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Miscellaneous - 130 HEATH ROAD 4/30/2018 (2)
130 HEATH ROAD 210/097.0-0039-0000.0 Date..p1.;1 Iq ............... 10 G3 6 of".SRT"'ti TOWN OF NORTH ANDOVER R PERMIT FOR PLUMBING Bs�cHus� P_ 1 Thiscertifies that.................. . .. .......:................................................................................ has permission to perform........V--1 c4 e r!YM Y2 ............................... plumbing in�the�buildings of.........vf..��.Sb ..................................................... at................ -{ ....���':��.............:,North Andover, Mass. FA4'4.�....Lic. No.C1..9P.... ..Hk................................................................. PLUMBING INSPECTOR Check,4 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK quoCITY I North Andover MA DATE 10/30(14 PERMIT# JOBSITE ADDRESS 1130 Heath Road OWNER'S NAME Aaron Preston POWNER ADDRESS same TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL 0 RESIDENTIAL PRINT CLEARLY NEW: RENOVATION:Q REPLACEMENT:0 PLANS SUBMITTED: YES Q NOF FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER 1 D DRINKING FOUNTAIN FOOD DISPOSER _ FLOOR I AREA DRAIN 3 INTERCEPTOR(INTERIOR) KITCHEN SINK 1 LAVATORY ROOF DRAIN SHOWER STALL _ SERVICE/MOP SINK Q TOILET r3 URINAL WASHING MACHINE CONNECTION ` 1 WATER HEATER ALL TYPES ` WATER PIPING _ 0 OTHER - INSURANCE COVERAGE: I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES E] NO E IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BONDF71 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 © AGENT E SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this appli tion re true ad cc,aate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will in mpanjl* �th 11 Pertinent provision of the -- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME I Wayne Webster LICENSE# 9790 SIGNATURE MP F! JP F1 CORPORATION # 1562 PARTNERSHIPQ#0LLCQ# COMPANY NAME Webster Corporation ADDRESS 1 Old Chester Road CITY Derry STATE NH ZIP 103038 TEL FAX CELL 1 781 727 0481 j EMAIL wayneandkaren2@gmail.com Q 0 ____�-�_ �E� '�O i / �4,1�.1�J91 35�I V � � The Commonwealth of Massachusetts Department of Industrial Accidents u W Office of Investigations a I Congress Street, Suite 100 Boston,MA 02114-2017 5� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Webster Corporation Address: 1 Old Chester Road j City/State/Zip: Derry NH 03038 Phone #:781 727 0481 Are you an employer? Check the appropriate bog: Type of project(required): 1.0 1 am a employer with 1 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its . 10.E] Electrical repairs or additions officers have exercised their 11.■ Plumbing repairs or additions 3.❑ I am a homeowner doing all work p 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' 13.0 Other comp. insurance required.] *Any 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. ;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. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:The Ohio Casualty Policy#or Self-ins. Lic. #:XWS(14)55764514 Expiration Date: 10/3/15 Job Site Address: 130 Heath Road City/State/Zip: North Andover MA 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA f r insurance coverage verification. I do hereb ce under t e a s and penalties of perjury that the information provided above is true and correct. Si ature: Date:10/30/14 Phone#: 817270481 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t° COMMONWEALTH OF MASSACHUSETTS BOARD OF PLUMBERS ,A.ND GASF ITTE;R5 ISSUES THE FOLLOWING LICENSE : REQl:S.TERED ASIA PLUMBING. CORP: WAY:N;E E WEBSTER i W E 'WEBST;ER CORPORATION ;M 9790 1. OLD CHESTER 'RD D EIRY NH, 03038=:4016. 1562 05/01./t6 2oi522 w +COMMONW ALTH,`OF M `SSAOHUSETTS r • • - • • BOARD OF PLUMBERS,'AND GASF.I.TTFRS. ISSUES. THE FOLLOWING E'fCENSE # E GI~NSED AS A MASTER °PLUMBER WAY.:N E WEBSTER v 1 OLD CH>ESTER RD DERRY NIH 03038-401$` :: 9790 05/012,1 Zo1524 O \� Date..IL. .�..!....................... �►OR7N TOWN OF NORTH ANDOVER p PERMIT FOR WIRING a � ... CHUS�t This certifies that . (4-1�nSP ...... ..................................................................................... has permission to perform ....¢--... ... ...�r..1N`ac.0 e 1... ¢ Wring in the building of......... .....C� ( ...............n........................................................................... u �.. ........................................................ ..................... h Andover,Mass Fee....V....�2.�.......Lic.No.cmj6. ..ELEcrx . . ..... .. ....... ICALINSP CTOR Check# 3PZ3 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. a��� Occupancy and Fee Checked 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 Code(NEC),527 CMR 12.00 (PLEASE PRINT IAT HK OR TYPE ALL INFORMATION) Date: /1/ 4//'/ City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 130 Jf e g r h R61 Owner or Tenant V(M 6 eotI y P(t es 1'O ✓ Telephone No. Owner's Address e?A e Is this permit in conjunction with a building permit? Yes �No ❑ (Check Appropriate Box) Purpose of Building o M e Utility Authorization No. Existing Service ),00 Amps r / 2 4 Volts Overhead❑ Undgrd[4----No.of Meters r�New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity / Location and Nature of Proposed Electrical Work: ( �� n e� f (�,!? VqA&ea�— Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires '7 No.of Ceil:Susp.