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38A-137 (2) Nov 1512 03:32p A Plus HVAC Inc. 4135620064 p.5 -7 Level l�� • cfrr - 39 cfn 1' • oom12 8xE Room11 rt 8xE 4 I ,. o r. 8► E 8xf 4 1. ' + Roorn1 t c ■ 7 SxE 12 cfn 8xf Room8 Jib Room9 6 ' , I. fit 83 cfrr 38 cfrr E] Job #: A Plus HVAC Inc. Scale: 1 : S5 Performed by Nathan LeMay for: Page 1 Don Clarke 26 Airport Drive Right - Suite ®Unitiersal 2012 215 Baldwin Street Westfield, MA 01085 12.0.13 RSUO2778 West Springfield, MA Phone: 413 478 -5352 Fax: 413 562 -0054 2012- Nov -15 09:04.49 www.aplushvacinc.com nathan @aplushvacinc_com ...Me, Model Home, Northampton.rup Nov 1512 03:32p A Plus HVAC Inc. 4135620064 p.6 • • Level 2 � 158 crr ° "18cf Room3 X38 cfrr Room4 Room2 Rooms ® 153 262 cfrr 260 cfrr 104 cfrr Room6 Room7 p 130 cfrr m k 104 cfn 130 cfn Job #: A Plus HVAC Inc. Scale: 1 : 55 Performed by Nathan LeMay for: Page 2 Don Clarke 26 Airport Drive Right-Suite OUrthersal 2012 215 Baldwin Street Westfield, MA 01085 12.1113 RSUO2778 West Springfield, MA Phone: 413 478 -5352 Fax: 413 562 -0054 2012 -Nov -15 09:04 :49 www.aplushvacinc.com nathan @aplushvacinc.com ...ire, Model Home, Northampton.rup Nov 1512 03:32p A Plus HVAC Inc. 4135620064 p.7 • Level 1 • 190 cfn • I ,• x F 8xe ' f. 4 • 8xE vi 8x• • 1 xf I 1Q 1 9 Q e 12 x ------ 10 x C3 7 " --- 8xf © ,� Job #: Scale: 1 : 55 Performed by Nathan LeMay for: A Plus HVAC Inc. Page 3 Don Clarke g 2fi Airport Drive Right-Su lie iLersal 2012 215 Baldwin Street Westfield, MA 01085 12.0.13 RSUO2778 West Springfield. MA Phone: 413 478 -5352 Fax: 413 562 -0054 2012- Nov -15 09:04:49 www.aplushvacinc.com nathan@aplushvacinc.com ...ire, Model Home, Northampton.rup Nov 1512 03:32p A Plus HVAC Inc. 4135620064 p.4 Pro ect Summary Job: J ' 7 Date: Sep 03, 2012 `:- Entire House By: Nathan LeMay ;..: r='' .' FOrv,. IlN.a A Plus HVAC Inc. 26 Airport Drve, Westfield, MA 01085 Phone: 413 478 -5352 Fax: 413 562 -0054 Email: nathan @aplushvacinc.com Web: www.aplushvacinc.com Pro'ect Information For Don Clarke 215 Baldwin Street, West Springfield, MA Notes: Desi • n Information Weather Hartford, CT, US Winter Design Conditions Summer Design Conditions Outsidedb 8 °F Outsidedb 88 °F Inside db 70 °F Inside db 75 °F Design TD 62 °F Design TD 13 °F Daily range M Relative humidity 50 % Moisture difference 26 grub Heating Summary Sensible Cooling Equipment Load Sizing Structure 26439 Btuh Structure 11195 Btuh Ducts 7530 Btuh Ducts 6033 Btuh Central vent (62 cfm) 2113 Btuh Central vent (62 cfm) 450 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 36083 Btuh Use manufacturers data n Ratelswing multiplier 0.93 Infiltration Equipment sensible load 16494 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Tight Fireplaces 1 (Average) Structure 861 Btuh Ducts 897 Btuh Heating Cooling Central vent (62 cfm) 1104 Btuh Area (ft 2586 2586 Equipment latent load 2862 Btuh Volume (ft 14640 14640 Air changeslhour 0.19 0.06 Equipment total load 19356 Btuh Equiv. AVF (cfm) 47 15 Req. total capacity at 0.85 SHR 1.6 ton Heating Equipment Summary Cooling Equipment Summary Make Lennox Make Lennox Trade ELITE 90 Trade 14ACX SERIES Model EL296UH045XV36B - Cond 14ACX- 024 - 230 -16 AHRI ref 4988231 Coil CX34- 25 +EL296UH045XV36B` +TDR AHRI ref 5535916 Efficiency 96 AFUE Efficiency 13.5 EER, 16 SEER Heating input 44000 MBtuh Sensible