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24B-031 (4) SM-2023-0023 312 KING ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24B-031-001 CITY OF NORTHAMPTON Permit: Sheet Metal PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # SM-2023-0023 PERMISSIO IS HEREBY GRANTED TO: Project# 316 KING INT RENO 2023 Contractor: License: Est. Cost: 15000 Const.Class: Exp.Date: Use Group: Owner: LLC AKE RENTALS, Lot Size (sq.ft.) Zoning: HB Applicant: STE :N STEBBINS Applicant Address Phone: Insurance: 74 LILLIAN ST (413)544-4488 LUDLOW, MA 01056 ISSUED ON: 08/07/2023 TO PERFORM THE FOLLOWING WORK: HVAC FOR NEW HEATING SYSTEM POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: , Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NOR HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: F if t j2 31, Fees Paid: $105.00 212 Main Street,Phone(413)587-1240,Fax: ( 13)587-1272 Office of the Building Commissio er Commonwealth of Massachusetts AUG - Sheet Metal Permit 7D t% ! A 3 Permit#34/- DEPT.of cuiLniN. tonged. ' bb C�st: $ 15 DO. 00 Permit Fee: $ 105. C(G t*z/4'7 NORTHAMPTON.MA) 50 J Plans Submitted: YES NO ✓ Plans Reviewed: YES NO Business License# Applicant License# l 3 0 7 Business Information: Property Owner/Job Location Information: Name: S-tEt/en 5febb ins Name: Peer Pdoser Street: 7'1 I-i 1 j,av 5 ¢. Street: 3 /6 K,vi S City/Town: L V d 1 o i/ ) CIA City/Town: /IA r *h a/p/0m Telephone: L!(3 —5 L./Lf yy$g Telephone: Photo I.D.required/Copy of Photo I.D. attached: YES V NO Staff Initial 9ir-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 V 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: V HVAC V Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: Remove old eal-1h s y�shni. Rohov44-e c I replace o/'e ,ork, h her,✓ elegy'IC 11 e A I 1 . .,. . , � �.. �r +" .>+" , rM , M "c � +' • ?'� � " ' ^ �n+ ,. .;,,«s#. wYw� �„. �Fv y r h a. .. ' ;.,-_arwY �P°"' �- "���.��" � �*,. ' `• `°� � "`` '�' dx 1 ' ` "el .. S c . , `4,: y f te, - „.. ^f � � _+, „r...„ '- s * y , a r x , a ,- ./ x '" ' . � - :-,0, m . . - , MASSACHUSETTS DRIVER'S0 LICENSE SA • ISS . NUMBER i : zlo9lzo� o • :, S00533102 EXP DOE : �. 01120120.25 01/20/1956 �� �a� CLASS �� REST END - - .. r, 1 . STEBBINS STEVEN WILLIAM 74 LILLIAN ST 14 . LUDLOW, MA 01056-2636 ..I vd4elfq 4141)12ige). EYES HAZ , SEX M , HGT 5'-11" 1 DD 12/10/2019 Rev 02122/2016 01 /2 / 6 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/26/2022 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: BIBERK PHONE 844-472-0967 FAX 203-654-3613 P.O. Box 113247 IA/C.No.EMI: (A/C.No): E-MAIL customerservice@biBERK.com Stamford, CT 06911 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Berkshire Hathaway Direct Insurance Company 10391 INSURED Steven Stebbins INSURER B: INSURER C: 74 Lillian Street INSURERD: Ludlow, MA 01056-2636 INSURERE: 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 LTR TYPE OF INSURANCE A INSD SWVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDDPYYYI/) (MMIDDIYYW), X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE '$ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Eaoccurrence) $ 50,000 A N9BP853478 10/25/2022 10/25/2023 MEDEXP(Anyoneperson) $ 5,000 PERSONAL&ADVINJURY $ Included GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ - WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yyes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability (Errors & Per Occurrence/ Omissions): Claims-Made Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached i1 more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Steven Stebbins ACCORDANCE WITH THE POLICY PROVISIONS. 74 Lillian Street Ludlow, MA 01056-2636 AUTHORIZED REPRESENTATIVE • 71 ©1 88-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered mar s of ACORD Project SummaryJob: Date: Aug 03,2023 44 °'air Entire House By: For: Clean Air Mechanical 316 King St, North Hampton Notes: Baystate Winair Company assumes no liability for the sizing of installed equipment as we are not an Engineering Company and have not been on the job site.We are only using information supplied to us. 44 r rn nf ion.R .!es• oat Weather: Springfield,WestoverAFB(Worchester Dd), MA,US Winter Design Conditions Smmer Design Conditions Outside db 0 °F Outside db 87 °F Inside db 70 °F Inside db 70 °F Design TD 70 °F Design TD 17 °F Daily range M Relative humidity 50 % Moisture difference 34 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 63519 Btuh Structure 22565 Btuh Ducts 18997 Btuh Ducts 13605 Btuh Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh (none) (none) Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 82516 Btuh Use manufacturer's data n Rate/swing multiplier 0.92 Infiltration Equipment sensible load 33276 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Loose Fireplaces 0 Structure 4692 Btuh Ducts 1791 Btuh Central vent(9 cfm) 0 Btuh Heating Cooling (none) Area(ft2) 2275 2275 Equipment latent load 6484 Btuh Volume(ft3) 20475 20475 Air changes/hour 0.66 0.34 Equipment Total Load (Sen+Lat) 39760 Btuh Equiv.AVF(dm) 225 116 Req.total capacity at 0.70 SHR 4.0 ton Heating Equipment Summary Cooling Equipment Summary 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 1935 Jrn Actual air flow) 1935 cfm Air flow factor 0.023 cfm/Btuh Air flow factor 0.053 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.85 Calculations approved byACCAto meet all requirements of Manual J 8th Ed. wrigFltsoft� 2023-Aug-0311:55:57 - ,�-,,.,.,,,,.,,... ...„,, Right-Suite®Uroversal2022 22.0.05 RSU11776 Page 1 ACCl ...ricanStandard\Loads\2023\Clean Air KingStrip Calc=MJ8 Front Door faces N •" 1 Ile I..Uminunn' uttn UJ IYluJJuG,LuJC113 Department of Industrial Accidents 9 k Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 '" www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): / c-Ve ri J,(, 1 1.1 5 Address: 7'f 1 /hay, 3k City/State/Zip: (ut£leiA) inq 0 (O-34) Phone#: 4 1 ; 1"9-1f4 y(l . Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.M I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' p �' $ 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.❑ 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.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.12 Other hec.-4- comp. insurance required.] *My 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 ant 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 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 and penalties of perjury that the information provided above is true and correct. Signature: AL, 04-444,--- Date: gf Y f?"3 Phone#: 'ill- sm-g q I S Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 1❑Board of Health 2❑Building.Department 3❑City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s) name(s), address(es)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, 2 Avenue de Lafayette Boston, MA 02111-1750 Tel. (617)727-4900 or 1-877-MASSAFE Revised 7-2019 Fax (617) 727-7749 www.mass.govidia