provided between any Combustible material and the supply air duct work. • The products of combustion must not be allowed to accumulate within a confined space and recirculate. • Refer to the Technical Guide for unit Spee fications. - Unit may be installed on combustible floors made from wood or class A. B or C roof covering material, • Units must be installed outdoors. Overhanging structures or shrubs should not obstruct air discharge outlet • Johnson Controls Unitary Products 288797 - YSD - - 1009 Fold, Then Detach Along All Perforations h IWEAI.TH OF.MASSA E T[ .. DIV OF PROFESSIONAL 1 ICFIJ'�11RE -BOARD OF BOARD • SM l IF ` STER UNRESTRICT . h $UE;ifiE A ]V 1G NSE TES TYPE IARI A £H1:1/.AL IEft 91 '1.00$rS S M 1 1 t ES 'k OEi l ry . MA O O8S 396.E . 984144 7-110 - 06 --- 8 / -9841 LICENSE NO. EXPIRATION DATE SERIAL NO Fold. Then 6etacP Along All Pertorationa , 3 ft is aEx f ` I s 101 LOEfIEIA,IAA 01Alf8 -"Ns.' //,,t.,. �1. WESTPWI• 3161 v ' a .i.....is 00 1111.17-2411 Rev e . �. - - -- _-1 The Commonwealth of Massachusetts * . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly F / � Name ( Business /Organization/Individual) : (� 'yjG ✓� . V °V , D'SC' 1 1740/s ) 4 Address: 111 J /" ,CCCI _Ma 1 I L (J i(l � 14 � ' L'i City /State /Zip: „J silt~ uj l /4— j% /0 c / Phone #: ( j)- 7V/ 43 .S Are you an employer? Check the appropriate box: Type of project (required): 1. m an employer with /J` 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part time).* have hired the sub - contractors ❑ Remodeling 7. 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ 9. ❑ Building addition required] 5.0 We are a corporation and its 1(1. J ctrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no 12. ❑ Roof repairs employees. [no workers' 13.1kOther 410 141,4-0 comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. tllomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contactors that check this box must attach an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providin workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 7 VPai _ 2Lt&7) (t p Policy # or Self -ins. Lic. #: C. / 7 q �� 47 ��y / J� Expiration Date: Job Site Address: %) ` 3 1 1 PC SC G2 / (if City/State /Zip: /((30N p 441 ,4f 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 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage veri, ation. I do herby ce ' der the pa' s an pe' alties off erjury that the information provided above is true and correct. Si: nature: t Date: Zeift Print Name: / ,y (a Phone #: V/3 7,P9-9,5 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 Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact person: Phone #: 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: 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 Massac setts General , an • • , at my signature on this permit application waives this requirement. 4 1 Check One Only ( P� 2 2 aL. 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 Title ❑ Master - Restricted City/Town ❑Journeyperson Signature of Licensee Permit # ❑Journeyperson- Restricted License Number Fee $ ❑ Check at www.mass.gov /dpl Inspector Signature of Permit Approval 7 C .l1f at\ YLfo£. -Joi1i piri �ciu 12 Commonwealth of Massachusetts p.�. )6 o di i � . .)/ 0) J /Y)0, 0 1--. fu, 4 O i p' n,1 Er :i e ] „75;, : . 3 mit 14 14 Cioup ;►, ate: . ? O I SE — i Permit # SEP Job Cost: $ ), 5 'C' _ ' -rmit Fee: $ 56. 0F.T _ " Plans Submitted: YES NO � IT "j` ' ans • e �iewed: YES NO .K Business License # Applicant License # Business Information: Property Owner / Job Location Information: Name: 41c>\ 4 1 2 0 . Name: 6(.. r7n,,( %r) tt 0 /2a 37 a /IS /t' Street: p!D . 0)0\L lG ,?) (c Street: d i/ , 3 1 / a 3'(1/) 7 67 City /Town: 17, ed, nc1 [r I I s 1 A 0 )0-3 City /Town: N0.6'/ /2H f1'slc0. 414 • Telephone: LI I.' 3 C cr ?? Telephone: Photo I.D. required / Copy of Photo I.D. attached: YES NO Staff Initial J -1 / M- 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: Sheet metal work to be completed: New Work: Renovation: ; k HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: yo 64_ , is )'1 04- d4t0 o A 5 v) `J doe urn i I `- File # SM- 2012 -0006 APPLICANT /CONTACT PERSON ACTION AIR ADDRESS/PHONE P 0 BOX 636 (413) 789 -9305 PROPERTY LOCATION 30 PLEASANT ST MAP 32A PARCEL 148 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out zpos J 1- O Fee Paid / Typeof Construction: INSTALL NEW HVAC SYS FOR UNITS 1 & 5 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 7110 3 sets of Plans / Plot Plan THE . 1 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN . d RMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER : § Intermediate Project : Site Plan AND /OR Special Permit with Site Plan Major Project: Site Plan AND /OR Special Permit with Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management • / 0th ►y 9/029,-/// Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of Planning & Development for more information.