cooling 20910 Btuh Heating output 42000 Btuh Latent cooling 3690 Btuh Temperature rise 47 °F Total cooling 24600 Btuh Actual air flow 820 cfm Actual air flow 820 cfm Air flow factor 0.024 cfm/Btuh Air flow factor 0.048 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.86 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 1 4 wri htsoft_ 2D12- Nov- 1509P e9 a � Rght- Suitet� Universal 2D12 120.13 RSUO2778 Paga 1 ACCA . Peeoy Companies, Yortshire, Model Home, Northampton-nip Calc = MJ8 Front Door faces: Nov 1512 03:32p A Plus HVAC Inc. 4135620064 p.3 5' Load Short Form Job: Date: Sep 03, 2012 t....-#7, . , Entire House By: Nathan LeMay ` A Pius HVAC Inc. r, t,lunc, - t ic 26 Airport Drive, Westfield, MA 01085 Phone: 413 478-5352 Fax: 413 562 -0054 Email: nathar aplushvacinc.com Web: www.aplushvacinc.ccm Project Information For: Don Clarke 215 Baldwin Street, West Springfield, MA Design Information Htg Clg Infiltration Outside db ( °F) 8 88 Method Simplified Inside db ( °F) 70 75 Construction quality Tight Design TD ( ° F) 62 13 Fireplaces 1 (Average) Daily range - M Inside humidity ( %) 30 50 Moisture difference (gr /lb) 26 26 HEATING EQUIPMENT COOLING EQUIPMENT Make Lennox Make Lennox Trade ELITE 90 Trade 14ACX SERIES Mode] EL296UH045XV36B -* Cond 14ACX -024- 230 -16 AHRI ref 4988231 Coil CX34- 25 +EL296UH045XV36B' +TDR AHRI ref 5535916 Efficiency 96 AFUE Efficiency 13.5 EER, 16 SEER Heating input 44000 MBtuh Sensible cooling 20910 Btuh Heating output 42000 Btuh Latent cooling 3690 Btuh Temperature rise 47 °F Total cooling 24600 Btuh Actual air flow 820 cfm Actual air flow 820 cfm Air flow factor 0.024 cfm/Btuh Air flow factor 0.048 cfrn /Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.86 ROOM NAME Area Htg load Cig load Htg AVF Gig AVF (ft (Btuh) (Btuh) (cfm) (cfm) Zone 3 p 1008 7869 364 190 17 1St & 2nd Fl p 1578 • 26101 18590 630 885 Entire House d 2586 . 33970 17228 820 820 Other equip loads 2113 450 Equip. @ 0.93 RSM 16494 Latent cooling 2862 TOTALS 1 2586 I 36083 I 19356 I 820 I 820 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2012- Nov -15 09:01:59 - wrightsof Right- Su iLe® Universal 2012 12.0.13 RS(102778 Page i ACC .,,tslThe Pecoy Companies, Yorkshire, Model Home, Northamplon.rup Calc = MJB Front Door toes: Nov 1512 03:32p A Plus HVAC Inc. 4135620064 p.2 - Manual S Compliance Report Job: Date: Sep 03, 2012 Entire House By: Nathan LeMay t�wac i �C A Plus HVAC Inc. 26 Airport Drive, Westfield, MA 01485 Phone: 413 478 -5 352 Fax: 413 552 -0054 Email: nalhan @aplushvacinc.00m Web: www.aplushvadnccom Project Information For: Don Clarke 215 Baldwin Street, West Springfield, MA Cooling Equipment Design Conditions Outdoor design DB: 88.3 °F Sensible gain: 1767B Btuh Entering coil DB: 77.8 °F Outdoor design WB: 71.8 °F Latent gain: 2862 Btuh Entering coil WB: 64.1 °F Indoor design DB: 75.0 °F Total gain: 20540 Btuh Indoor RH: 50% Estimated airflow: 820 cfm Manufacturer's Performance Data at Actual Design Conditions Equipment type: Split AC Manufacturer. Lennox Model: 14ACX- 024-230- 16 +CX34- 25+EL296UH045XV36B * *TDR Actual airflow: 820 cfm Sensible capacity: 0 Btuh 0% of load Latent capacity: 0 Btuh 0% of load Total capacity: 0 Btuh 0% of load SHR: 0% Heating Equipment Design Conditions Outdoor design DB: 7.6 °F Heat loss: 36083 Btuh Entering coil DB: 65.2 °F Indoor design DB: 