(Paddle)Fans No.of Total 3 r7 Transformers KVA No.of Luminaire Outlets „3 No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires 3 Swimming Pool rnd. ❑ rnd. E] Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches y� No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tons TotNo.of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained J No.of Waste Disposers 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: jV1IGE7p iN�`'G o _� Attach additional detail if desired, or as required by the Inspector of Y➢ires. Estimated Value of Electrical Work: -5-000# (When required by municipal policy.) Work to Start: ACI/ 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 BOND ❑ OTHER ❑ (Specify:) Icertify, tinder thepains andpenalties ofperju ,that the information on this application is true and complete. FIRM NAME: . q S C'n I S � �.f 2 tG r 0 nc > LIC.NO.: X Licensee: 714-/ # [ fr �c-j Signature LTC.NO.: (Ifapplicable,entT`exempt"in the license numberdine.) Bus.Tel.No.- Address: 19M Sfi Ve3QM (y) 9 67aZ0Zd Alt.Tel.No.' 7 97 ;?-Sil I-gY6 *Per M.G.L c. 147,s.57-61,security work requires Department 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. 'i ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the r 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: Trench Inspection Pass[N Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: PassM Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed❑' Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed IN Re-Inspection Required($.) ❑ > Inspectors Com nts: Inspectors Signature: Date: FINAL INSPECTION: Pass❑' Failed 0 Re-Inspection Required($.) ❑ Inspectors Com 12- I nspector Inspectors ignature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com ' Y The Commonwealth of Massachusetts - DepaYtment of Industrigl Accide is Office Oflnvestigations 600 Washington Street Boston,.MA 02111 www.mass govIdla Wgrkers'Compensation Insurance Affidavit:Bui devs/Cont°actors/Elecfricians/Pliunbers Appheant information Please Print Le 'bCO z Name(Business/Organi�zation&dividual): SG^ Address: City/State/Zip: 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 an(Vox part timo).* have ned the sub-contractors 2.❑ I am a sole proprietor or partner listed on the attached sheet:t 7� emodeling ship and'have no-employees These sub-contractors have 8. [[Demolition working for me in any capacity. 1Ns5tx ws' comp.insurance. 9. El Building addition [N'o workers' comp.insurance 5, e are a corporation and its 10. lectrical repairs or additions required.] officers have exercised.theix 3.El am a homeowner doing all work right of exemption per MGL 11.[(Plumbing repairs or additions myself:[No workers'comp. c.152,§1(4),and we have no 12.❑Roofrepairs insurancere employees.[NO workers' �iced.a 1311Other comp.insurance required.] XAny applicantthat checks box#X must also fill outthe section below showingthek workers'compensationpolicy information. T'Homeowners who submit Phis affidavit indicatingthey Zia doing all work and then hire outside contractors must submit anew affidavit indicating such. TContractors that cheek this box must attached as additional sheet showing the name of the sub-contractors and their workers'comp.policy information. X am an employer that is providing workers'compensation insurance for my employees Below is the policy and jab sue information. Insurance Company Name..A be Policy#or SON ins.UG.#: ig a �© Expiration Date: 62 _�• Job Site Address: © C Neuf U` CitylState/Zip: Irco / 4,e)Ve clew l��o r Attach a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as xequiredunder Section 25A ofMGL o.152 can lead to the imposition of criminal penalties of a fine up to$1,50 0.00 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. X do Hereby cert under the pains andpenalt's of perjury that the information provided ab/move i`s�tr,(ue and correct. - Si afore• � Date: Phone#: �2" 2' Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitlLicense# 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 employes 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. Ijowever the owner of a dwelling house having not more than three apartments and who resides therein,or the o ccupant 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 employes." MGL chapter 152,§25C(6)also states that"every state or local lie-ening agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings iu 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 chapterhave beenpresented to the contracting authority." Applicants Please fill,out the workers'compensation affidavit completely,by checking the boxes thatapply to your situation and,if necessary,supply sub-contractors)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 an LLC or LLP does have employees,a polloy 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 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 jM in.the,permit/license number which will be used as a reference number. In addition,an applicant that must submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessmy)and under"J'ob Site Address"the applicant should write"all locations in .(city or town)."A copy of the affidavit that has b eon officially stamp ed 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 ox permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc)said person is NOT required to complete this affidavit. The Office bf 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 andfax number: The Commoa�toaXth o�Xi�assarhvsP�fs - JDep.attenl;o.�Zudusal.A.ccXdcz�ts Off ce oflimstigAtima 6.00 Wasblugfi�. 