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HomeMy WebLinkAboutMiscellaneous - 126 MOODY STREET 4/30/2018 (2) t 126 MOODY STREET / 210/080.0-0012-0000.0 f I Date...... ....... ....`..�L� OF NORrti,� TOWN OF NORTH ANDOVER O 9 PERMIT FOR WIRING ss�CHU /yam<, q /{r � This certifies that .........ble...... .......................................1............... has permission to perform ...T. '.t......SP.......`...:...`..............'....... ............ wiring in the building of.............. l/ -.` . < P..3,............................................. at .......,1.?...�............. -/c..........�r..�/.................. ............,North Ando er,Mass' Fee.......... .......... Liu. Np. ................. ....... / ELECTRICAL INSPEC'�I'OR Check# s a E`TQ, 1 '.tC)1c, Commonwealth of Massachusetts Official Use Only p Department of Fire Services Permit No. Occupancy and Fee Checked a s BOARD OF FIRE PREVENTION REGULATIONS [Rev-1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code76)7;11 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL DWORMATIOA9 Date: City or Town of: NORTH ANDOVER To the Insp ctor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 1.2- 6 I-Zaaly -sl— Owner " _ Owner or Tenant -Fe ria r1d4f-S, Telephone No. Owner's Address _ 60-re Is this permit in conjunction with a buildin permit? Yes kQ No ❑ (Check Appropriate Box) �^ Purpose of Building Sic4en'�7, Utility Authorization No. 17O 9 3 3 9 0 1 - Existing Service� Amps / Volts Overhead❑ Undgrd[:1No.o e ers 7 New Service 200 Amps 12,01 ?09 Volts Overhead®. Undgrd ❑ No.of Meters Number of Feeders and Ampacity <<. r 7/1./ �_ Location and Nature of Proposed Electrical Work: T rnpryi�C t A,(gw &wee r OQRb-01-76 Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires if No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets 8 No.of Hot Tubs Generators KVA Above In- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. El Battery Units No.of Receptacle Outlets 50 No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches 30 No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: '' ' -' "'" ''""'"" '"" """"""'"""' Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No,of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: 9;000 ev (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 14 BOND ❑ OTHER ❑ (Specify:) Icertify,under thepa'ns and penalties o perjury,that tlt information on this application is true and complete. FIRM NAME a l Me / (t2Gt LTC.NO.: Licensee: 1-62(rn e /6r).?c 64d Signature LIC.NO.: (If applicable, er "exemp ''in the li ense nu ber if e.) Bus.Tel.No. Address: P d. t'�Ub. q4 =90c�iy NK 03 3 Alt.Tel.No.: 603-765--22� *Per M.G.L c. 147,s.57-61,security work requires Depalfraent of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE:$ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit❑ ❑Permit Extension Act—Permit/Date Closed: I Trench Inspection Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE CTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: }� i • Inspectors Signature: Date: �p PARTIAL ROUGH INSPEC ON: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass IN Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Commen Inspectors Signature: obC Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 4 The Commonwealth of Massachusetts Department ofIndustrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L�e/>�sibly Name(Business/Organization/Individual): 70j lme Arghi (;>BA Address: © , boK 46 r City/State/Zip: d/lolor!gk22-V Act C.WPhone#: 603 76 S-- 22-R 2 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.'R 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 for me in any capacity. workers'comp.insurance. g. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. ,Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am 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.L/ic.#: Expiration Date: n Job Site Address: l 2 6 &o o dY St City/State /Zip:�fl i Tr�?t luo y 2 f'. 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 o. 