32C-308 (3) RIGHT -J SHORT FORM
or,. Entire House
SIBLEY MECHANICAL Job: 12 5 -03 -2011
Project Information f, A,
For: "2ND FLOOR APT"
NORTHAMPTON, MA
Design Information '.,° <
Htg Clg Infiltration
Outside db ( °F) -2 93 Method Simplified
Inside db ( °F) 72 75 Construction quality Average
Design TD ( °F) 74 18 Fireplaces 0
Daily range - M
Inside humidity ( %) - 50
Moisture difference (gr/lb) - 14
I
HEATING EQUIPMENT COOLING EQUIPMENT
Make NORDYNE Make NORDYNE
Trade GIBSON Trade GIBSON
KG7TC- 060D -23B JS4BD -018KB
C6BA -X24CB
Efficiency 95.1 AFUE Efficiency 13.0 SEER
Heating input 38000 Btuh Sensible cooling 12880 Btuh
Heating output 35000 Btuh Latent cooling 5520 Btuh
Heating temperature rise 42 °F Total cooling 18400 Btuh
Actual heating fan 750 cfm Actual cooling fan 750 cfm
Heating air flow factor 0.031 cfm /Btuh Cooling air flow factor 0.066 cfm /Btuh
Space thermostat Load sensible heat ratio 88 %
ROOM NAME Area Htg load Clg load Htg AVF Clg AVF
(ft (Btuh) (Btuh) (cfm) (cfm)
BED ROOM 2 150 5504 2906 169 193
MASTER BED ROOM 225 7333 4033 226 268
KITCHEN 450 9203 3354 283 223
BATH 30 2316 988 71 66
Entire House d 855 24356 11280 750 750
Ventilation air 2849 693
Equip. @ 0.98 RSM 11734
Latent cooling 1570
TOTALS 855 27205 13304 750 750
,
Printout certified by ACCA to meet all requirements of Manual J 7th Ed.
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www.cetonline.org
MID Construction Performance Testing Documentation
Date of Test 5.24.2011
Builder /Homeowner John Sibley
Address 5 Henry Street Northampton
Test completed by Beth Paulson
Test Information
Conditioned Floor Area r 900 sq ft Number of Stories 0
Duct System 1 Duct System 2 (if installed)
Air Handler Installed? yes Air Handler Installed? 0
Duct Flow in CFM25 37 Duct Flow in CFM25 0
Pass or Fail? Pass Pass or Fail? 0
RESULTS of Rough -In Duct Leakage Test
Rough In Total Leaka a Test at 25 Pascals
Total Leakage Test 4.11 CFM per 100 sq ft of conditioned floor area
Notes on Area Tested and /or Testing Conditions:
Total duct leakage test only; paid on site - -sent recipt
2009 IECC Minimum Requirements
Rough In Test with Air Handler Installed < 6 CFM per 100 sq ft of conditioned floor area
Rough In Test with NO Air Handler Installed < 4 CFM per 100 sq ft of conditioned floor area
Questions about this Report?
Contact Megan McDonough - Phone: 413 -586 -7350 x221 - E -Mail: MeganM @cetonline.org
The Commonwealth of Massachusetts ?- I f
Department of Industrial Accidents (I ^
•
i F" ft Office of In Investigations , �,{
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600 Washington Street r/
• 7.--141—= � � �
Boston, MA 02111
.', � www.mass.gov/dia
-Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Auplicant Information Please Print Legibly
Name ( Business /Organization/Individual): S, 1, (, y hri' c i, ,. I, , c
Address: 3 Afr, L,
City /State/Zip: tit. c f tie h t- l %) ,( Phone.#: Lf(i ? C % (v I
Are you an employer? Check the appropriate box: Type of project (required): /
1.0 I am a employer with 4. 0 I am a general contractor and I
employees (full and/or part-time).* have hired the sub- contractors 6. ❑New construction
listed on the attached sheet. 7. 0 Remodeling
2. g( I am a sole proprietor or partner-
ship and have no employees These sub - contractors have 8. ❑ Demolition
for me in any capacity. employees and have workers'
working Y P ty. $ - 9. 0 Building addition
[No workers' comp. insurance comp. insurance.
required ] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required] t c. 152, § 1(4), and we have no
employees. [No workers' 13.6Z1 Other h. i''....1. .c j t-r..ti
comp. insurance required]
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation 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.
:Contractors that check this box must attached 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.
lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self-ins. Lic. #: Expiration Date:
•
Job Site Address: 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 u to $1,500.00 and/or "one =earl on,sien ; as well as civil penalties in "the form of STOP
-. WORR - ORDER and a fine.
P Y -... ris t, p �
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 pains and penalties of perjury that the information provided above is true and correct
/ ,
Signature: ,./ , 1I . — Date: j �
Phone #: w
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 #:
•
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 12 ' Yes No, _,
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy El 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 0 Master
Title
❑ Master Restricted ; , :°
City/Town
❑Journeyperson Signature of Licensee
Permit #
❑Journeyperson- Restricted YZ t1�
License Number:
Fee $ ❑
Check at www.mass.qov/dpl
Inspector Signature of Permit Approval
RECEIVED , JAC_-
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Commonwealth of Massachusetts
_
JUL 8 ali >
DEPT. OF BUILDING INSPECTIONS Aict 'd
She Metal Permit l
NORTHAMPTON, I 1111p1 ``
Date: ` Lib Permit # P1) oY ' '
Estimated Job Cost: $ C j u�•. ` '� Permit Fee: $ 1/41 r (j) C '
Plans Submitted: YES VNO „/ Plans Reviewed: YES NO
Business License # Applicant License #
Business Information: Property Owner / Job Location Information:
Name: Srbk /'�z. �.a+�� < Name:
Street: 3 8,v ,k vs- e Join( Jv' Street: X %e v
City/Town: 14 t /1 y h City/Town: (` J
Telephone: 'I/ 3 Z ( ! L t, 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 ` Townh u. es Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. V 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:
'1 ) f 4 11 2 h f G, 'C ►. S f9 •, i