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31A-129 (3) 7/28/2015 11:49 AM FROM: Fax AQUADRO INSURANCE TO: 1-913-587-1272 PAGE: 002 OF 002 DATE iMNII0j;YYYY} � r CERTIFICATE OF LIABILITY INSURANCE L 7 f1.S'2 115 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 Palicyliesj must be endorsed. If SUBROGATION IS WAILED,subject to the terms and conditions of the Policy,curtain policies may require an endorsement, A statement can this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c RTA T PRODUCER Chrietine_ Su11ivan y�.hiE'_ _. k raairo & F sc�.iate pHqus {413)586-"x373 ax..rp ra iser fa o 355 Hr:adye ,St. P. U. Box 35'? E•iaA=L AooR�ss INSURFRisi AFFOROINC COVERADE NAIL 5 �*4ortha I tar: MA �INSURERA Ma`r l-- 1 8t, eet kneea Snsurarica 29929 INSURED RUSSELL B ANCHARD �INSURERB 'Travelers *'nsurance Co ....., ., 256i-5 140 ENI RCY SJLLtSSi,tFS NSURERC 27 r At P INSURER G CT Two�N 1 SC?UTTI HADIFY 2�..Y} 01073-].624 INSURER r; COVERAGES CERTIFICATE NUMBER:CL1572806803 REVISION NUMBER: T!-IS T` R i Y THAT THE OF WSt RANCH F I, O`N FAVE BEEN IS J-I)10 THE INSURED NANIF,)ABOVE F{)h THE PCL l r PER 01) "t Y R Ci IR ° E hT F+1 h C aC I 'ICV F A,NY ONI RA 1k OT�-I r. 01') 1`IEP l'l I µ SF CT TO -1,1S t sTi(1 r tAA V 7+L 1SS Fig '}I2 I Ir i F-K AIN HE NVjRAIU0 AFFO E,, n( THE HIERE 1 IS Su EC7 1 TH TF A;!%1 11K pFtNrtIRA N°E A[5f5�3'ITe"�i"-. YEFe RQLiOt LX.P i Lhi✓LI� I�y�Ah) �NDI IJ �u + 1 $ JyR POLICY NU446 @4Y WWELD�'LtYYI iAOAXWYYYYi. i_iNt'S � � ', CO45MER^wiAl GENERAL AR LtTY ', F.1 I f fC'Cti_ I � C r`t�G - LV CTL' 71f - dy X ,h.� .'>`E s:_;t'MS31. °k t, � tF'("iCk• reef � r, 3 10;u0Q NERA L�C AJ F. d-,51 M_� Ian t AUTOMOBILE LIAeiLiTY r._ +EINCD TINGLE.JMI T i C ,dJE:: 5t 11 - ...a t ?,„y�„Q.. ?tG / t C Rota N ,H f F a ,=°nb T �,i t- •0b JTp: X - ��� �N.,e,MECi �, I u a•Nt��>i e UC 0pi„, r,ytE:Ar a.:• :{ AU”— - IJ'n.i:.�3rtr,,`.r L, v I+lht t T 23 03C,1/40;00C, W)MRRE.LLA L1AFJ .1'.:^,.7}{j tets..H J..'N 7i�R4 h:r f EXCESS LAO I V9CRKERS CCMPENSAT€ON 1'VTUTL M- AN361APLOYERS LIABILITY '� ' tMtraa4ar� , h rti F l � "E r MY C :YF.T +T f DESCR1PT10N OF OPERATION$;LOGA710`*7 VEHIGLLS aAt^CRG i0;,AaiaF,jpaiai R--k.Schedule,may h=ahIchev.I more srae.A 1s req'-!Id! I i x CERTIFICATE HOLDER CANCELLATION } (413)587-3272 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF NORTiLkCIPTGN THE EXFIRAFIGN DATE THEREOF, NOTICE WILL HE DELIVERED IN 212 1,iASb7 STREFT ACCOROANCB WITH THE POL'CY PROVISIONS, Ppp NORTHAMPTON SSA 01060 } �AUTHQRIX1aD?YcPRESEM YA rIVr` IkI[ C:1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(20141101", The ACORD nano,and logo are,,registered marks of ACORD iNS02&;i`ifi`s 7"s 3rc ' x F i d r 7 L i ± i E s a j rl v � 3 jai?^,������� � '7';►,l�r✓ i. El _ _ �. � Load Short Form Job: 35 FORBES AVE - - wr'ightSOft' Date: May A 2015 Entire House By: MJH HOME ENERGY SOLUTIONS SOUTH HAMEY.MA • • ect Information For. 35 FORBES AVE, NORTHAMPTION, MA Design Information Htg Cig Infiltration Outside db(°F) 0 92 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 70 17 Fireplaces 0 Daily range - M Inside humidity(%) 30 50 Moisture difference(gr/lb) 28 21 HEATING EQUIPMENT COOLING EQUIPMENT Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 80AFUE Efficiency 0 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 °F Total cooling 0 Btuh Actual air flow 1769 cfm Actual air flow 1769 cfm Air flow factor 0.031 cfm/Btuh Air flow factor 0.042 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.92 ROOM NAME Area Htg load Cig load Htg AVF Clg AVF (ft2) (Stuh) (Btuh) (cfm) (cfm) 2ND FLOOR p 737 26130 32740 817 1365 (Rest of House) p 804 18529 23919 579 997 ATTIC 3TH FLOOR p 520 11927 7803 373 325 Entire House d 2061 56585 42444 1769 1769 Other equip loads 0 0 Equip. @ 0.97 RSM 41170 Latent cooling 3580 TOTALS 2061 56585 44750 9769 1769 Bol MricvalueshavebeennonLe yomMden Calculations approved byACCA to meet all requirements of Manual J 8th Ed. + wrightsoft- ftmsujb,9Lmwe w20151s.0.15Rsuo7086 2015-Jul-2308-.07-67 Page 1 /ICCK .