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Home My WebLink AboutBuilding Permit #194-2017 - 44 COMPASS POINT ROAD 8/24/2016 1 - ✓ OF r10RTf{ q BUILDING PERMIT �tLEo;e ti TOWN OF NORTH ANDOVER 3r h r,.. ,_ .•*6 0 APPLICATION FOR PLAN EXAMINATION I a Permit No#: J Date Received °RwTED 1 SSACHUS�C Date Issued: I l ORTANT:Applicant must complete all items on this page 1 LOCATION Y6 I Print PROPERTY OWNER Cf-(_1 1 Lv Print 100 Year Structure yes n MAP \C)�o_PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑Addition '1 Two or more family ❑ Industrial ❑Alteration No. of units: 4 ❑ Commercial ❑ Repair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑1Nell' ❑ Floodplaina p Wetlands q Watersheak®istnct� -- ' DESCRIPTI N OF W RK TO BE PERFORMED: r Identifica ' n- Please Type or Print Clearly OWNER: Name: Phone: I S 1 3 S(o Address: h O f ev) •S (-LJ Ma . Q `7 ContractorName: �-� �'�1C Phone: 506 S.-)O Ct33 Email: Ak �Jui1 , C4 e (ApL Co Address: Qh a15.60 Supervisor's Construction License: l� b5 _Exp. Date: Home Improvement License: V43 196 Exp. Date: ARCHITECT/ENGINEER V '1�uD Phone: ��B 33-7 SaSO Address: � � Y��l. "(-n Reg. No. _2- 131 FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. ,, Total Project Cost: $� ' � �� FEE: $ 3 1 Q -�'(,,o ' 3 3 Check No.: 7111L Receipt No.:<5678 2-1 NOTE: Persons contracting 'h un gistered contractors do not have acces to the anty fund m. - 3 Or`, Location ��'��' IS No. 1 1�1 t i ! i Date 's 3° • TOWN OF NORTH ANDOVER � 6 Certificate of Occupancy $ Building/Frame Permit Fee $ 4, �= Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# f r� Buildi4lns5ector r J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ [Public YPE OF SEWERAGE DISPOSAL Sewer Tanning/Mas sage/Sody Art ❑ S`�+"nuni g Pools ❑ ell ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ivate(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING Q& DEVELOPMENT Reviewed On Signature_ rr�P COMMENTS tug - i CONSERVATION Reviewed on— 1 A6 Signature COMMENTS - ( / 1 ' \ HEALTH Reviewed on__ Si nature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comment Wafter& Sewer Connection/Si nature Date Drivewav Permit DPW Town Engineer: Signatureol04 S lZ�(ll� FIREDEP Located 384 Osgood Street ARTMENT um s _ ~Tem D r to �+ u�x,` 1 .. .� p�t ex,y � no � .� Lo ated of 124�MaimStr�eet o #i,, 4 ✓L rt�'tt• a a fx tic �fi`•. , �.'�,`"y --�- � c` x �. artme gnature _ ¢ FiretD'e_p t --nt si X. • cam, r 1 /y, �'�, z ;t n L ` `.T'.„ . , .. �+�� . . .'« L f � tr�;pti- �.a� ;.e}. ♦�:ey,.'jF,`• �Ne t•fX tzfi ,��.�':t.�r ''Ti ,*. _--r +,�,-T�'�. COMMENTS-;' 1 - Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensio ns. � Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No i DANCER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine �® NOTES and DATA— (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 - - r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits 4 Building Permit Application 4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses ' Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan &. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family.) 4 Building Permit Application 4 Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doe:Building Permit Revised 2014 I Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 271 ,875.00 m $ - $ 3,262.50 Plumbing Fee $ 407.81 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 407.81 Total fees collected $ 4,178.13 44 Compass Point 194-2017 on 8/24/16 single family condo II X10 R Tlh q Town of t 6 ndover 0 . . - No. I 2� T Z y o�h ver, Mass, rAl A COCNICKl WICK It. A I S U BOARD OF HEALTH Food/Kitchen PERM Septic System T.x. BUILDING INSPECTOR THIS CERTIFIES THAT .................... . ..P .. . ........ ....................... ....s... ................ ... . has permission to erect .......................... buildings on ....... ... .. ........ ... ...... 1 .... .. Foundation 11 a Rough to be occupied as .......3..... ....�X.... ... ....... .... . . ..........