70.0 ° F Manufacturer's Performance Data at Actual Design Conditions Equipment type: Gas furnace Manufacturer: Lennox Model: EL296UH045XV36B -* Actual airflow: 820 cfm Output capacity: 42000 Biuh 116% of load Temp. rise: 50 °F The above equipment was selected in accordance with ACCA Manual S. wri htsoft 2012-Nov-15 09:01:59 Q R igh -- Suite®Universa1201212.0.13 RSUO2778 pages ACCA .. ts\The Pecoy Companies, Yorkshire, Model Home, Northamplon.rup Calc = MJ8 Front Door faces: Nov 1512 03:31p A Plus HVAC Inc. 4135620064 p.1 1441i Why Settle For Less? FACSIMILE TRANSMITTAL SHEET TO: FROM: COMP AN " D A'Z'E: FAX NUMBER: \ ` TOTAI. NO. OF PAGES INCLUDING COVER: PHONE 1 [M$13R c � ` ` 4 13) 56 2 R'S NUMBER: I '13) 56 -0054 RE: Cr T 1 O. NUMBER: ❑ URGENT FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE NOTES/COMMENTS: If you have any questions, please feel free to give me a call at the number referenced below. Thank you. 26 Airport Drive Westfield_ MA. 01085 Phone (413) 562 -0054 Fax (413) 562 -0064 Visit us or_ or. ;, vu:;gap is ww\v:1 plLlsh\ acII1C.corn • DRIVER'S LICENSE t, 536 648111' EXP DOD _ 11 - 11 - 2014 11 -11 -19 CLASS REST HGT SEX DM 6-00 M NATHAN T • 51 WHITE OAK RD SPRINGFIELD MA 01128 -1034 ///1, „�1 OF SHEET METAL WORKERS AS A MASTER - UNRESTRICTED ISSUES THE ABOVE- JCENSE TO. NATHAN T LEMAY \ \ A PLUS HVAC INC. 51 WHITE OAK RD �^ SPRINGFIELD MA 01128 -1034 �,?Y 905 11/28/13 91106 ,\ 1 r- COMMONWEALTH OF MASSACHUSETTS SHEET METAL WORKERS AS A BUSINESS ISSUES THE ABOVE LICENSE TO: NATHAN T LEMAY A PLUS HVAC INC 51 WHITE OAK RD SPRINGFIELD MA 01128 -0000 103 11/08/14 286214 � • CONTROL # ' , IMPORTANT If this license is lost or destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118 -6100. If your name or address shown is changed, notify your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws as amended. It is a personal privilege, and must not be loaned or assigned to any other person. Keep this license on your person or posted as required by law. • APLUS -1 OP ID: MN ' CERTIFICATE OF LIABILITY INSURANCE DA 1o/ov12 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). PRODUCER 413 789 - 3995 NAME Melanie Nacewicz Canary Blomstrom Ins. Agency FA 789 - 3995 413 413 - 786 -7004 PHONE - 868 Springfield St (A/c, No, Ea 41 No): 413 - 786 -7004 Feeding Hills, MA 01030 -2151 E -MAIL mnacewicz@canaryblomstrom.com ADDRESS: V ry INSURER(S) AFFORDING COVERAGE NAIC # INSURER A General Casualty Ins.Co. 24414 INSURED A Plus HVAC, Inc. INSURER B : Technology Insurance Co. 51 White Oak Rd Springfield, MA 01128 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) UMITS GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CCX 0807057 03/01/12 03/01/13 PREMISES (Ea $ 100,000 I CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 X POLICY PRO- LOC $ .IFf;T AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) A ANY AUTO CBA 0566284 10/05/12 10/05/13 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS X AUTOS NON -OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) X UMBRELLAUAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE CCU 0807215 03/01/12 03/01/13 AGGREGATE $ 2,000,000 DED X RETENTION $ 10000 _ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY X TORY LIMITS ER Y / N B ANY PROPRIETOR/PARTNER /EXECUTIVE TWC3332840 10/17/12 10/17/13 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) HVAC