-HaddadMMIE ENERGY SOLUMNS-43 CENTER STrup fatc=AA,B FrontDoorf =N wrightsoft. Load Short Form Job: 35 FORBES AVE ATTIC 3TH FLOOR By: NI A 2015 HOME ENERGY SOLUTIONS SOUTH HADLEY,MA Information Project For 35 FORBES AVE, NORTHAMPTION, MA Design Information Htg Clg Infiltration Outside db(°F) 0 92 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 70 17 Fireplaces 0 Daily range - M Inside humidity(%) 30 50 Moisture difference(gr/lb) 28 21 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref n/a Coil rVa AHRI ref n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 ROOM NAME Area Htg load Clg load Htg AVF CIg AVF M (Btuh) (Btuh) (cfm) (cfm) i ATTIC 520 11927 7803 373 325 ATTIC 3TH FLOOR p 520 11927 7803 373 325 Other equip loads 0 0 Equip. @ 0.97 RSM 7569 Latent cooling 979 TOTALS 520 1 11927 8548 373 1 325 eokftfv vakms have been nwnweyoversdiom Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 201 5-Jul-23 os:m� w�9ht� Right Suite Unive1sa1201515A.15 RS11p7086 Page a /CCK JiaddaMHWE ENERGY SOLUTIONS-43 CENTER STlup Cale-ME Front Dow twes:N . Load Short Form Job: 35FORBESAVE WrlghtSOft Date: May 22,2015 2ND FLOOR By: MJH HOME ENERGY SOLUTIONS SOUTH tiADLEY,6% Project • For 35 FORBES AVE, NORTHAMPTION, MA Design Information Htg CIg Infiltration Outside db(°F) 0 92 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 70 17 Fireplaces 0 Daily range - M Inside humidity(%) 30 50 Moisture difference(gr/lb) 28 21 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref rVa Coil n/a AHRI ref n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flaw 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 ROOM NAME Area Htg load CIg load Htg AVF Clg AVF M (Btuh) (Btuh) (cfm) (cfm) BED FRT RIGHT 143 3982 4525 125 189 BED FRT LEFT 143 3692 3761 115 157 HALL UP 35 1466 2116 46 88 BED LEFT 130 3882 4499 121 188 BATH 35 1178 1264 37 53 BED RIGHT 143 4951 6617 155 276 NEW BATHROOM 108 6978 9958 218 415 2ND FLOOR p 737 26130 32740 817 1365 Other equip loads 0 0 Equip. Q 0.97 RSM 31758 Latent cooling 840 TOTALS 737 26130 32598 817 1 1365 Bokykabc values have been manwPloveakWn Calculations approved byACCA to meet all requirements of Manual J 8th Ed. c wrightsoft" Right,%-&D universal 2o15 15A.15 Rsuo7ose 2015.J,l.2306:07:57 Pie 3 ACCK .h addadWOME ENERGY SOLUitONS-43 CENTER STjup Cale=MJ8 Fronl Door ft ms:N Load Short Form Job: 35 FORBES AVE wrigh#soft Dace: May 22,201S (Rest of House) By: MJH HOME ENERGY SOLUTIONS SOUTH HADLEY,NW Project • f For 35 FORBES AVE, NORTHAMPTION, MA Design Information Htg CIg Infiltration Outside db (°F) 0 92 Method Simplified inside db(°F) 70 75 Construction quality Average Design TD (°F) 70 17 Fireplaces 0 Daily range - M Inside humidity(%) 30 50 Moisture difference(gr/lb) 28 21 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref n/a Coil n/a AHRI ref n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 ROOM NAME Area Htg load CIg load Htg AVF CIg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) KITCHEN 208 3236 2868 101 120 ` PANTRY 42 1510 2107 47 88 DINING 143 3179 4913 99 205 LIVING 156 4635 5281 145 220 HALL 112 1771 1825 55 76 DEN 143 4197 6926 131 289 (Rest of House) p 804 18529 23919 579 997 Other equip loads 0 0 Equip. @ 0.97 RSM 23202 Latent cooling 1761 TOTALS 804 18529 24963 579 997 BokWabc vah=have been mantsoyouenkl0m Calculations approved byACCA to meet all requirements of Manual J 8th Ed. ` wrrght"ft` $w"t)r,.,4m201515A.15RsuD7m 2015-Jul-230807:57 Page 2 ACCK .-HaddadAOME ENERGY SOLUTIONS-43 CENTER STrup Calc=ova FmM Door faces;N FROM :HOME ENERGY SOLUTIONS FAX NO. 4135365477 Jul.28 2015 05:37PM P2 r7. it la'1'�9�3IA��i�SPYi,°�rtov�r4ct�el'L5.:1843 p'. Commonwealth of Ma$SachuseEts Departmafft of Public Safety Oil Burner Technician Certificate License: SUM0325 :A i, �y RUSSELL P R 27 PERSHING E ; SO HADLEY MA 01 -.0. -„?I-IiLl I=XlJ1 C21ttOr7:. Cammisssonr 05/07/2016 n1 r S to / J E ^FI 1{/, b, tom'�yy�� f.�I tai ll�[l)Fil�a'i CVan r' 1n Y. '7 FROM :HOME ENERGY SOLUTIONS FAX NO. : 4135365477 Jul.28 2015 05:37PM P1 The Commonwealth of Massachusetts Department of IndusoialAecidents Office of Investigations I Congress Street,suite 100 k1V Boston,MA 02.114-2017 WWW.MassgovIdia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aipplicant Inform tion Please Print Lei 1 Name(Business/Orgmization/Individual): T41—ss 44*64W r Address' �'.