1xe Bostw,MA 02111 `J QJ, Q`27-4900 @A 406 ox 1-877 r1AMAF'F Revised 5-26-05 FaX 0 617-727'7749 wwwaaagov/dia COMMONWEALTH OFMSkCFIUSETT 0 0 0 101= o BOAt#DOt ELECTRICIANS I<SSUES THE FOLLOW I NG L f t-NSE —:, RE-G). TIIRED MASTER ELECTft;l C I AN4 ..'14A pus ELECTRICAL SERV THEODORE :W H S'E!,N S " r 63 AMES ST `'r; 1;; iv OEDHAM MA 02026 X813 .:...:, �8r�6 <A. "07i 31:� 1f�. `;`7�cs 197 Date. .q' I �. . .. .. .. . . d. „ORT/y TOWN OF NORTH ANDOVER OF PERMIT FOR MECHANICAL INSTALLATION O ' P F �9SSACe"USEt4 This certifies that . '... . . . . . ..1." has permission for mechanical installation in the buildings of '� �.�. . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . �l).:� ���r. . 1�.v � .' North Andover, Mass"*"',- G .1. n(� 11 GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit 1 / Date: 2,t-1 /13 Permit# V� Estimated Job Cost: Permit Fee: $ f Plans Submitted: YES NO X Plans Reviewed: YES NO X Business License# 5d Applicant License# y 6 7 Business Information: Property Owner/Job Location Information: Name: cen-1-c-al Cool i na+ e�A} r��,Tn� Name: Pro,S'n Y, tes4zN--, Street: 5 N r a sol P .fie&- Street: f 30 ��- '9-64 City/Town: W c,&urn, M,4 a/Pjl/ City/Town: N, q nJ(w Q r, M16 Telephone: --7?(-13- �e Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff uunal d-+/ 'I-1 unrestricted license 4-24-M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family/ Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. V/' over 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 work to be done: 6r cc j` p/a re INSURANCE COVERAGE: I have a current liability insurance policy or Its equivalent which meets the requirements of M.G.L.Ch.112 Yes® No❑ If you have checked Yes.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 Owner ❑ Agent ❑ Signature of Owner or Owners Agent By checking this box&I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Prowess Inspections Date Comments Final Inspection Date Comments Type of License: By ®Master Title ❑Master-Restricted City/Town ❑Joumeyperson Signature of Licensee Permit# ❑Joumeyperson-Restricted License Number: 9 6 9 Fee$ Check at www.mass.aovidol Inspector Signature of Permit Approval The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations Map# Lot# 600 Washington Street Address: Boston,MA 02111 Permit# www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information. Please Print Legibly Name(Business/Organization/Individual): C e rel0 n�kVV J+J y,a t -'n c— Address: �/e r-fl, .,�,�Ad 1 Q Sh-�e r•�' City/State/Zip: W o b tAri i A- a i Ea/ Phone#: 7 r 1-933_r.1_e Are you an employer?Check the appropriate box: Type of project(required): I.N I am a employer with t O 4. E] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have g• E]Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp.insurance comp.insurance.t required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1.1.El Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,41(4),and we have no employees.[No workers' 13.[ Other -�f ,/� comp.insurance required] *Any 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 employee`s. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: j a t a I Xrtis tutu ,c e- t k . --rnc Policy#or Self-ins.Lie.#; PPr 6 n n J 9 L.3 G Expiration Date: /(�3 1,,26 Job Site Address: 13U City/State/Zip: IV, f-lL\-� T �_ 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 t . 0•a,day against the violator. Be advised that a copy of this statement may be forwarded to the Office of InvAigations of the Dk�,for insurance coverage verification. I o her y ce nde h tare e ains and penalties of perjury that the information provided above is true and correct Si Date `A Phone#: 7 l g3 Official use only. Do not write to this area,to be completed by city or town offu:iaL 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"...everyperson 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-contractors)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 permittlicense 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877 MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia f^_Fy r.... �ynk�f.'.; ���r ,: 'k.s't:.kyr ; {p,.,.� .� ��, i¢Ya. ` e"{ �t,.::""' k- `7 �,,+� z.,,; r:wa ;�,. a` yr_n r.ti -y,�."• �'?a€a"'�?4 ��'-'�i i'kF�:•�: �.��sT:��v,}a � !��(� +',.� };°J:°• �;',* y >,�'^ �1:ri?'��s}4a'�rk :fly ;v—�'F�?r sY 'W�.�'f?s �.x,,�iY«�.�?. 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NEWTON AREA (617)928-3M NIOR-1 14 AAA +E . 1 UP 'A'080M J,.AA 018()1 March 28,2013 Aaron Preston 0 130 Heath Rd North Andover,MA 978-688-6043 atDrestonCa)Zmwfi.com Prni"t Ma Harris Ductwork and AC Replacement Proposal Equipment: I Carrier FE4ANF005000 Infinity High Efficiency,Variable Fan Coil Unit I Carrier 24ANB748AO03 4.0 Ton Infinity Series Condenser I Carrier SYSTXCCITN01 Infinity Series Thermostat I April Aire 2000 Series Air Filtration System Rating: AIM#4648042 16.5 SEER 13.10 EER Work Induded: • Installation of Equipment listed above • Run new refrigerant lines as needed • Pouring of new concrete pad for condenser • Supply Electrician to reconnect to existing electrical • We will come and perform a duct leakage test on the existing system and then the new system to be able to provide the exact percentage of duct leakage savings. • We will remove and properly dispose of all the existing aluminum ductwork. • Installation of a new galvanized steel duct system to existing air handler. The new duct system will be installed tight with less than 4%duct leakage to the unconditioned attic space. • Install manual adjustment dampers in all supply branches • Insulate all Ductwork to standard building codes • Install return branches to all bedrooms • Start up, check system and explain operation. Your Comfort is Our Priority... Since 1966 Serving The Boston Area (781)932-9017 fax www.centralcooling.com • NO e2of4 We propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum$17,950.00 dollars. 