`!L...... ...... � Chimney provided that the person accepting this permit shall in every espect conform to the t s of th pplication Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTH ELECTRICAL INSPECTOR UNLESS CON 10 TS Rough Service .. .... ... .... ...... ..... Final BUILDING PE OR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. BLDG"E" EXISTING FOUNDATION BLDG"F" EXISTING FOUNDATION 4 BLDG"D" o EXISTING ry�o EXISTING FDN OUNDATION 4 BLDG"G" BLDG"H" . 3 Q h ti \� Q X60 2?0. EXISTING CO P� FOUNDATION � °o .0- 7 BLDG"I" °o SS / o s A 1a EXISTING ' O FOUNDATION BLDG"J" 0 -o- CERTIFIED PLOT PLAN NO OTHER USE INTENDED BOUNDARY LINES AND EASEMENTS SHOWN ARE BASED ON THE APPROVED, RECORDED PLANS FOR THIS PROJECT. THE FOUNDATION AS SHOWN DOES NOT VIOLATE ANY ZONING REQUIREMENTS REGARDING STRUCTURE TO PROPERTY LINE UWNER/APPLICANTi OFFSETS, ONE HUNDRED FOURTEEN THIS PLAN IS NOT TO BE USED TO ERECT FENCES, OTHER ANCILLARY TRUST STRUCTURES, OR FOR LANDSCAPING LIMITS, 51 MOUNT JOY DRIVE TEWKSBURY, MA 01876 THIS CERTIFICATION IS NON-TRANSFERRABLE,- AND IS. FURTHER MADE WITH. THE PROVISION THAT THE INFORMATION SHOWN HAS BEEN ACCURATELY FURNISHED BY ASSESS,MAP&LOT ft THE OWNER TO THIS FIRM. 1 O6D-63 FOUNDATI❑N AS-BUILT BUILDING " J" PATRICK C. GARNER, PLS MERRIMAC CONDOMINIUMS r�o R❑UTE 114, NORTH AND❑VER, MASS, ; f PROJECT NO: NAND13 SCALE: 1'=40' I�Y DRAWN BY: PCG DATE: 10/24/15 9 No 32661 o ' CHECKED BY: SC SHT: 1 SS��NAL LAti��y� REVISED: syr, OF: 1 GIleanr»>aarraenl/�nfC'/�?rau�rcrrtcl _ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR a Registration: 143758 Type: Expiration:- 712812018 DBA BARLOW BUILDING4 TIM BARLOW 13 DEPOT ST S.GRAFTON,MA 01560 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-059359 Construction Supervisor x TIMOTHY MICHAEL BAR OW A r' P.O.BOX#12 SOUTH GRAFTON MA 01500 Expiration: Commissioner 01/2412018 CREScheck Software Version 4.6.2 �J( Compliance Certificate Project 160714Trust_MerrimackCondos_BIdgj_UnitsB-B-B-B_NAndover Energy Code: 2012 IECC Location: North Andover, Massachusetts Construction Type: Multi-family Project Type: New Construction Conditioned Floor Area: 2,326 ft2 Glazing Area 12% Climate Zone: 5 (6322 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: Bldg J, Unit J1 North Andover, MA Compliance: 0.0%Better Than Code Maximum UA: 327 Your UA: 327 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Envelope Assemblies Gross Area Cavity Cont. Perimeter Floor 1st Floor:All-Wood Joist/Truss:Over Unconditioned Space 416 30.0 0.0 0.033 14 Wall 1st Separation: Wood Frame, 16" o.c. 96 15.0 0.0 0.077 7 Wall 1st Ext 2x6:Wood Frame, 16" o.c. 812 21.0 0.0 0.057 40 Window DH:Vinyl Frame:Double Pane with Low-E 32 0.290 9 Door Front Ground Flr entry: Glass 20 0.260 5 Door Back: Glass 34 0.290 10 Door Metal: Solid 18 0.160 3 Floor 2nd Over garage/entry: All-Wood Joist/Truss:Over Unconditioned Space 481 30.0 0.0 0.033 16 Floor 2nd Over entry:All-Wood Joist/Truss:Over Outside Air 39 30.0 0.0 0.033 1 Wall 2nd Floor 2x6: Wood Frame, 16"D.C. 855 21.0 0.0 0.057 39 Window DH:Vinyl Frame:Double Pane with Low-E 100 0.290 29 Window Fix:Vinyl Frame:Double Pane with Low-E 19 0.280 5 Window CSMT:Vinyl Frame:Double Pane with Low-E 12 0.260 3 Door Slider: Glass 34 0.290 10 Wall 2nd Fir Separation: Wood Frame, 16" D.C. 279 15.0 0.0 0.077 21 Ceiling Bay Win: Flat Ceiling or Scissor Truss 6 30.0 0.0 0.035 0 Wall 3rd Floor: Wood Frame, 16"o.c. 749 21.0 0.0 0.057 36 Window DH:Vinyl Frame:Double Pane with Low-E 86 0.290 25 Project Title: 160714_Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndover Report date: 08/10/16 Data filename: Page 1 of 9 \\suttonnas.corp.koopmanlumber.com\Sales\Ebbeling_Ed\160714 Trust MerrimackCondos Bldgj_UnitsB- B-B-B_NAndover\REScheck\160714 Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndoverjl.rck Gross Area Assembly or Cavity Cont. LI-Factor LIA Window Awn:Vinyl Frame:Double Pane with Low-E 7 0.270 2 DoorFrench: Glass 18 0.260 5 Wall 3rd Separation: Wood Frame, 16" o.c. 243 15.0 0.0 0.077 19 Ceiling Main: Flat Ceiling or Scissor Truss 936 38.0 0.0 0.030 28 Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application.The proposed building has been designed