CERTIFICATE HOLDER CANCELLATION CITYNOI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Northampton MA AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Acorn TM CERTIFICATE OF LIABILITY INSURANCE D D(M2 /D 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). PRODUCER COMPANIES AFFORDING COVERAGE PAYCHEX INSURANCE AGENCY, INC. COMPANY Technology Insurance Company 150 SAWGRASS DRIVE A ogY P Y ROCHESTER, NY 14620 COMPANY 877 - 266 -6850 B INSURED COMPANY APLUS HVAC INC C 51 WHITE OAK ROAD SPRINGFIELD, MA 01128 COMPANY D 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. O TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS TR DATE (MMIDD/YY) DATE (MM /DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS - COMP/OP AGO $ � MADE r — IJCCUR PERSONAL & ADV INJURY $ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE (Any one fire) $ MED EXP (Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS = BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM WORKER'S COMPENSATION AND X WC STATU- OTH- • EMPLOYERS' LIABILITY TWC3336069 10/17/12 10/17/13 TORYI IMITS FR EL EACH ACCIDENT $ 100,000.00 THE PROPRIETOR/ X INCL PARTNERS/EXECUTIVE - EL DISEASE - POLICY LIMIT $ 500,000.00 OFFICERS ARE EXCL EL DISEASE - EA EMPLOYEE $ 100,000.00 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION CITY OF NORTHAMPTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 210 MAIN STREET DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY NORTHAMPTON, MA 01060 PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 23-9 (2009/09) OACORD CORPORATION 1988 The Commonwealth of Massachu,setts Print Form - . De of Industrial Accidents u! Office of Investigations _ � 1 Congress Street, Suite 100 0 1111•171t 1- 4- W ♦ s Boston, MA 02114 -2017 W = www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information �) Please Print Legibly iii Name ( Business /Organization/Individual): rt'J IA L- ( . 0 - Address as) }, cj� \ J A Q,- ., G A r City/State /Zip: , &,. A 0 0 9 q 4\ D\ ( Phone #: ,3 _ )� -- 7 - Are you an employer? Chec the appropriate box: Type of project (required): 1,,XJ I am a employer with 4. ❑ I am a general contractor and 1 employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working acit employees and have workers' g for me in any capacity. y . 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.1] Electrical repairs or additions 3. ❑ 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 J Vfl c/ _4!` employees. [No workers' 135 Other 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. tContractors 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. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. l (�� Insurance Company Name: ' ' -) n =, 1.�AOCCI. `�-' i fit a ll Policy # or Self -ins. Lic. #: - rvd L> ?T � , - Expiration Date: 1 j I ( I�� ) J Job Site Address: f . o-, 4 .City /State /Zip:1 (- , i1/I/\ J S, 1,►■- 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 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 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 ce tij under the I ains and ) enalties o I et.' that the in ormation provided above is true and correct Signature: 11 I O-- l.C' I ct- Date IPil�/i 1- / Phone #: �1_ - ��`�- ( --� � �1 ' 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. 