1/3 deposit upon acceptance, progress bills to be submitted at the onof the month to be paid on the 10th of the following month,balance due to the service technician at the stup of the system. Past due balances will be charged 1 1/2% interest charged per month which is an annui�p�rcentage rate of 18% on past due amounts. Rebates and Tax Credit: Central Cooling Instant Rebate Above duct changes are eligible for up to a$600.00 instant rebate. There will be an additional rebate of$2/ cfm for the amount of air that we are able to improve the system. We are being reimbursed directly from the electric company for making ductwork improvements to your existing duct system in the attic. This program ends on December 31, 2013. We will provide necessary rebate forms and supporting paperwork after payment in full. Carrier Instant Rebate This system is eligible for a$900.00 instant rebate from Carrier Corporation(must be purchased by June 30, 2013,installed and paid in full by July 15, 2013.) We are being reimbursed directly from Carrier for providing you this rebate. This is being offered to you as an "instant rebate"that will be deducted from your balance due. Central Cooling& Heating Instant Rebate for QIV Testing The above system is eligible for a$325.00 instant rebate. We are being reimbursed directly from the electric company for performing a QIV start up of the system including an air flow test. In order to get the rebate,the new system must be tested with the outside temperature above 60 degrees. . The testing may be done at a later date,after we install your system,pending on the weather. Cool Smart Electric Company Rebate The above system is eligible for a$500.00 rebate for NStar Electric or National Grid customers only(subject to available funding.) To claim eligible rebates the system must be purchased,installed and paid in full by 12/31/2013. Rebate applications must be received by the electric company before 1/31/2014. It is the customer's responsibility to pursue.available rebates. After system is paid-in-full,Central Cooling&Heating will provide the customer with the appropriate invoice and rebate forms(please allow us 1-2 weeks from the date we start up the system to provide the invoice and rebate forms. System must be paid-in-full before we can provide the required invoice.) Cool Smart Electric Company QIV Rebate The above system is eligible for a$150.00 rebate for NStar Electric or National Grid customers only. This is an additional and separate rebate from the electric is company for performing a QIV start up of the system including an air flow test. In order to get the rebate,the new system must be tested with the outside temperature above 60 degrees. The testing may be done at a later date,after we install your system,pending on the weather. The electric company will mail you a separate check for this rebate,after the QIV test has been performed. Federal Tax Credit The above listed equipment is eligible for a$300.00-2013 Federal Tax Credit(the maximum amount an eligible homeowner may receive in tax credits for"residential energy property"is$500.)The cap is on the total amount of credits a homeowner may claim for purchases between 2006 and 2013,not just for 2013. If a homeowner has already claimed credits of$500 or more through this allowance,they will be unable to claim new credits for improvements made during 2013.We recommend verifying with your tax adviser on how to best take advantage of this tax credit. Your Comfort is Our Priority... Since 1966 Serving The Boston Area (781)932-9017 fax www.centralcoofing.com POOA3of4 Authorized Signature: Date: March 27, 2013 Payment terms,warranty information an home owners responsibility are listed below Notes This proposal may he withdrawn by us if not accepted within 30 days. • Central Cooling and Heating,Inc.agrees to provide a Two(2)year warranty on parts and labor to repair or replace(at our option) any defective materials or equipment. Service agreements are available. • This agreement does not include improvements to your present system except as specifically outlined in your contract. If it is not stated in writing in the contract,than it is not included! • Central Cooling and Heating,Inc. will endeavor to render prompt and efficient service,but it is expressly agreed that the company shall in no event be liable for damage or loss arising out of the performance of this agreement • It is mutually agreed that this agreement does not cover any work required because of negligence,misuse of equipment,or because of fire,flood,acts of God,shortage of electrical or water supply,sabotage,or damage caused by freezing. • The company and the customer agree that any alteration or deviation from the specifications set forth in the contract agreement, including extra costs will be executed only upon written orders,and will become extra charge over and above the contract price. All agreements contingent upon strikes,accidents,or delays beyond our control. • All cooling and heating warranty service to beperformed during normal business hours M-F 7:30AM—4:OOPM. Emergency heating warranty service will be provided only if heat is off completely • The homeowner agrees to have the work areas free and clear