to meet the 2012 IECC requirements in REScheck Version 4.6.2 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Notes: Building J, Unit J1 Project Title: 160714_Trust_MerrimackCondos_BldgJ_UnitsB-B-B-B_NAndover Report date: 08/10/16 Data filename: Page 2 of 9 \\suttonnas.corp.koopmanlumber.com\Sales\Ebbeling_Ed\160714_Trust MerrimackCondos BldgJ_UnitsB- B-B-B_NAndover\REScheck\160714_Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndoverjl.rck REScheck Software Version 4.6.2 Inspection Checklist Energy Code: 2012 IECC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement,the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. S 466 Puns Verified rF�eld V:elrified:` # Pre.Ir►specrkfpn/Plan._Review Compties2 Comments/Assumptio>is Vatue 1/atde 103.1, :Construction drawings and Y ❑Complies 103.2 ;documentation demonstrate ) ❑Does Not [PRI]i energy code compliance for the i building envelope. ❑Not Observable i x h x ❑Not Applicable 103.1, ;Construction drawings and k j❑Complies 103.2, documentation demonstrate i ❑Does Not 403.7 ;energy code compliance for [PR3]1 :lighting and mechanical systems i❑Not Observable 'Systems serving multiple a ❑Not Applicable !dwelling units must demonstrate i ;compliance with the IECC `:Commercial Provisions. g 3€7 :1 iHeating and cooling equipment is; Heating:µ Heating: ❑Complies sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not IPR2]. on loads calculated per ACCA ` Cooling: 3 Manual]or other methods Cooling: g: ❑Not Observable a approved by the code official Btu/hr Btu/hr ❑Not Applicable Additional Comments/Assumptions: 1 JHigh Impact(Tier 1) 2:,Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 160714_Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndover Report date: 08/10/16 Data filename: Page 3 of 9 \\suttonnas.corp.koopmanlumber.com\Sales\Ebbeling_Ed\160714_Trust MerrimackCondos Bldgj_UnitsB- B-B-B_NAndover\REScheck\160714 Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndoverjl.rck Section 1'Ountlatott fnspectian tonpt�e5? '' Co'menCs/Assumptions . Vii'Req`iD, 303a 1„ A protective covering is installed to ❑Complies (EOIl] protect exposed exterior insulation j❑Does Not ;and extends a minimum of 6 in. below ' grade. ,❑Not Observable =❑Not Applicable 403:8 ;Snow-and ice-melting system controls'❑Complies F,O12]2 1.installed. ;❑Does Not ;❑Not Observable ❑Not Applicable Additional Comments/Assumptions: F71 —High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) I Project Title: 160714_Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndover Report date: 08/10/16 Data filename: Page 4 of 9 \\suttonnas.corp.koopmanlumber.com\Sales\Ebbeling_Ed\160714_Trust MerrimackCondos Bldgj_UnitsB- B-B-B_NAndover\REScheck\160714_Trust_MerrimackCondos_BIdgj_UnitsB-B-B-B_NAndoverj 1.rck 5ettion Plans Ver+rtied Fetd Verif#ed f"ramr+g/Rouiff-tn tnspecittonoita �es' Carnmeraits/Assumptions &;Req.tD 1/atue Vatue 402.1.1, :Door U factor U ; U- ❑Complies See the Envelope Assemblies 402.3.4 ❑Does Not table for values. [FR1]1 ;❑Not Observable :❑Not Applicable _ 402.1.1, ;Glazing U-factor(area-weighted U- U ❑Complies ;See the Envelope Assemblies 402.3.1, average). ❑Does Not ;table for values. 402.3.3, 402.3.6, 0Not Observable 402.5 ! ;❑Not Applicable [FR2]1 303.1.3 !U-factors of fenestration products . y❑Complies [FR4]1 ;are determined in accordance y "i❑Does Not with the NFRC test procedure or y :taken from the default table. []Not Observable ❑Not Applicable 402.4.1.1 ;Air barrier and thermal barrier :,�v ❑CoV. mplies [FR23]1 installed per manufacturer's ( ❑Does Not instructions. t ❑Not Observable t ❑Not Applicable 402.4.3 iFenestration that is not site built , ]❑Complies [FR20]1 'is listed and labeled as meeting '❑Does Not j AAMA/WDMA/CSA 101/I.S.2/A440 4, ❑Not Observable for has infiltration rates per NFRC 400 that do not exceed code t 40Not Applicable limits. ::: 402:4 4 IC rated recessed lighting fixtures ❑Complies {FR16]�, asealed at housing/interior finish ' ❑Does Not ;and labeled to indicate <_2.0 cfm ?leakage at 75 Pa. ❑Not Observable a FlNot Applicable 403.2.1 .Supply ducts in attics are ; R- R- ,❑Complies [FR12]1 insulated to >_R-8.All other ducts R- R- ❑Does Not in unconditioned spaces or pNot Observable outside the building envelope are insulated to 2:11-6. ❑Not Applicable 403.2.2 ;All joints and seams of air ducts, j❑Complies [FR13]1 air handlers,and filter boxes are �❑Does Not j sealed. ❑Not Observable ; ❑Not Applicable 403;2 3 Building cavities are not used as t 10Complies [FR15]3 ducts or plenums. 