112 Yes El No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy X1 Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee dne.c not have. the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application maims this requirement. II/` Check One Only V) i t QJf I CLL Owner [ Agent ❑ Signature of Owner or OwnekAgent 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 Prngrees 1ncre.rtinns Date Comments Fine laved Date Con ments Type of License: By It' / aster Title ❑ Master - Restricted F J I& L' T w oieu City/Town ❑Joumeyperson Signature of Licen ee Permit # ❑Jou rneyperson- Restricted /1 License Number: c.J Fee $ ❑ Check at www macs anvidpi Inspector Signature of Permit Approval RECE V S3 Commonwealth of Massachusetts NOV .. 9 2012 City Of Northampton DEPT. OF BUILDING INSPE IONS NORT -_ PTON, �1 6, Sheet Metal Permit • • -- 111111111111L- 111111111111L- 5� ` �� Permit # o' d Estimated Job Cost: $ ) Lou Permit Fee: $ j . Plans Submitted: YES NO Plans Reviewed: YES NO Business License # ,t Applicant License # 6 ,05 Business Information: ii PProperty Owner / Job Location Information: Name' '' (LX 4 kin C. j-x c T � 1 �1 .' \A1 Street: ( U • C -- t)c 1v e _ Ore Cit /Townik i—e JI � Ihi' 0\`Ab City/Town: ■..A)(1 c.),-;^1\ Dr) Telephoner I S - j %� � c� Telephone: 5 I n� ` Photo I.D. required / Copy of Photo I.D. attached: YES NO Staff Initial J - / 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: HVAC )( Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: c -\ (c. . t_ Fees with Building Permit: $25.00 Residential, $50.00 Commercial. Fees for jobs without a Building Permit $6.00 per $1000 Minimum fees for jobs without Building Permit $50.00 Residential, $100.00 Commercial File # SM- 2013 -0028 APPLICANT /CONTACT PERSON A PLUS HVAC INC ADDRESS/PHONE 26 AIRPORT DR (413) 562 -0054 PROPERTY LOCATION 107 MOSER ST MAP 38A PARCEL 137 001 ZONE PV THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out I10]L1111IF Fee Paid Typeof Construction: INSTALL HEATING & A/C SYSTEM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 905 3 sets of Plans / Plot Plan THE FO ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN O ATION 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 ' e • om Elm Street Commissio Permit DPW Storm Water Management // 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. 107 MOSER ST SM- 2013 -0028 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON GIS #: 12112 /o�1AMp;ory Map: 38A (*II) Block: 137 i -; -� P SHEETMETAL PERMIT Lot: 001 r. Permit: SHEETMETAL \Tf �tiN ek Category: SHEETMETAL Permit # SM -2013 -0028 PERMISSION IS HEREBY GRANTED TO: Project # JS- 2012 - 001620 Est. Cost: - $12,400.00 Contractor: License: Expires: Fee Charged: $25.00 A PLUS HVAC INC Sheetmetal - 905 11/28/2013 Balance Due: $.00 Owner: KENT PECOY & SONS CONSTRUCTION INC # of Fixtures: Applicant: A PLUS HVAC INC DigSafe # _ AT: 107 MOSER ST UseGroup ConstClass ISSUED ON: 15- Nov -2012 AMENDED ON: EXPIRES ON: TO PERFORM THE FOLLOWING WORK: INSTALL HEATING & A/C SYSTEM THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fixtures: Floor: Type: # of Fixtures Floor: Type: # of Fixtures Fee Type: Receipt No: Date Paid: Check No: Amount: Sheetmetal REC 2013 - 001902 09 Nov - 12 4219 $25.00 212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :Ihasbrouck@northamptonma.gov GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.