of personal belongings,construction materials etc,if this is not the case when our crew appears onsite,you will be billed the necessary time needed to scifely move the articles to make the work area accessible. • Owner to carry fire,tornado and other insurance.Central Cooling and Heating,Inc.workers are fully covered by Workmen's Compensation Insurance • Central Cooling and Heating,Inc.adheres to sound environmental practices relating to the procedures governing refrigerant recovery, recycling,and reclaiming stated in the Federal Clean Air Act. Buyers Rights Option 1: Notice:Any holder of this consumer credit contract is subject to all claims and defenses which the debtor could assert against the seller of goods and services obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the debtor shall not exceed amounts paid by the debtor hereunder. Buyers right to cancel:You may cancel this agreement or purchase by mailing a written notice to the seller postmarked not later than midnight the third business day after the date this agreement was signed. You may use this page as that written notice by writing"I HEREBY CANCEL„ at the bottom and adding your name and address. The notice must be mailed to 9 North Maple Street,Woburn,MA 01801. Option 2:Under the Mechanics lien law,any contractor,subcontractor,laborer,material man or other person who helps to improve your property and is not paid for his labor,service or materials,has a right to enforce his claim against your property. Under law you may protect yourself against such filings,before commencing such work of improvement,an original contract for the work of improvement thereof,in the office of the county recorder of the county where your property is situated and requiring that a contractor's payment bond be recorded in such office. Said bond shall be an amount not less than fifty percent(50%)of the contract price and shall,in addition to any conditions for the performance of the contract,be conditioned in full of the claims of all persons furnishing labor,services,equipment or materials for the work described in said contract. To expedite installation,I hereby waive my right to the 3-Day Recission Law. Payment Terms: Payment terms are agreed upon signing this contract to be 1/3 deposit upon acceptance,progress bills to be submitted at the end of the month to be paid on the I(fh of the following month,balance due to the service technician at the start up of the system. Past due balances will be charged 1 It2%interest charged per month which is an annual percentage rate of 18%on past due amounts.In instances of Punch list incidentals will only be done atter payment is made in full. No service,warrantee or otherwise will be rendered if the customer has a past due balance. I acknowledge that this is a fair and reasonable charge for the above stated work.I undersigned understands the terms and conditions of payment,the Services to be performed as well as my responsibilities as far as having the work area ready and free and clear of personal property. The undersigned shall pay Central Cooling and Heating,Inc.one and one-half percent (1%%)monthly rate of interest on any balances unpaid after 30 days after receipt of invoice plus any and all costs incurred in the collection of outstanding balances whether or not resulting in the initiation of litigation,including but not limited to reasonable attorney's fees. I understand and acxrrrt the terms and conditions of plyment and 1 herby authorize Central Cooling and Heating Inc to proceed with the work as described above and charge my gMdkWAW1hftd below with the Rjyments as W the payment term stated above. Customer signature Date 4/16/2013 Printed name as it appears on your credit card Aaron T Preston Your Comfort is Our Priority... Since 1966 Serving The Boston Area (781)932-9017 fax www.centralcooling.com Central ( ()OiilLoad Short Form Job: & Fieating W. Date: Mar 28,2013 ■■�i■. I.., Entire House By: Central Cooling and Heating, Inc. 9 North Maple St.,Woburn,MA 01801 Phone:(781)933.8288 Fax.(781)932-9017 Email:sales@centralcooling.com Web:www.centralcooling.com License:MAMaster Sheet... Project • • For: Aaron Preston 130 Heath Rd, North Andover, MA Phone: 617-733-0489 Email: atpreston@gmail.com Design Information 141:9 a9 Infiltration Outside db(°F) 9 88 Method Simplified Inside db(°F) 68 75 Construction quality Average Design TD (`F) 59 13 Fireplaces 0 Daily range - M Inside humidity (%) 50 50 Moisture difference(gr/Ib) 44 31 HEATING EQUIPMENT COOLING EQUIPMENT Make Na Make Carrier Trade n/a Trade Model Na Cond 24ABC736 AHRI ref no.n/a Coil FV4CNF005 AHRI ref no.3636962 Efficiency Na Efficiency 17.5 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 1737 cfm Air flow factor 0 cfm/Btuh Air flow factor 0.043 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.95 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) Bedroom 1 192 8497 4627 0 197 Bath 72 2341 1702 0 72 Closet 72 1311 455 0 19 Master 216 6302 2985 0 127 Closet 2 36 389 155 0 7 Ma Bath 84 2180 1196 0 51 Kitchen 240 6540 3734 0 159 Office 224 7376 6394 0 272 Entry 126 3205 1921 0 82 Living 384 17616 13145 0 560 Dining 196 7608 4100 0 175 Hall 88 950 379 0 16 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wr htS(ft2013-Mar-28 12:10:48 Right-Sufte®Universal 2012 12.0.03 RSU15657 P:\Sales\Chad Hams\Preston Aaron DW\Preston Load calc.rup Calc-MJ8 Front Door faces: N Page 1 Entire House d 1930 64315 40792 0 1737 Other equip loads 0 0 Equip. @ 0.93 RSM 37855 Latent cooling 