3❑Does Not { " 4C]Not Observable ,. ❑Not Applicable 403':3 HVAC piping conveying fluids R- i R- ',❑Complies ' {F#tI7]z ,.above 105 4F or chilled fluids ❑Does Not below 55 4F are insulated to zR- ,:,, 3 ❑Not Observable ; '❑Not Applicable 403.3.1 :Protection of insulation on HVAC ❑Complies [FR24]1 piping. x E-]Does Not ❑Not Observable ❑Not Applicable 4..": Hot water pipes are insulated to ; R- R- ❑Complies [FR8]� >_R-3. ;❑Does Not i ❑Not Observable ❑Not Applicable I 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 160714-Trust MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndover Report date: 08/10/16 Data filename: Page 5 of 9 \\suttonnas.corp.koopmanlumber.com\Sales\Ebbeling_Ed\160714 Trust MerrimackCondos Bldgj_UnitsB- B-B-B_NAndover\REScheck\160714 Trust MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndoverjl.rck ' 5ection ' Plans Verr#ied "Fr`eld'1[�trfied; . . # ra;rtring/,Rough ltt lrispection �ames,? �imm�trts{Assumptions 6i)teq.lb ;Value Ualue 4035 ;Automatic or gravity dampers are j 1❑Complies ji Ft9 installed on all outdoor air ❑Does Not k intakes and exhausts. M � i ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 I High Impact(Tier 1) 2 Medium Impact(Tier 2) 13J Low Impact(Tier 3) Project Title: 160714_Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndover Report date: 08/10/16 Data filename: Page 6 of 9 \\suttonnas.corp.koopmanIumber.com\Sales\Ebbeling_Ed\160714 Trust MerrimackCondos_Bldgj_UnitsB- B-B-B_NAndover\REScheck\160714_Trust MerrimackCondos_BIdgj_UnitsB-B-B-B_NAndoverjl.rck Section pians Verified 6ieid Vnr�/wed # in5ulation7nspection Comisiies?' ComrnentslAssumptions Value ' Vaiue•. 303:1 ,All installed insulation is labeled w ?]Complies [11413]2 or the installed R-values ElDut=b Not i provided. •.,DNot Observable kONot Applicable 402.1.1, Floor insulation R-value. R- R- ;]Complies See the Envelope Assemblies 402.2.6Wood ❑ Wood UDoes Not ;table for values. [IN1]1 Steel ❑ Steel i]Not Observable I ']Not Applicable 303.2, Floor insulation installed per DComplies 402.2.7 manufacturer's instructions,and t ..,:[]Does Not [IN2]1 in substantial contact with the underside of the subfloor. ONot Observable y -DNot Applicable 402.1.1, ;Wall insulation R value. If this is a i R-' R- ;]Complies ;See the Envelope Assemblies 402.2.5, 'mass wall with at least 1/2 of the El Wood ;❑ Wood ;]Does Not ;table for values. 402.2.6 wall insulation on the wall E] Mass ❑ Mass ]Not Observable [IN3]1 ;exterior,the exterior insulation requirement applies(171110). i❑ Steel F-1 Steel jONot Applicable j i f 1 1 f 303.2 !Wall insulation is installed per „'< ,]Complies [IN4]1 manufacturer's instructions. „]Does Not ' 1-]Not Observable i x.. " DNot Applicable Additional Comments/Assumptions: 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 160714_Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndover Report date: 08/10/16 Data filename: Page 7 of 9 \\suttonnas.corp.koopmanlumber.com\Sales\Ebbeling_Ed\160714 Trust MerrimackCondos BldgJ_UnitsB- B-B-B_NAndover\REScheck\160714_Trust_MerrimackCondos_BIdgJ_UnitsB-B-B-B NAndoverj1.rck Section `' `] Pians verified" •Plielcl Verif�ecii # Finai i[�rspectlon Provisions;; ,: Cornpiie5? CommentslAssumptions 402.1.1, Ceiling insulation R-value. R- R- ;❑Complies ;See the Envelope Assemblies 402.2.1, ❑ Wood ❑ Wood ;❑Does Not table for values. 