-s 11fJQ ee Ci /State/Zi A Phone#: / Are you an employer?Check the ap ropriate box: Type of project(required); 1.❑ 1 am a employer with 4- ❑ t am a general contractor and 1 employees(full and/or part-lime), have hired the sub-contractors b. New construction 2,19 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees, These sub-contractors have g n Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance_# 9. ❑Building addition required.] 5• We art;a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I l,❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL i2[]Roof repairs insurance required.) t c. 152,§1(4),and we have no 13.�Oth cinployccs. [No vt�orkers' comp. insurance requited.] *Any applicant dwchecks box#t must also fill our the section below showing their workers'compettsat Mpolicy infarmwim. t Hompowneta who submit this affidavit indicating they are doing al l work and then hire outside contractors must subunit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-oontineu s and staw wbether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy ntunbcr, I am an employer dw ispropidfng workers'conrem4idorr fnssimnree for my employees. Bdow is the policy and job siteo infomiadon. insurance Company Name: Policy#or Self-ins. Lic.#: ._ Expiration Date: Job Site Address: City/Staterzip;_ Attach a copy of the workers' compensation polity declaration page(showing the policy number and expiration date). Failure to secure coverage as required u n&r Scction 25A of MGT.,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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains a►rd pe aides of perjury that the info nradon provided above is true and eomee4 Si Ffa& Date: -" Phone#_ Qa kd use only. Do not w i'te in tkis area,to be completed by city or town offlekd. City or Town: Permit/Liceuae# Issuing Authority(circle one): 1. Board of Health 2.Building Departinent 3.CityiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes[K.❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy 9j Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee daps not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application weive this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boXEl,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Prncrracc 7ncnPrtinnc Data Final Tncnarfinn Date f nmmPntc Type of License: By ❑Master Title ❑Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at xarwar macs gavljdN Inspector Signature of Permit Approval 2 8 �+I Commonwealth of Massachusetts 2015 City Of Northampton n9&c"-;�ins.� Nor,haMt'"O KIA 6 eciior �� Sheet Metal Permit a o J Permit# " Estimated Job Cost: $ 024,4 Permit Fee: $ �I / Plans Submitted: YES v NO Plans Reviewed: YES NO Business License Applicant License# Business Information: Property Owner/Job Location Information: Name: /`vS5' / / Name: /'i 1 /.�.0 Ajollel;V5- Street: Street:c ~�/" S Ile City/Town: City/Town: Telephone: f�3 3�'��.s�3' Telephone: /llt7' %20?- 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: HVAC v Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: ca- 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 35 FORBES AVE SM-2016-0007 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON IGIS#: _ 5738 � (Map. 31A Block: -- _ 129 SHEETMETAL PERMIT Lot: 001 „..• Permit SHEETMETAL Category: SHEETMETAL Permit# SM-2016-0007 PERMISSION IS HEREB Y GRANTED TO: (Project# ' JS-20'.16-000018 Est. Cost: $26,000.00 Contractor: License: Expires: Fee Charged:$25.00 HOME ENERGY SOLUTIONS Sheetmetal-209185 06/28/2016 Balance Due:$.00 Owner: HAWKINS CHRISTIAN #of Fixtures Applicant: HOME ENERGY SOLUTIONS IDigSafe# _ AT: 35 FORBES AVE luseGroup_ �ConstClass ISSUED ON: 29-Jul-2015 AMENDED ON. EXPIRES ON: TO PERFORM THE FOLLOWING WORK: DUCTWORK FOR FURNACE/AC THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Sheetmetal REC-2016-000414 29-Jul-15 3771 $25.00 212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @ northamptonma.gov GeoTMS©2015 Des Lauriers Municipal Solutions,Inc.