2164 TOTALS 1930 64315 40019 0 1737 R ` I I i Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. I wr ht$ 2019-Mar-2812:10:48 Right-3uifeQ�1 Universal 2012 12.0.09 RSU15857 P:\Sales\Chad Harris\Preston Aaron DW\Preston Load calc.rup Calc-MJ8 Front Door faces: N Page 2 Central t uo,lint; Pro ect Summalw Job: Heating i Summary Date: Mar 26,2013 �� Entine House By: Central Cooling and Heating, Inc. 9 North Maple St.,Woburn,MA 01801 Phone:(781)933-8288 Fax(781)932-9017 Email:sales@cemraoGoling.com Web:www.centralcooling.com License:MAMaster Sheet... Project Information For: Aaron Preston 130 Heath Rd, North Andover, MA ®, Phone: 617-733-0489 Email:atpreston@gmail.com / Notes: Design Inf• • Weather: Lawrence Muni, MA, US Winter Design Conditions Summer Design Conditions Outside db 9 OF Outside db 88 OF Inside db 68 OF Inside db 75 OF Design TD 59 OF Design TD 13 OF Daily range M Relative humidity 50 % Moisture difference 31 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 55882 Btuh Structure 33584 Btuh Ducts 8433 Btuh Ducts 7209 Btuh Central vent(0 cfm) 0 Btuh Central vent f cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 64315 Btuh Use manufacturer's data n Rate/swing multiplier 0.93 Infiltration Equipment sensible load 37855 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 1086 Btuh Ducts 1077 Btuh Heatingg Cooling Central vent (0 cfm) 0 Btuh Area(ft2) 1930 Equipment latent load 2164 Btuh Volume(ft3) 15440 15440 Air changes/hour 0.38 0.20 Equipment total load 40019 Btuh Equiv.AVF(cfm) 98 51 Req.total capacity at 0.70 SHR 4.5 ton Heating Equipment Summary Cooling Equipment Summary Make n/a Make Carrier Trade n/a Trade Model n/a Cond 24ABC736 AHRI ref no.n/a Cal FV4CNF005 AHRI ref no.3636962 Efficiency n/a Efficiency 17.5 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 1737 cfm Air flow factor 0 cfm/Btuh Air flow factor 0.043 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.95 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. i wriplg�.ht"f;t` 2013-Mer-2812:10:48 •Zi RigMSude®Universal 2012 12.0.03 RSU15857 Page 1 P:\Sales\Chad Harris\Preston Aaron DW\Preston Load calc.rup Calc-MJ8 Front Door faces: N i This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17,2009 and Dec 31,2013. I Certificate of Product R AHRI Certified Reference Number: 4648042 Date: 4/16/2013 Product: Split System:Air-Cooled Condensing Unit,Coil with Blower Outdoor Unit Model Number:24ANB748A**30 Indoor Unit Model Number: FE4AN(B,F)005+UI Manufacturer: CARRIER AIR CONDITIONING Trade/Brand name: INFINITY 17 PURON AC Manufacturer responsible for the rating of this system combination is CARRIER AIR CONDITIONING i Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating accuracy by AHRI-sponsored, independent,third party testing: Cooling Capacity(Btuh): 49000 EER Rating(Cooling): 13.10 SEER Rating (Cooling): 16.50 Ratings followed by an asterisk(•)indicate a voluntary rerste of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for; the product(s)listed on this Certificate.AHRI expressly disclaims all Witty for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahrldirectoryorg. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential referencepurposes. The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated;entered into a computer database;or otherwise utilized,in arty form or manner or by any mans,except for the user's individual,personal and confidential reference. CERTIFICATE VERIFICATION The information for the model cited on this certificate can be verified at www.atrri nmtory org, Mr-Conditioning, ", dick on"lle ft Certificate"link and enter the AHRI Certified Reference Number and the date on � w ea(nH ifi ge which the certificate was issued,which Is listed above,and the Certificate No.,which is listed below. ©2013 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE NO.: 130106019153949470 i Aco CERTIFICATE OF LIABILITY INSURANCE P�4'7IDDNYYY)512013 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 endorsement(s). PRODUCER Risk Strategies Company CONTACT NAME: 15 Pacella Park Drive Suite 240 PHONE A/c No Ext: 81-986-440 FAX AIC No: 781-963-4420 Randolph, MA 02368 E-MAIL ADDRESS: R ndol CLD ri k-str a ies.Com INSURERS AFFORDING COVERAGE NAIC# risk-strategies.com INSURER A: Arbella Protection Ins.Co. INSURED INSURER B: Central Cooling&Heating,lnc 9 North Maple St INSURER C: Woburn MR 01801 1 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 16116040 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 TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP LIMBS LTR POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY 8500045287 11/30/2012 11/30/2013 EACH OCCURRENCE $ 1_0_00000 ✓ COMMERCIAL GENERAL LIABILITY PREMISES Ea ocaErrOence $ 100000 CLAIMS-MADE ❑✓ OCCUR MED EXP(Any one person) $ 5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2000000 POLICY ✓ PRO- LOC $ a AUTOMOBILE LIABILITY 15050400003 11/30/2012 11/30/2013 Ee COMBINEDaccidenSINGLE LIMIT $ 1000000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident)AUTOS ✓ AUTOS $ ✓ HIREDAUTOS FVNON-OWNED PROPERTY AMAGE AUTOS Per a.dent $ $ A UMBRELLA LIAB ✓ OCCUR 4600029637 11/30/2012 11/30/2013 EACH OCCURRENCE $ 3000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3000000 DED LJ RETENTION$10000 $ $ TH $ A WORKERS COMPENSATION 00486811-12 11/30/2012 11/30/2013 �/ ORYLIMITS ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500000 OFFICERIMEMBER EXCLUDED? ® N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) HVAC work CERTIFICATE HOLDER CANCELLATION HVAC replacement SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Aaron Preston THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 130 Heath Road ACCORDANCE WITH THE POLICY PROVISIONS. North Andover MA AUTHORIZED REPRESENTATIVE Bernard Gitlin ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 16116040 Brian Dixey 4/25/2013 10:39:53 AM Page 1 of 1 INN Ell ■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■ -,■■■■ ■■!.!