402.2.2, ❑ Steel ❑ Steel ❑Not Observable 402.2.6 [FI1]1 ❑Not Applicable 303.1.1.1, ;Ceiling insulation installed per "` ad❑Complies 303.2 manufacturer's instructions. >F❑Does Not [FI2]1 Blown insulation marked every 300 ft2. Not Observable ; t ❑Not Applicable b 4Q2 3 Vented attics with air permeable ] ❑Complies [Fi22]z insulation include baffle adjacent a. ❑Does Not to soffit and eave vents that �? ',extends over insulation. I❑Not Observable ❑Not Applicable 402.2.4 ;Attic access hatch and door R- R- ❑Complies [FI3]1 insulation zR-value of the ❑Does Not 'adjacent assembly. ❑Not Observable ❑Not Applicable j 402.4.1.2 Blower door test @ 50 Pa. <=5 i ACH 50 = ACH 50 = :❑Complies [F117]1 Fach in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8. ❑Not Observable ❑Not Applicable 403.2.2 Duct tightness test result of<=4 ' cfm/100 cfm/100 (]Complies [F14]1 cfm/100 ft2 across the system or `. ft2 ft2 ❑Does Not to <=3 cfm/100 ft2 without air ❑Not Observable handler @ 25 Pa. For rough-in 'tests,verification may need to ❑Not Applicable ,occur during Framing Inspection. 403.2.2.1 ;Air handler leakage designated f." = ❑Complies [FI24]1 by manufacturer at<=2%of r El Does Not ,design air flow. ] s f []Not Observable 1]Not Applicable 463.1.fProgrammable thermostats 3❑Complies [Fig j3 +installed on forced air furnaces. ( aEJ Does Not d a gE]Not Observable F ❑Not Applicable 403:4. 2 Heat pump thermostat installed a❑Complies +on heat pumps. ❑Does Not i ❑Not Observable ❑Not Applicable 4084A. :Circulating service hot wate, --T❑Complies [Fi1 ] ,systems have automatic or s❑Does Not accessible manual controls. [ ❑Not Observable []Not Applicable 4035 ] All mechanical ventilation system( ❑Complies [fl2j� fans not part of tested and listed [ :❑Does Not HVAC equipment meet efficacy ;and air flow limits. ❑Not Observable ,.w 0Not Applicable 404.1 i75%of lamps in permanent ❑Complies [F16]1 ;fixtures or 75%of permanent �❑Does Not fixtures have high efficacy lamps ❑Not Observable Does not apply to low-voltage [ lighting. s r ❑Not Applicable 1 High Impact(Tier 1) 2" Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 160714_Trust_MerrimackCondos_BIdgj_Units B-B-B-B_NAnclover Report date: 08/10/16 Data filename: Page 8 of 9 \\suttonnas.corp.koopmanlumber.com\Sales\Ebbeling_Ed\160714 Trust MerrimackCondos Bldgj_UnitsB- B-B-B_NAndover\REScheck\160714 Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndoverjl.rck I Kanayo Lata, P.E. .............03103/2014 PROJECT: Merrimack Condominiums J-TYPE BB-Compass Point,N Andover,iv1A DESIGN FOR-GIRDERS/JOISTS/RAFTERS Third Floor Beam T1 Supporting Floor,Wall,Attic&Point Load From T5 LOADS: DEAD LOAD 22.54 PSF 323.00 PLF Ce= 1 CF= 1.00 SNOW LOAD PSF 0.00 PLF Cq= 1 Cs= LIVE LOAD 30.00 PSF 425.90 PLF qs= 29.10 Cd= 1 TOTALLOAD 753 PLF I= 1 Cm=1 WIND SPEED 100 MPH 29.10 PSF POINT LOAD 3510 LBS 3.25 FT Ra= 2925 LBS 7341 LB=TOTAL REACTION TRIBUTARY WIDTH 14.33 LF E= 2000000 PSI JOIST/GIRDER SPAN 19.5 LF Fb= 2900 PSI WIDTH- IN 10.50 PSULVL 11.875 IN = d Fv= 285 PSI ROOF PITCH- N:12 Fc= 2700 PSI Fcp= 750 PSI MOMENT= 35786 LB-FT MOMENT2= 9506 LB-FT 246.78 =S provided OK S= 187.42 IN^3 1465.24 =I Deflection= 0.836 1N =LI 240 For Total Load Required L1240 Deflection2= 0.139 IN =L/ 421 For Lime Load Required 0360 Fcp'= 652 PSI OK 1.50 In Bearing Length Fv'= 123 PSI OK USE BETTER HEADER#65 (FLITCH BEAM) 2-LVLs 117/8"WITH 1/2"STEEL PLATEt1 of BOLTED WITH 5/8"DIA@12"O.C. IN TWO ROWS. ,Qt?`�' KANAYO N. LALA VA No.33710-' br stE'� � 1 . Kanayo Lala, P.E. .............03/03/2014 T+13.11Lvl. +r+clluua+.nvVjluVliiuuu+ua MA D-- FCir,ki Pi ui 1 ti I iRA hKC Third Flnnr Roam T9 Supporting Floor,Walt&Attic LOADS: DEAD LOAD 22.54 PSF 322.95 PLF Ce= 1 CF= 1.00 LIME ICAD 30.00 PSF 429.90 PLF qs= 28.10 Cd= 1 V10111.D SPEED 100 h1PH 29.1^0 PSF v F011-14) LVh1U LIDO r 1 Ra= p I RS 8211 1_R=TOTAI, REACTION I KIIWU I AKY VVIU I I-I 14.J3 LF t= 1UU000U PSI J0IQT//'_`I0n CD QDAAI 4a C 1 C Ch- )onn Dci WIDTH- IN 7.00 PSL/LVL 11.876 IN = d Fv= 285 PSI r.Sl Fcp= 750 PSI YIVIVILI•l� LVVLV -I N-70,^40*4T2= 0 LB-FT 164.52 =S provided OK J= IUO.UL 1114••0 aio.oi -1 n rAl IN =1 f 111R Fnr Tnfal I nail Panuirad I 19Q#) Deflection2= 0.000 IN =Ll 54U For Live Load Required L suu Fv'= 112 PSI OK i. � NSA No.337104C Kanayo Lala, P.E. .............03/03/2014 �Rl/JLI.I. Ivlerrmlaan wnuvuuuiwua DE 1-iOne Ream T9 Supporting Floor &Point Load From T1&T2 LOADS: DEAD LOAD 20.00 PSF 360.00 PLF Ce= 1 CF= 1.00 LIVE LOAD 30.00 PSF 540.40 PLF qs= 29.10 Cd= 1 1 V InL LVnLJ JVV 1'Lt 1� 1 V111= � W!N' SPEED 10c 29.A.l PSF R011V 1 LUAU 10411 Lbo 5.23 r,I R8= 13o-7 LBS 7G.