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. Xdo hereby cert under the pains and Penalties of erjury that the information provided above is true and correct. Signature: Date: Phone#: 60 3 - 76 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(circle one): 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 ofhire,- 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 numbers)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 au LLC or LLP does have employees,a policy is required. Be 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 retained 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 bum 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 Gozx i ponwealth of Mo ssa ft setts ]Department of Industrial Accidents Office of Investigations 600 Washington Street Boston?MA,02111 Tel#617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#61.7-727-'7749 ww�v.m�ass,govfclia 10! 0 Date..... TOWN OF NORTH ANDOVER 0. PERMIT FOR PLUMBING This certifies that....... has permission to perform plumbing in the buildings of.............................................................. ........ at.... ......A.0CA S-� .............. ........... t4orth,Andover, Mass. Fee--"r-1:..b7,).Lic. PLUMBING INSPECT 0R Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK. CITY o �y(�®y P� MA. DATE_�"��Z"'l PERMIT# JOBSITE ADDRESS�_ (�� f^ OWNER'S NAME OWNER ADDRESS / lJL1c i S TEL FAX TYPE OR OCCUPANCY.TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL[� PRINT CLEARLY NEW:❑ RENOVATION:[� REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO ❑ FIXTURES 7. FLOOR BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL �. SERVICE/MOP SINK S TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142.• Yes)] No❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. ❑ ❑ Signature of Owner or Owner's Agent CHECK ONE BOX ONLY: OWNER AGENT 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 plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142of the General Laws. ;04 PLUMBER NAME Peter J. Crane SIGNATURE I=�� 21805 —�- LIC# MP❑ JP E] CORPORATION ❑# PARTNERSHIP ❑# LLC ❑# COMPANY NAME Crane's Plumbing & Heating ADDRESS: 70 Douglas Street CITY Haverhill STATE IIA ZIP 01830 EMAIL annacrane.ac@verizon.net' TEL 978.771.1155 CELL 978.771. 1155 FAX c� � i ?y1l�✓ 'J �yC,c �✓ � �� s�� �� � � I� � COMMONWEALTH OF MAa�ACHIS�TTS BQARD`Of PLUMBERS"AND G S>S V:E:S::;;TH E F O L L O W I`N:G";`L L i CN5ED AS A JOUEtN I'MA.N-T ' B ; PETER J CRANE . ;, f W 70 DOUGLAS ST ✓` �� J AVERHILI: MA 0183076.741 Date...4�-''11.//`.f............. NOR*h TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ....,1/�I. L.......t.. . ...................................... has permission for gas installation ..... i ......................................... inthe buildingss_of.................................................................................................................. at..... ....ffl. a .....S�.............................�... AN o...v...e...r..,..M......a...s..s... FeeV.-, Lic. No. 1101.�e... ..... INSPECTOR Check# . MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY >r MA DATE._ PERMIT# t� — JOBSITE ADDRESS OWNER'S NAME c , OWNER ADDRESS _ TEL � �}FAx TYPE OR OCCUPANCY TYPE COMMERCIAL[J] EDUCATIONAL[ RESIDENTIAL PRINT CLEARLY NEW:1- RENOVATION:[ REPLACEMENT:® PLANS SUBMITTED; YES®.I NOR-1 APPLIANCES 1 _•FLOORS--► BSM 1 2 3 4 5 6 7 8 3 10 11 12 13 14 BOILER M_1 ) TI _J BOOSTER CONVERSION BURNER ._I __..J ___._l ._ .1 .____ _.�_. _.- 1 ___.t_I -4 __=1 .... 1J _ —z--1 •-- _ -.--- ----( Q� COOK STOVE DIRECT VENT HEATER -� .__. .�_i I ) --J= _ — •-� g DRYER FIREPLACE FRYOLATOR J= FURNACE GENERATOR _ ,�� GRILLE - -- - - --i -� _-- -- I ----- - --- f -- ___.,..( ..�._ _.._f INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN _j -_..� .,___ POOL HEATER ROOM/SPACE HEATER C ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER -,--J=_ WATER HEATER -�- OTHER INSURANCE COVERAGE I have a current liab_ I{Ity insurance policy or Its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0N0 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY LFf OTHER TYPE INDEMNITY E] BOND (JI OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F__Jj AGENT [---] SIGNATURE OF OWNER OR AGENT 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 plumbing work and Installations performed under the permit Issued for this application will be In compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 PLUMBER-GASFITTER NAME h G- - LICENSE# 1 0Ic i�_4_ .(_.w--� D=!� --- - cj- SfGN URE MP[TSI MGF[M] JP��I JGF ..�- LPGI ---------- © CORPORATION�# _ PARTNERSHIP[ #L: LLC( # -� COMPANYNAME: «� ��(.._G.