Loading...
HomeMy WebLinkAboutBLDSM-19-000758 RECEIVED %E South Shore AUG 23 2018 4 u\ R Energy Raters : se ;1 BUILDING DEPARTMENT \,\ */ Duct Leakage Test Form Svaa I far-MA Code Compliance .ra WV Client Information Building Information Name: Ronald A Defigueiredo Address: 4 Pondview Avenue Address: 4 Pondview Avenue City/State/Zip West Yarmouth,MA 02673 City/State/Zip West Yarmouth,MA 02673 Test Date: 8/17/2018 Phone: 508-367-7718 Test Time: 9:00 am Email: avelinocarpentry@gmall.com Point of Construction: FINAL System# 1 System# 1 Location: ATTIC Location: Type of Test: TOTAL Type of Test LTO Approx.Floor Area Served: 1,457 Approx.Floor Area Served: 0 CFM Leakage at 25pa: 58 CFM Leakage at 25pa: 0 %Leakage for single system•: 3.90 %Leakage for single system': #DIV/01 Supplys 14 Returns 6 System it 2 System fi 2 Location: Location: Type of Test: TOTAL Type of Test LTO Approx.Floor Area Served: 0 Approx.Floor Area Served: 0 CFM Leakage at 25pa: 0 CFM Leakage at 25pa: 0 %Leakage for single system': #DIV/0l %Leakage for single system': #DIV/01 44 System# Combined Results Location: Total Conditioned Floor Area: 1457.00 Type of Test 0 total 0 to Outside Leakage limit%: 0.04 Approx.Floor Area Served: Leakage limit cfm@25: 58.28 CFM Leakage at 25pa: Combined Leakage cfm@25: 58 %Leakage for single system•: 2009 IECC Compliance: PASS 2015 IECC Compliance: PASS •Approximations for single systems are for diagnostic use only. ••Total combined duct Leakage is required for 2009/2015 IECC Compliance. I certify that this test was performed� Incompliance with applicable standards: A ,1_ Shtill Friday,August 17,2018 Tester's Signaturer f/ UU Date HERS Rater Name: Jay D Smith RIN:705583 ERM-015 HERS Rater Company: South Shore Energy Raters PO Box 204 Hanover,MA 02339 781-771-9119 HERS Rater Provider: Energy Raters of Massachusetts 2 Woodlawn St.Amesbury,MA 01913 978-270-3911 • ,,a, • Al '(3..-.. 7 AUG 0'7 2019 ,. /41,----F r� SHEET METAL PERMIT i ElfI t� f3UILU1Nii GEF �1 t;Ra.._�dT , i i Commonwealth of Massachusetts ey �_ -- — \ \'" ;; : `� Town of Yarmouth Building Department Date: og/0S/26 J$ Permit It ,Z3125 SH' /9-DM 17.Cr Estimated Job Cost:$ a p, Permit Fee: $ .570-its Plans Submitted: YEA NO Plans Reviewed: YES/ NO Business License tt 74'91/ Application License P 71i 5 y Business Information Property Owner/Job Location Information Name: cJ p) (w,9(•• rcAaht• _. Name: 'rzntent at� A. F•lqueredo Street: 5? Ix, e_9 R ci Street:y condo pu) ouv City/Town: cromtyqw ham MO City/Town: weM,�- Yarrrioftir MA , Telephone: •SCg +'o 3232 4 Telep/h/one: SGS,_ 367 77/g Photo I.D. required/Copy of Photo I.D. attached: YE'S/ 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 A stories or less� • Residential: 1-2 family I/ Multl-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft.Vover 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 ork to be done: %y 44L A cen-Irnr 4h1 ondtltnn ►• q 'tnMe a17{ e• , vets /IL ill-C-- Am hgv1dLer- ttlicttoc-Ithrk a d Pie X l b le ctcte--F W I .3 ©n e do ri/'e I. is.if:t w . net1 For: M4-% e r bedreowt and 045 ey bq-th nrn 2-011e# a dor' Kcctipn L , rornA. an t/ rc n' zpn2 3 For -TG, lee "bionedrMsaMg . • INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes_ V No If you have checked yam, 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only f// 1 - A///t Owner_ Agent_ Signature o "ner or Owner 'gent By checking here ere sy 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 installation 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. Inspections shall be called for prior to insulation installation. Duct inspection required prior to insulation installation:Yes V No Date: Comments: Date: Comments: • Type of license: yf /J � Title: _ Master � at7/ /��. . Title: Master-Restricted TSignatur: . Licensee • City/Town: Journeyperson t Permit#: Journeyperson-Restricted License Number Fee: $ Check at www.mass.gov/dpi 0. — > T Inspector Signature of Permit 1` of Permit Approval • 0 --ow 516 r--- 8 32 .8 § ; ..._-......._ Lc) 21,1> 3....mas t.. • 8— (4 ... • . -, ." • ,.. • . . -"- .. is C‘.1 i' E„,. ,.. c a -, . ... 0, t_ T.:"5 g 87 gi c) gtres Pm :g: -.. .-' ' - .- , ” -,? - ' - .• - , .•,;, . , . . • • n34 \ The Commonwealth ofMassachusetts t --=•:•&tDepartmentofIndustrialAccidents ? Office of Investigations •= = �, 600 Washington Street ,r ��, Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A t t!leant Information Please Print Name(Business/Organizat%n/Individual)Vic/ • Ay ` ibl Address: te 9 /1/1<7 r JCs / C e `.% ti a% City/State/Zi,:j4,7_ „� A✓ /-j IIIIIIIIIIIr Are you an employer?Chec. ----- Phone#; O 'e appropriate box: 1.0 I am a employer with_ 4. 0 I am a general contractor and I Type of project(required): employees(full and/or part-time),* have hired the sub-contractors 6. 0 New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet ship and have no employees These sub-contractors have 8. 0 Demodeong working for me in any capacity, employees and have workers' $' ❑ Demolition [No workers'comp. insurance comp.insurance.: 9. ❑ Building addition required.] 5. u-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 insurance required.] t c. 152, §I(4),and we have no 12 ❑ Roof repairs employees.[No workers' 13.0 Other comp. insurance re ed.] *Any applicant that checks box XI must also fill out the section below showing their workers'rcompensation policy inrornation. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mug 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. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: Or A Policy if or Self-ins.Lic.#: 4 95/ Expiration Date: Job Site Address: 2A d ole w � C Attach a copy of the workers'compensation policy declaration page(showinthe/Stat e pto�y 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 car if under the pi penalties ojperJury that the information provided above is fru •nd correct Si; ature: kri ., • Date it r al hone#. .9 g 1!0 + 2' Official use only. Do not write in this area,to be completed by city or town oJrciaL 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#•