■■ ■O■M ■■■■MEN■■■■ EO■■■N■OOM■ MEM■ ' �iiiiiiiiilii■■■■■■■■ ■■■■■■■®■■!i'�■■■11;M■■a■■ ■MAIM■■■■■■■■■■■■■■■■■■■■■ ■■■■■■�_■s�l�■■■■■ ■■ NUMN �■■■ ■OEN on ■■ 0 ■■■E; i , , :1■■■■■■■■■■ ■■■■■■■■■■1■■I■■ ■ ■■ ■■■■ ■■■iii■■■EO■■®■■M■MMM■■■OEMEI 111N■MM ■ ■■ ■ ■■■■■■■■■■■ ■■E■■M■■■M■■■MI 111■■■�i ■ ■ ■ ■r'WOMM■■ ■■■■■■■■■MEMMEMEMEM OM■■■■■1 Immall ■■ ■ ■■■ ■:( � ■■ ■■■E■■■■■■■■■■■■■ ■ ■EIS ■■ ■ ■■■■ ■ _�■. ■NEEM ■■■ ■■■■■■■■■■ ■ ■■��■■ ■■ ■ ■■■■ ■■■■�■1 ■■!!••••!� ■■■■■■■■■■i!■ON/A■ NJ ■■■■■■ on 1I1 ■■ IM"V6 �!■ ■■■■■■■■■■■■:a■�ii■ ■ ■ ■■■■Mom- 1111■M ■■MEMO■■■■■M■IENNO M■M■ MEN■MEANME ME :0 111111111IMMEMISMEM MEEMMEMEMEMPINMEN ■IIMEO■O■OO MEOOM■O■■O■■■i■■■■ No ■ ■■■■■■■■ 11Leiw■■■■Eli iiii■i■,�e■i�ii M.�( ■MM■ ME ■ ■SOMEONE MDE►N, 111.011111/OR 01011 0imu-■M■ow SOMEN N■' ■ ■■OM■■■MME■ MMMMMMMMM■r■■ M■` ■OM■ ■ME ■OO!�M owMEN MME■ M■EN■ MEI�M■ t. ■■■■ ■■■ ■ONO NONEME■■■ M ■■ ■■■ M�:�MM■■■■M ME■M ■■■E MM■■■ ■ ■■m ■■■■■MMEM'�a 'a!� m ■EMM NNE IN ■■■■■■N■■No ■■ MEN■MEMP■■■■ ■� M■ MME■M■M ■ ■ ■■ E ■■■ ■ ■MIINNION ■■ ■ ■■ ■ ■■ ■ MMM ■■ ■■ r�oE■■■■ ■..,.....__a■■■..■�■�■■� ■■i ■i■ =� a01 momm M mmo SENN MMON NEON oi ■■ ■■■■■ ■��■■■■■■■r��■■■■1E■■E■■■ ■ ■ ■�i■ 001 ommomi loommommommunommmom NOIRE ■■■■■■■ ■ MEN■■ ■■■■■■■■�E 111 ■I■I■■m. ■E No MEN ■■■ ■■■■®� ■■■■1�7■■■■ 111 o■I■1■■l1/1■■■ii■■■■■Ill■ ■■■■ ■■N 17 ■■Ori■■■®■■111■■1�1■■��■■■■■■■■I! 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Plumbing Permit $30 each item 978-688-9545 phone Sheet Metal $12 per$1,000 of contract price 978-688-9542 fax hftp://www.townofnorthandover.com/bulding_departmentl.htm 1/8/13 Dixey on phone with Maura Sheet metal permits require the following... Sheet Metal App Copy of License j Workman's Comp Cert of Insurance ( Manual J J VManaaf-B^ "Sheet Metal Permits must be obtained in person by the license holder. You can only pull the permit when the building inspector is in/ the office. His office hours are 8-10am&1 2pm ' 1/9/13 Ed Pollack on phone with building dept. Manual D is not required. The office hours are from 8:30 AM to 4:30 PM. Inspectors for Electrical,Plumbing,Gas office hours are from 7:30 AM to 9:00 AM Any building,electrical,plumbing or gas questions can be addressed during the inspectors office hours. Permit applications are accepted during the hours of 8:30 AM and 4:30 PM. Inspector of Building Gerald Brown Local Building Inspector Brian Leathe Electrical Inspector Peter Murphy Gas and Plumbing Inspector James Diozzi Fire Prevention _ -- Oil Permit $50 J 124 Main Street North Andover,MA 01845 978-688-9590 Fire Prevention Officer Office Hours:Tue-Fri 12:30-2:OOpm Fire Prevention Officer Lt.Fred McCarthy fmccarthy@townofnorthandover.com Plumbing&Gas Department Mechanical Permit N/A 235 North Street Oil Permit North Reading,MA 01864 Gas Permit $30 http://www.northreadingma.gov/Pages/NReadingMA_Building. Plumbing Permit $30 Sheet Metal Residential $30.base fee $5 per supply $5 per return $5 per kitchen hood $5 per duct access door Sheet Metal Commercial $75.base fee (same sub-fees as listed above) *8/23/11 Dixey with Michele Mawn on phone: N.Readnig is not doing this at this time. The inspectors just took their first class this week. They probably won't require sheet metal permits until 2012. Phone:978-664-6040 *2/21/12 Dixey with Michele Mawn Fax:978-644-1713 They are now on board with the sheet metal permit program. t Location f2 No. Date A Q a NOR,N TOWN OF NORTH ANDOVER f?O•,(`•D ,•,hO y G Certificate of Occupancy $ Building/Frame Permit Fee $ �SSACNusEFoundation Permit Fee $ Other Permit Fees{cy $ �� Sewer Connection Fee $ i � M Water Connection Fee $ TOTAL $ �( Building Inspect Div. Public Works I'I;RMIT NO. �� APPLICATION FOR PERMIT TO TII ANDOVER, NTA �T1.N I'Nl).E LOT NO- 2. RECORDOFON'NntSIIII' DATE BOOK PACE LON l: SIIII DIN'. LOTNO. /�� ITh' I-ru:\ru)N PuurosF:of Buu.nwG 7-4 1 NO.OF sroRlFs SIZE 0\\'NF'.lt'S:IDDRF:SS(/�4�M—�—�l- BASEMENT ORSLAD Alct'lllI'FCI'S NATI F: SIZE OF FLOORTINIDEIts j 1 2ND 3Ro _111111"DL.ICS NAT I E / ]QUI V /! �/ ,� r a J SPAN - MS1'ANCE10NEARES-1-IMILDINC Dli\IENSIONSOFSILLS I)LSEANCF FROM SIIiEET DIMENSIONS OF POSTS DIS IANCEFROM1.01'LINES-SIDES REAR DIMENSIONS OFGIRDERS MEA OF LOT FRONTAGE IIEIGIITOF FOUNDATION T111CKNESS IS BUILDING NEW SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CIIITINEV IS IMILDINC ALTERATION IS BUILDING ON SOLID OR FILLED LAND \PILI.BUILDING CONFORM TO RE0111RENIENTS OF CODE ��� IS BUILDING CONNECTED TO TOWN WATER• BOARD OF APPEALS A'-IION, IF ANN' IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING:CONNECTED TO NATURAL.GAS LINE INS"I'IICYIONS 3. PROPERTY INF'ORNIATION LAND COST - - - — EST. BLDG.COST i'\CL I FILL.OIIT SECTIONS 1-3 EST.BLDG.COST PF.It SQ. FT. EST. BLOC.COS"f PER ROOM FLFCTItIC i\IF:TF:RS Ni IIS"1'nE ON OUTSIDE OF BIIILDINC SEPTIC PLIMITNn. .N"FI".Wit ED C;A It.1CFS III UST"CONF011Tt TO STATE FIRE RECIILATIONS 4. APPROVED BY: 1NS TILIST BE PILED AND APPROVED B\'IMILDING INSPECTOR BUILDING INSPECTOR 1)\LE FILED OWNERSTE1.11 w f CONTR.TEt-H CONT11.1.101 SICNA I'IIRF. OF OWNFR Olt All-IIIORIZED AGENT OQ 11.I.C.11 6 - I'I:RTI I"I'CR:W'IED Revised 5/s/99 .01 w a BUELDING DEPARTMENT DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: r S' S Location of Facility Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector f. , _ HOME IMPROVEMENT CONTRACTOR j Registration 104569 } Type - PRIVATE CORPORATION Expiration 01/14/00... 