-)u Lia-T,07,%,-.1EfiCT+CN TRIBUTARY WIDTH 18.00 LF E= 2000000 PSI J0lc'T1r•iQi-4:rw QadN 17 I F Ph= oann Dci WIDTH- IN 14.00 PSL/LVL 11.875 IN = d Fv= 285 PSI T'a/�I'ar rIITl�I I AI v _ r' ?Sl Fcp= 750 PSI IVIVIVICIV I— 0/-0 1.3 LD-r'I -Z-FT „p•Ivvlaicli 0 S= 313.!6 IN"3 1953.65 =I M-flantinn= n AT1N =11 757 Fnr7ntal 1 nwi Rprsllin-/iii aQ Deflection2= 0.378 IN =U 419 For Live Load Required L/360 Ann not nl/ 9 nn 1.., p....r:.....i w..w.tM Fv'= 189 PSI OK ur5oc or_I I Crc r ICrlucrtrroY fru 11„n oCruvlj rLcp�V La i I 110 vv1 1 1-1 cv/u a I ELL-rLr%i E AVL I CIJ VY1 1 f'1:Jlv ul.-a I .A. v.v.ll. .•.v.Av. S. TTRT T _ 111/[)IIT IT TT AaTTA �/I 1� SIH M � � Irk No.3yp3g7i" :ti ryt Cl$5�.� Kanayo Lala, P,E. .............03/03/2014 f 11VJCl.t. IVIG111111a\.n 1iV 11UV11t1111 ti 111J f1�fill�N 1-1 i}C-l-i1F'(1 lrn.�..i,n.�.:�n.r+r-� _ .� f li. .. ...u•.c;'�i^_L Supporting Floor &Point Load From T1&T2 LOADS: DEAD LOAD 20.00 PSF 360.00 PLF Ce= 1 CF= 1.00 LIVE Lnnn 3n.nn PSF 5540 nn of F rbc= Cd= 1 r„ A^fn a ,� Vii.. __ ti 2 PSF i lCjnv 1 LOAD 4 L !'ii AD 10 /! L66 5. O fR �� a= 4,332-_/ LES 7573 LIJ�1 V ML I (RC1P1l. fON TRIBU-f ARY VVIR i H 18.00 LF t= aUUUUUU F'Ji I(11CT/!?iRiIFR CLfiIAI 17 i G Fh= 'l Grn-ni PSj WIDTH- IN 6.60 36KSI W12X30 12.34 IN = d Fv= 16200 PSI nennn ncl Fcp= 405 PSI IVIV fVIi...I V`IJ� JLJ IJ LU-1� C K J= W.Ul IN-3 LIU.UU = I n;7n 4,;u =i/ al r()I i ejimi i oF�d Reauired L/240 Deflection2= 0.242 IN =L/ 654 For Live Load Required L/360 ncl nv n nn I„ o,.7"c Fv'= 10,200 PSI OK U Jli L-L V LJ 1 1 /10 1'Vl\"A-lr lVl 1't. u' �f l Tild� 1 Qt A �a•/ll No.337-V, .as. n. cQ .La' • �� .. i� 'SSJIAL f ' 1 Kan'Cyz L?!al P.E. .............03/03!2014 r'Iw✓Lv t. Incl uula�.n vultuvuiuuulit3 r DESiUivr�-Gin-LJ c-fx 1 1.:, ti.0 i i.:. Z .:'5 Supporting Floor&Wall LOADS; DEAD LOAD 24.00 PSF 240.00 PLF Ce= 1 CF= 1.00 LIVE LOAD 30.00 PSF 300.00 PLF qs= 29,10 Cd=1 V`.`,^ TOT,-"- enn nnDH 20.10 PSF rVliv I LVMU L175 FT Ra= 0 LSS 35'3 LC TRIBUTARY WIDTH 10.UU LF- �x E= 2U11U000 Pbi Ini�l/t�IK11rK 1Z'IPA.1. 1`� i.F Fh= -,11) FIST WIDTH- IN 3.50 PSL/LVL 11.875 IN = d Fv= 285 PSI nnr_ nrrrru nl.-In- DCI Fcp= 750 PSI IVIVIV IILItl i" I 1-!VV LU-i'1 0 L2 FT Al J= 41.LU IIV"3 488.4-i =i Dcnact;c,l= 0.3:7:) ";11 =L/ 4:9 F:..,T . 1 wuu &uau.cu uiyTl Deflection2= 0.000 IN =L/ 790 For Live Load Required L/360 Cnnl- FFn DCI r1K 4 rn In Raarinn I an.,l Fv'= 127 PSI OK V n• nn •'ihT iii t -11'Y+li'.i TT A l x =�J 1 i>U• AT tM r�N0.33710�D/Nl u o a s '""r 'Ts� __a K2niy c L9!3, P.E. .............03,`03/2014 rIIVJCI.+f. aVlclluHAl,n vUUUVatailtaulnS FIuua i3earn S1 Supporting Floor&Wall LOADS: DEAD LOAD 24.00 PSF 240.00 PLF Ce= 1 CF= 1.00 n..- Lla.1E l`.,� - en nn OSS .,nn nn PLF qs= 29.19 Cd= 1 1 V 1/l1.LV/'a1J v�v . �. . • �••• 2f. FSF i'VIIV I LVHU LDJ F7 Ra= 0 LBS 4'1 L k;1. :7 N TRIBUTARY WIDTH 10.00 LF E= 2uuuuuu N51 `pAxi V; I F Fh= 94-00 PSI WIDTH- IN 3.50 PSL/LVL 11.875 IN = d Fv= 285 PSI r��r�r rlTnl l \I .en_ Cn- 7701? DSI Fcp= 750 PSI IVIV IVILIV I IJJLV LU-1 1 5= 00.V4 IN-3 400.41 =I naflar.tinn= 0.421 IN =iJ 371 Fo.Toto;1.v&; Deflection2= 0.000 IN =L/ 593 For Live Load Required 1.1360 Fcp'- ?9� DCI nw A nn In Rcarinn I Rannfh Fv'= 150 PSI OK n Kanayo Lala, P.E. .............03/03/2014 PRO.tFCT: Merriota,c: :.u.,.:.. J-TYPE BB-Compass Point,N Andover,MA DUSI(,AI IMP_(,IRnGRC/_Ir)1RTC/R4FTERS 2nd Floor Beam S2 u S;::'.. __."-:^ =SF 0.22 71LC C;= 1 Cs= UVr wr+U +u.vu rr'5r 0,3.ZU rLr ys= iv.iu Gu-- i TOTAL L3AD 73 F-LF I= 1 Cm=4 WIND SPEED 100 MPH 29.10 PSF POINT I.nnn AlAn 1 R.q -�qh f:T Ra= 3467 LBS 713 LB=TOTAL REACTION 'ri IM 11T A M X11 A I1 n1 U A 77 1 f. /_: nol J0ICTrr_IRnFR -SPAN 19.5 LF Fb= 2900 PSI ROOF P!TyH- N:12= Fc= 2700 PSI Fcp= JV 1"J1 MOiv1FNT= 3477 1 R-FT MOMENT2= 11267 LB-FT 82.26 =S provided OK C_ Q4 n4 WAI AQQ n4 =I Deflection = 0.244 IN =U 318 For Tote!Loed )9AD Fcp— 30° PSI OK 3.