>..d► ADDRESSC`� .' -... � CITY ._. _ ..... STATEKAZIP .O TEL FAX CELL EMAIL ___ f 4�COMMONWEALTH OF MASSACHUSETTS s • - • • BOARD OF PLUMBERS AND GASFITTERS I I SSUES THE FOLLOW14 G LICE NSE.,.,,. ., 1 1 G:1 NSED AS A MASTER P,L-UMBER . UK M1GH_AEL G MAGOON $ LAWREN;CE. ST ::tXTd. . CONCORD HH 03301-532o to10(i 05/01/1.6x: 227413 � . L Date.!F Jv X/ti. . ... .... NORTH TOWN OF NORTH ANDOVER a? O "w� p` PERMIT FOR MECHANICAL INSTALLATION m 1- D o� SAC'NUSEtl This certifies that . .Vit.OJ.` .�{�'�.�./.�1�: : • :•K • . • • • . • . • . has permission for mechanical installation . . . . . . . . . . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. .%.. {.:?. Lic. No.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date : �G/ Permit# Estimated Job Cost: '�� &,�� Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# Business Information: Properly Owner/Job Location Information: Name: yO ,Ch/do� Name: �c�x•.tomrr Street: Street: ,62Co r''boJY 5,��� City/Town: !�J�(x4yz/ City/Town: j4,t Aoys-,/Yt A Telephone: ��� -TA-00-292, Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: ,/ Residential: 1-2 family /` Multi-family Condo/Townhouses Commercial_: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC X Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done:: K�,.J �i,���. O�l'rr �riccx�.� �-/e�..1 �xs�•��� � �iu✓S I=Coo�C- tT1ot,r � � 4 [INSURANCE COVERAGE: have a current Iiability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes�o❑you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy ( Othertype 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 Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxE],l 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. Progress Inspections Date Comments Final Inspection Date Comments Type of License: 3y � dnr S�'�r Master < < rltle ❑Master-Restricted ;ity/Town ❑Journeyperson 'ermit# Signature o icensee�Journeyperson-Restricted License Number: J ? -ee$ Check at www.mass.gov/d I ispector Signature of Permit Approval � I I � x COMMONWEALTH OF MASSACHUSETTS BOARS`�E SHEET 'METAL WORKERS ISSUES THE FOLLOWIN'G 'LICENSE A :A 'MASTER-UNREST ED 1 z ...:R ERT E PHILBROOK JR W 19 SPR I N'G ST LL GdFESTOWN::; RN 43045- 909 -i. F. W tp WEBkB COMPANY RESIDENTIAL HEAT LOSS/GAIN CALCULATIONS PREPARED BY ANDY BERUBE BR54 PROJECT # : 205431 BY AHB ENTERED 08/11/14 BLDG 1. NAME :COMFORT AIR GAIN BTU: 36636 2. LOCATION :FERNANDEZ RES GAIN CMF: 1222 3. HI DESIGN TMP: 91 8.GRND TEMP 50 LOSS BTU: 43132 4. LO DESIGN TMP: -10 9.000L AIR TMP: 50 LOSS CFM: 815 S. ROOM TEMP 71 10.WARM AIR TMP: 120 BASEBRD' : 80 6. LEEWAY 10 TONNAGE : 3.1 7. # OF PEOPLE 5@400 ------------------------------------------------------------------------------- ROOM # 1 OF 10 41.WALL G DELTA 20 12.ROOM NAME :DINING ROOM 42.WALL L DELTA 81 43.FLOOR G DELTA 20 44.FLOOR L DELTA 81 45.CEILNG G DLTA 0 46.CEILNG L DLTA 0 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 26 24.FLOOR R-FACTOR: 11 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : N 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 30 27.HEAT/CL ABOVE?: Y 39.MOIS TURE 23 17.WINDOW GLASS. D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 0 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 4072 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 136 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) 200 * LOSS BTU: 5122 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 97 815 23.FLOOR SQ FT 168 34.BATH(Y*N) N * BASEBRD' : 9 80 ------------------------------------------------------------------------------- ROOM # 2 OF 10 41.WALL G DELTA 20 12.ROOM NAME :KITCHEN 42.WALL L DELTA 81 43.FLOOR G DELTA 20 44.FLOOR L DELTA 81 45.CEILNG G DLTA 0 46.CEILNG L DLTA 0 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 26 24.FLOOR R-FACTOR: 11 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : N 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 22 27.HEAT/CL ABOVE?: Y 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 21 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 5370 34636 20.N,NE,E,SE. . . : S 31.EXTRA PEOPLE * GAIN CFM: 179 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) 200 * LOSS BTU: 5561 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) Y * LOSS CFM: 105 815 23.FLOOR SQ FT 168 34.BATH(Y*N) N * BASEBRD' : 10 80 ------------------------------------------------------------------------------- ROOM# 3 OF 10 41.WALL G DELTA : 20 12:ROOM NAME :LIVING ROOM 42.WALL L DELTA 81 43.FLOOR G DELTA 20 44.FLOOR L DELTA 81 45.CEILNG G DLTA 0 46.CEILNG L DLTA 0 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 29 24.FLOOR R-FACTOR: 11 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : N 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 45 27.HEAT/CL ABOVE?: Y 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 21 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 5512 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 184 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) 200 * LOSS BTU: 7279 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 138 815 23.FLOOR SQ FT 204 34.BATH(Y*N) N * BASEBRD' : 13 80 ------------------------------------------------------------------------------- ROOM # 4 OF 1(h 41.WALL G DELTA 20 12.ROOM NAME :ROOM 4 42.WALL L DELTA 81 43.FLOOR G DELTA 20 44.FLOOR L DELTA 81 45.CEILNG G DLTA 0 46.CEILNG L DLTA 0 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 24 24.FLOOR R-FACTOR: 11 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : N 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 45 27.HEAT/CL ABOVE?: Y 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 0 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 4965 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 166 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) 200 * LOSS BTU: 5351 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 101 815 23.FLOOR SQ FT 144 34.BATH(Y*N) N * BASEBRD' : 10 80 ------------------------------------------------------------------------------- ROOM # 5 OF 10 41.WALL G DELTA 20 12.ROOM NAME :BATH 1ST FLOOR 42.WALL L DELTA 81 43.FLOOR G DELTA 20 44.FLOOR L DELTA 81 45.CEILNG G DLTA 0 46.CEILNG L DLTA 0 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 6 24.FLOOR R-FACTOR: 11 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : N 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 8 27.HEAT/CL ABOVE?: Y 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 0 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 912 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 30 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) * LOSS BTU: 1847 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 35 815 23.FLOOR SQ FT 60 34.BATH(Y*N) Y * BASEBRD' : 4 80 ------------------------------------------------------------------------------- ROOKI# 6 OF 10 41.WALL G DELTA 20 12:ROOM NAME :MASTER BEDROOM 42.WALL L DELTA 81 43.FLOOR G DELTA 0 44.FLOOR L DELTA 0 45.CEILNG G DLTA 20 46.CEILNG L DLTA 81 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 29 24.FLOOR R-FACTOR: 19 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : Y 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 24 27.HEAT/CL ABOVE?: N 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 0 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 3693 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 123 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) 200 * LOSS BTU: 4818 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 91 815 23.FLOOR SQ FT 203 34.BATH(Y*N) N * BASEBRD' : 9 80 ------------------------------------------------------------------------------- ROOM # 7 OF 10 41.WALL G DELTA 20 12.ROOM NAME :WALK IN CLOSET 42.WALL L DELTA 81 43.FLOOR G DELTA 0 44.FLOOR L DELTA 0 45.CEILNG G DLTA 20 46.CEILNG L DLTA 81 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 20 24.FLOOR R-FACTOR: 19 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : Y 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 0 27.HEAT/CL ABOVE?: N 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 0 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 1084 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 36 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) 100 * LOSS BTU: 2129 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 40 815 23.FLOOR SQ FT 100 34.BATH(Y*N) N * BASEBRD' : 4 80 9 ------------------------------------------------------------------------------- ROOM # 8 OF 10 41.WALL G DELTA 20 12.ROOM NAME :MASTER BATH 42.WALL L DELTA 81 43.FLOOR G DELTA 0 44.FLOOR L DELTA 0 45.CEILNG G DLTA 20 46.CEILNG L DLTA 81 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 8 24.FLOOR R-FACTOR: 19 36.MISC BTU LOSS 14;EXT WALL HGT 8 25.HEAT/CL BELOW : Y 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 10 27.HEAT/CL ABOVE?: N 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 0 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 1606 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 54 1155 21-WIN. SHADING N 32.LIGHTS(WATTS) : 100 * LOSS BTU: 1927 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 36 815 23.FLOOR SQ FT 96 34.BATH(Y*N) N * BASEBRD' : 4 80 ------------------------------------------------------------------------------- ROOM# . 