4 DAVID CASTRICONE ROOFING, SID . ,s David T. Castricone . llside Road S,D STRATOR Boxford MA01921 c I ,t i I i I 1 0 J � a - h�.fi ^}�' ? x _� NORTH F fTown of3. Ldover Otl c^ No. 4106 rt o dover, Mass., C OC HIC MEWICK V ADRATED P' "\Ll � S 5 BOARD OF HEALTH PE M 'T27 1 11 ai Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.... .........................�' ...... Foundation has permission to erect. .., ?' buildings on ..... #aazz...... ............ i Rough to be occupied as-A-1 ........ ... ..... .. '. ....................... _........ ................ .......... .............. ...... ..... ............. ......... _ ......... . provided that the person accepting ti~�<i parimit s)3d;i ill avaiy fdspuLi t.ualorin to iito iunlis of the. dppiiGd6u1_i oil ilii: ill Finai 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 PERMIT EXPIRES TN 6 !ti ON_FH(� Final -- r - ................................................................................................................. Service BUILDING INSPECTOR Final � -- -- - - - - _ I Rnuph Display in a 101onspi+Cuous i lace, a die. i-Ifamis6s — 1ju Nut i tjiiiuve, i Final No L athinrn nr nrAt W-all Tn Qn nnr:n ---- - _: Until InspeC,1ad and Ajjvi ovt:Li uY Liiid L,uilluilij iii:,VGL us . Burner Street No. CCC C?C\ /rnc�r- �`ir�t- C•.,,.�,. i�... 3026 Date. ....... .. ........ L= f N�oT" � TOWN OF NORTH ANDOVER ti0 a Fr • `p PERMIT FOR GAS INSTALLATION o ,SSACHUSEt This certifies that . . . ... •— . M has permission for gas installation . . . . . . . . .•o• in the buildings of . �. �` . . . . . . . . . . . . . . . . . . . �. at . . . . . . . . . . . . .. North Andover, Mass. ter/ Feer. . .. . . Lic. No*Agz,10. . . . . . . . . . . . . . . . . . . . . . . . ... . . . GASINSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer 4 . MASSACHUSETTS UNIFORM APPLICATION FOR PERMi� TO DO GASFITTiNG (Print or Type) yam. Mass.. .Date d ^ :.19rL Permit a Building Location ���d \ Owner's Name Type of Occupancy --•� New ❑ Renovation ❑ Replacement p— Plans Submitted: Yes❑ ;_ No ❑. N LC 4I W' H • . Y S � W W W X O U 1C T. 71 N C Z m .(a }u w d d c e r 11 C W X v W W -C 99 Y in �-• S W ' J ! W 1z c C W W V y Q < W > ¢ W O < s < O O tri O F- > SUB-8SMT. BASEMENT 1STFLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR I 7TH FLOOR 8TH FLOOR Installing Company Name Check one: Certificate >t Address G' O Corporation ❑ Partnership Business Telephone y Firm/Co. Name of Licensed Plumber or Gas Fitter 6 —, INSURANCE COVERAGE: I hive a current Iiabli#y insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Yes LAY No ❑ ' If yo?u have checked yes, please indicate the type coverage by checking the appropriate boar A liability Insurance policy CDS— Other type of indemnity O Bond O OWNER'S INSURANCE WAIVER: I 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 above application are true and accurate to the best of my knowledge and that an plumbing work and InslallaUons performed under the AGeraf for this application be In compila with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 oLaws.T e of Ucense: Plumber cense um er or as titer Title rller � s} /jy0 aster License Number APY� Journeyman Date.3,l.?./.O. . ..... . NORTH Of .�ao 14.° TOWN OF NOR�,�HA DOVER Vigo\ ° b • PERMIT FOR GAS INSTALLATION �,SSACHUSE� This certifies that . . . . . . . . . . . . . . . . has permission for gas installation . .h- *.Cr: . . . -�. . in the buildings of . /r < . . . . . . . . at . . . . .�.. . Fl. . 2 1` . . . . . . . . North Andover, Mass. Feer)- ).,.- . . Lic. No.. ASINSPECTOR Check# /)GI L 6359 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING 2 (Print or Type) K)0111 N AlAOVC2 . Mass. Date3/11/ $ Permit # ?J Building Location 13 0 HEA V H RD Owner's Name HA kr CA /2OLL Type of Occupancy 2NS/ OCNT/RL —Slmc, t,E New ❑ Renovation ❑ Replacement ❑ Plans Submitted: Yes❑ No ❑ N I-- a Y W N U N wtlza H cF- U0 j W zoo o :3 0 to W F si N> V W O W W f FZr- yS RwWr wwocmix cc W d �, W W tl 0 > U. }- U J �H�++ W Y Q W < C H Y� N M 2 O 2 W O fA = Q W > W O 2. Q Cr Q cc '.S 010 Y LL 3 C tl J U 6 F� O SUB—BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: certificate # Address 55 MARSTON STREET �❑ Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone 9 71B-68,7-1105 ❑ Firm/Co Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142. Yes 9, r!o ❑ If you have checked ve, please indicate the type coverage by checking the appropriate box. A liability Insurance policy P< 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 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 ❑ 1 hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accuWe to the best of my knowledge and that all plumbing work and installations performed under the permit Iss f r this application will n mplianoe with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene S. (� i By T e of License: Plumber Signature of Licensed Plumber or Gas Title Gasfitter Master License Number 3745 City/Town Journeyman O IC SFO L BELOW FOR OFFICE USE ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO ADO GASFITTING NAME & TYPE OF 13UILDING LOCATION OF BUILDING PLUMBER OR GASFITTER. LIC. NO. PERMIT GRANTED DATE ...19 GAS INSPECTOR