^9 In Bearing Length �K i Ka,'—yo Lala, P.E. .............03 03/2014 rr\v�c� I. Mal lu110un vluvnlnneilulT:S qq :.3 Supporting Two Floors,Roof,Wall&Point Load From T1 LOADS- DEADLOAD OAD 73.72 PSF 718.75 PLF Ce= 1 CF=0.96 LIVE In^.ED 70.0^ PSF 6?2.5n oc qc= 2°.20 Cd= 1.15 I V I 1-Vl\✓ I I 1 1 . ti.1 . v... C IC 11.1^?! 22.10 PSF r'UIIV t LUHU 4yUU LDJ 6 rT Ra- 3 1.1... LSS 1 i v n. i,"-,v iZ/N TRIBUTARY WIDTH 9.75 LF L= 1000UUU f Sl IrIIC I IIi1Kl/rK >.F+i+�u 1R?i i,F FI)= 2 y., p S I WIDTH- IN 5.25 PSULVL Is IN = d Fv= 285 PSI wr,r 1'fIT/'4.1 •I .4e).- Cn- 7700 Del I! Fcp= 750 PSI IVIVIVILIV 1 UUYU i I.tJ-1 1 —K J= L234.tf/ IN"3 GLLtS.y4 =S Dru-G:Ci1l= v5 111 =U n•:U viol ivaU ;�auulred L/240 Deflection2= 0.160 IN =U 403 For Live Load Required L/360 C77 DCI r)k, G nn In Panrinn I cnnt Fv'= 245 PSI OK ✓ UaP-G-LVL8 i 1 /RS"NVKtSrAxi J4. t � P SPECIFIC CALCULATIOMIF PnP TUR Wntnnn rnAIQTPI 11-TIMI IN Jif,46,4L tk 44 (.(AVlrA66 r6um I,IVVK I r9 AIVULiVCI[,IYIA &.14 2R X36' DAclr 1 nnOS_ GROUND 1 O D 56 PSF VriN2 ".D 18 ^SF Riliiriinn i annth 1R ft Btdirlinn%Arldth 26 ft 1301ding Aspect Ratio= 1.38 ,-11- AA nnA +1nA I"11Ir: 1301d;r,. nn,...., u,,: > s �v t. St _1 In,�;;- ?,Ane 447 r„ F I UIQI nulul IL Y:J it Dean L 8 f!• r, .. .;;ivii 1 .:A ;:,.t i K_C i A ;,1 ri.,AC-iimrz POP 9/9" A A01 TC_ r1i`.n_..,.._..s t.... -Int;l a51 l,R-FT VTTH TWO V SYP PLATES U ..ET r.__I in,.n rynn nrn r.... .ri . ..._ ..._...-...,..... ....... --,_JL ...A ..u. .v, --=403 IVV UPLIFT ilvind IVIUritent Long UVan IU I,OJL LUIly VV IVI -/uU 146 IVV UrUr I I.E. NO UPLIFT EXISTS AT THE BASE OF THE RI,)II DlNr,. SHEAR AWHQRS ARE ADF(.IlTE. ..e.,,..0TV 4V 7AQI F 9-inc,7.1(1 /C VYaJ+ V✓/\1-LI YY1111 v IV.IVV/11 L. ViV vrr L✓VLV„Ir✓ v vrr r r�,..v L.v. .- w.4. r-^ r -K SHtAK WALL Kt(r;UIKtMI:N 1 tSY IALSLt KbUZ.7U.9.Zfl) I/11()CR WITH Rf)KfAll 1 A I h 1-Iiv HIVI) i i 1-�io r-r, r 1- ,;,. - Io FT CONTWI 101)S SHEATialnlr- AY/A 11 ARI F Al Mir-' 1 nklr_MIA L= 19 FT TI .'E7.777. TI -- .... ..._ ..•—T w 1 n.�ninlr_nTlr�Ai r]I nTFC Q,S UL 11111-LU VIV i i-IL r Lf11VJ. Vi,r-i 1 11 IVrr�v uvl✓i. vl v,rllry ur v,.v .v,vLL A-1tt-r 1 u v1,Lru..lil II IL Vr"uvu vt7 VVIVVER 673 LHS. A`1RAPS-)N I'G6fS 1-1051 GAN-LAI LKAL UAHAul I Y 1Z60W6-UK. TW- rAi (11 11 ATIMIQ ARnVR'ABrFT TWiz F1HF,i1 Llil not=nli s Ili- 'ii-ii= hairy -ii) wniia 'inin:ilnrth1. M FNnnnFnlTQ Tn 117r`On/l- - �:'nt /� ►�►Navcs' �i LA"LA iVU.3J,A IST S.SI0 AL Won plans Verified F�eici V�rt6 d # Finai lnspectl;dn provlslons OM es. e oromentsf�ssiuinptions.`: .ib Value Value 404. 1 Fuel gas lighting systems have t , ❑Complies fF-J 31, no continuous pilot light. El Does Not j ❑Not Observable j❑Not Applicable 4-1` ..Compliance certificate posted. ❑Complies ❑Does Not ❑Not Observable ❑Not Applicable 303: Manufacturer manuals for 3❑Complies (FI18j :mechanical and water heating " 5 T `_❑Does Not systems have been provided. ; ' ❑Not Observable , f . . . .:.. ' �..r� ,_. . .�.�❑Not Applicable Additional Comments/Assumptions: 1 I High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 160714 Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndover Report date: 08/10/16 Data filename: Page 9 of 9 \\suttonnas.corp.koopmanlumber.com\Sales\Ebbeling_Ed\160714_Trust_MerrimackCondos Bldgj_UnitsB- B-B-B_NAndover\REScheck\160714_Trust_MerrimackCondos_Bldgj_UnitsB-B-B-B_NAndoverjl.rck 2012 ICC Energy Efficiency Certificate Above-Grade Wall 21.00 Below-Grade Wall 0.00 Floor 30.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): D.. Window 0.29 Door 0.29 .. Heating System: Cooling System: Water Heater: Name: Date: Comments e The Commonwealth of Massachusetts Department oflndustirialAcciden€s f d 1 Congress Street,Suite 100 Boston,MA.02. 14--2017 www mass.gov/dia ,�. Workers'Compensation Insurance Affidavit:Builders/Contractors/Eiectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �+ �/� Please Print Legibly_ Name(Business/Organization/Individual): 1 ,�I fl_ Address: qC) 20 a �MG=k 0 GCS 1S hone#: 50h �n �31 City/State/Zip: (1 Are you an employer?Check t&appropriate box: Type of project(required): 1.❑1 am a employer with employees(full and/or part-time).