9 OF 10 41.WALL G DELTA : 20 12:ROOM NAME :BEDROOM 1 42.WALL L DELTA 81 43.FLOOR G DELTA 0 44.FLOOR L DELTA 0 45.CEILNG G DLTA 20 46.CEILNG L DLTA 81 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 26 24.FLOOR R-FACTOR: 19 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : Y 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 36 27.HEAT/CL ABOVE?: N 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 0 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 4124 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 137 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) 150 * LOSS BTU: 4821 43132 22.% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 91 815 23.FLOOR SQ FT 168 34.BATH(Y*N) N * BASEBRD' : 9 80 ------------------------------------------------------------------------------- ROOM # 10 OF 10 41.WALL G DELTA 20 12.ROOM NAME :BEDROOM 2 42.WALL L DELTA 81 43.FLOOR G DELTA : 0 44.FLOOR L DELTA 0 45.CEILNG G DLTA 20 46.CEILNG L DLTA 81 47.BELW GRD DLTA 21 35.MISC BTU GAIN 13.EXT WALL LEN 26 24.FLOOR R-FACTOR: 19 36.MISC BTU LOSS 14.EXT WALL HGT 8 25.HEAT/CL BELOW : Y 37.BASEBD BTU/FT 580 15.WALL R-FCTR 14 26.CEILING R-FCTR: 19 38.PEOPLE BTUS 400 16.WINDOW SQ FT 24 27.HEAT/CL ABOVE?: N 39.MOIS TURE 23 17.WINDOW GLASS D 28.SKY LGHT SQ FT: 0 40.ZONE 1 18.DOOR SQ FT 0 29.SKY LGHT TYPE D ***TOTALS FOR ROOM***ZONE 19.DOOR R-FCTR 2 30.AIR CHGS/HOUR .50 * GAIN BTU: 3298 34636 20.N,NE,E,SE. . . S 31.EXTRA PEOPLE * GAIN CFM: 110 1155 21.WIN. SHADING N 32.LIGHTS(WATTS) 150 * LOSS BTU: 4277 43132 22;% BELOW GRADE: 0 33.KITCHEN(Y/N) N * LOSS CFM: 81 815 23.FLOOR SQ FT 168 34.BATH(Y*N) N * BASEBRD' : 8 80 ------------------------------------------------------------------------------- Date. . . . . �. . . .. .. NORTH 3r �` TOWN OF NORTH ANDOVER o ;. PERMIT FOR GAS INSTALLATION S'q USES This certifies that . . . .�.�. 1'. .l . . ? .:{!.f. { .`. . . .4 . . .l.'. .%. . . . . . has permission for gas installation . . . .�.'. . . :.'. . . .: . . . . . . . . . in the buildings of . . . ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at �. . . . . . . . .. North Andover, Mass. Fee. .,!.,. . Lic. No.. . :. . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR ' Check 30 � - MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING r (Print or Type) /UU Ayooa__ , Mass. Date �- - .�00/ Permit # L Building Location � '7-- 04ners Name ��/Wd Type of Occupancy New ❑ Renovation ❑ Replacement '] Plans Submitted: Yes❑ No ❑ N cc X WN N N V Z ¢ N N LC N d O W OC O a m of H 4 ¢ Cr Cr CC O p t- H ¢ of c7 W a = Z i0 y d C W N cc W Z V W.4 x N W < a Hcc W c(n j F. Y tl f. Z J F' Z F. W W tl 0 > W }W- U J yN. W .Z' Q W a C �' Y• N ap Z O Z W O X a W >1 +� W z. < ac a O tl T W 3 G tl J U C y p a F- O SUB—BSMT. BASEMENT !ST FLOOR ,ar 2ND FLOOR + 3RD FLOOR ♦ 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET X7 Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone .687-1105 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes K No ❑ If you have checked ve, please indicate the type coverage by checking the appropriate box. A liability Insurance policy J Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accxr�qite to the best of my knowledge and that all plumbing work and installations performed under the permit issu I r this application will n mpliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene s. U i T of License: Title Plumber Signature of cense Plumber or Gas GasGtter Master License Number 8697 Glty/Town Journeyman O IC S_ONLY BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMITTO+DO GASFITTING .S, NAMES TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED . r DATE�.....�9 GA3INSPECTOR ' � r