* 7.)KJ New eoristraction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition IF]I am a homeowner doing all work myself.[No workers'compAnsuraace required.], 10 F]Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or.additions proprietors with no employees. ` 12.0 Plumbing repairs or additions 5 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.-F RObf Yep airs These sub-contractors have employees and have workers'comp.insurance. 14.0 Other 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] 7. *Any applicant that checks b6x41 must also fill outthe section below showing theirworkers'compensation policy information. t Homeowners who submit Itis 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-attapjied an additional sheet showing the name of the sub-contractors and state whether or not those entities have „ employees.'Ifthe sub-conl•<ac`tors fiave employees,they must provide their workers'comp.policy number. Iain an employer that is piovidingworkers'compensation insurance for my employees.'Beloit/is thepolicy acid jab site information. Insurance Company Name: Policy#or S elf-ins.Lir.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of thewoxkers' compensation policy declaration page(showingthe policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A,copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' nder th ns andpenalties ofpe jury that the informationprovided above is true and correct Simafore: Date: S Phone#: 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 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 common'Tealth for any applicant who lias 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 checkingthe boxes that apply to your situation and,if necessary,supply sub'contractors)name(s),address(es)and-phone number(s)along with their certificates)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. Ba advised that this affidavit maybe 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 dr if you'are required to obtain a workers' compensatioii 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 areference 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. Anew 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Aco OR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM 8///10/10/ 816 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(les) 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 endorsemen s). CONTACT PRODUCER NAME: Coonan Insurance Agency, Inc. PHONEJAIG W, 508 967-7122 Fox N : (508) 987-7152 267 Main Street ADDaREss: cind @coonaninsurance.com Oxford, MA 01540 Ir�Su. S-AFFORDING COVERAGE NAlc.n INSURER A:Travelers INSURED INSURER B: TJK, Inc. INSURER C: PO Box 12 I NSURER D: South Grafton, MA 01560 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 ANYCONTRACT 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. ILTR ADDL SUBR POUCY EFF POLICY EXP UMTS TYPE OF INSURANCE POLICY NUMBER MIDDN MM/DCVYYYY A GENERALLIABILITY 680-335M1703-15 11/3/15 11/3/16 EACHOCCURRENCE $ 1 000 000 DAMAGE TO RENTED $ 3OO OOO X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE a OOCUR MED DP(Any one person) $ 5 000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2. 000. 000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,00 000 X POLICY PRO LOCC $ AUTOMOBILE LIABILITY O arcideDtSINGLE LIMT $ BODILY INJURY(Per person) $ ANY AUTO ALLOWPED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED eraccdent $ HIREDAUTOS _AUTOS UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB [�CLAIMS-MADE AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION IE-UB-9914N01-3-16 1/26/16 1/26/17 X WCSTATU- OFR TH- AND EMPLOYERS'LIABIUTY ANY PROPRIETDR/PARTNER/EXECUTIVE �Y/N N/A E.L.EACHACgDEM $ ZOO000 OFFICERMIEMBER EXCLUDED? `• I E.L.DISEASE-EA EMPLOYEE $ 100,000 (Mandatory in NH) If as EL=DISEASE DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 11011,Additional Re m3rks Schedule,If more space is requi red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Cindy Davis O'ffi988-20,10 ACORD,CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: tdbuilding@aol.com