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Miscellaneous - 14 Longwood Avenue (2)
14 LORRAINE AVENUE 210/047.0-0001-0000.0 i I Date.Ao/ .............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING gsACHU This certifies that ............................................� ...................................... has permission to perform ...)�.Olt ........ ............................... .. ............................................. wiring in the building of....... . . .......L.tJq-..�.............................. ........... at ........1.4....... ..........X.o...................-, Prth Andover,Mas2- ...... ............. ..................... ........... Fee.................. ......Lic. No- m ."4:......... ..... ELECTRICAL INSPECTOR Check 0 L 1 9 7 7 I� Commonwealth of Massachusetts Official Use Only Permit No. I i Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [R BOARD (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: �6�,3 o L 1 I li 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)_ & „- Owner or Tenant 1�� l��f�d Telephone No. q 7f-a(es- 76 yl Owner's Address p, 0 I3ox y6.3 Is this permit in conjunction with a building permit? Ys 2- No ❑ (Check Appropriate Box) Purpose of Building S;r r k -pay Ax Utility Authorization No. S - Existing Service Amps / Volts Overhead ❑ Undgrd No.of Meters New Service Qao Amps I7.o/ bZ 40 Volts Overhead❑ Undgrd Q' No.of Meters II_ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: P Q VAoti$,d Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA 4o.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ NO-50-FEmergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No, of Zones No. of Switches No.of Gas Burgers No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No. of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal ❑ Other p g Connection No.of Dryers Heating Appliances KW Securityo Systems:* s Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Nod Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent O 'HER: Attach additional detail if desired,or as required by the Inspector of YYires. Estimated Value of Electrical Work:/t 10 0c (When required by municipal policy.) Work to Start: le 31 j3 Inspec—tions 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 c7BONDE] age is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: .QrCt 0 I(.-Vo a.ra; LIC.NO.:^/to 17 3 Licensee: _ � 1CjII.Ex.j jI Signature �® LIC.NO.: ab�{'35 A (If applicable,enter "exempt"in the li nse number line) Bus.Tel.No.-fj7F-7&7-(>79 8 Address: Qq Si fuer dret)V, JZA .-Su Le vrt AN 03x7 el Alt.Tel.No.: *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:$ 2A, 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: 'french Ins a tion Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: n., J Inspectors Signature: Date: PARTIAL,ROUGH INSPECTION:. Pass IN Failed Re-Inspection Required($.)❑ Inspectors Comments: f sZbas Inspectors Signature: Date: ROUGH INSPECTION: Pass r� Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments Inspectors Signature: Date: ]FINAL INSPECTION:,- Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimae.com J 1 • The Commonwealth of Massachusetts Department of Industrial Accidents Dep . Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name(Business/Organization/Individual): rcL, 16.1�ly cA Address: aq S u-e( brook )2A Sa�,YVL A/ 030-79 City/State/Zip: Phone#: 7,F- 2& -7-ol cy q 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. E]New construction grfiployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.[i 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 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 their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. ,�n Insurance Company Name:. 114, P_ Kolae f JS T.NS _ A &CY Policy#or Self-ins.Lic.#: ea g09(Q C,j 0 j Expiration Date:? Job Site Address:�l /_or rw. %_e A►v.p IV AY\c�uv of City/State/Zip:_AAA D 1 IS— Attack a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failuire to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine dip 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 uprto$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. g g X do hereby certlo un_der thee pains and penalties of perjury that the information provided above is true and correct. - Signature: Date: _ 14>13o 3 Phone#: 97do— "?(v7 - Q ZQ X- 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#: �r �. i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint.enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or loeal 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 tM 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 lf insurance license number on the appropriate line. City or Town Officials " Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture ' (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA.02111 Tel,#617-727-4900 ext 406 or 1-877rMASSAFE Revised 5-26-05 Fax 4 617-727-7749 www.m.ass,gov/dia t 315 Date.`. . .� .�.- ..... TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION F, F � o s 9v �'Iss USEt•( This certifies that . .�. . . . . . "T"""'.?. . . . . i . . . • . .�"" . has permission for mechanical installation. . . . . 'j r Ic- . . A . . . . . . . . . in the buildings of . .4!�. . . . L. !�.^'` � .' . . . . . . . . . . . at . . .It . . . . . .Lo.�.�'.t.`�'t. . �`. ., Nor t Andover, Mass. Fee. Lic. No.. . . . . GASINSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit gJ Date: j/ -/S -/3 Permit# c Estimated Job Cost: $—Y dU U Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# cj Applicant License # G Business Information: Property Owner/Job Location Information: Name: 6A I ' d. t,�,„ti,s Name: 'd r e Street: 1,r7 A r l T Street: L o V a i h e ,A Li -e— City/Town: QuC,ra.Jf" HA 01 8 L� City/Town: tVa.y-4 Aj,,,Qov--cv, py A 0441s Telephone: Telephone: y?i- - 54-1- 13 /V Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial iI-1 /M-1-unrestricted license J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square rootage: under 1.0,000 sq. ft. -/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: Nu'T w o �T S 7 �, INSURANCE COVERAGE: ! I 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 El Bond El 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 I By checking this boxE1,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 Progress Inspections Date Comments I i i. f Final Inspection Date Comments i Type f'License: � By Master Title El Master-Restricted Cityrrown ❑Journeyperson Signature of Licensee � Permit# ❑Journeyperson-Restricted License Number: / JT to e Fey$ ❑ Check at www.mass.gov/dpi Inspector Signature of Permit Approval The Commonivetllt/l o/Massachusetts Print Form Department of Industrial Accidents' �' •r P ,yy O�flce O!.Invest!-allolls 1 Con,,ress Street, Suile 100 _ j:. Boston i1IA 02.114-20.17 ►wlIll I,.nlasS.-ov/dia Workers' Comf)cnsation h1surance Affidavit: 13uildcrs/Contractors/Electricians/Plumbers p aplicant Informsttion Please Pr int LCOl ly Name (t3nsincss/Org;tniz,llion/II,(,ivill it,,,1): .I&j Heating & Air. Conditioning, Ibc. Aciclress:__ —17 Ar]-ington.St. City/Stale/'Lip: I. i).r icut, MA 0.1826 Phone#: 978-454-8197 Arc you an cn)ploycr? Cliccl(the appropriate box: Type of )mice! rer aired YI I .I ( 1 4. 1 am a _eneral contractor alld I ) 1. x❑ I am a en)plo�er with _FO_ ❑ g employees(full and/or part-time).* have hired the sub-contractors 6. New conshuction 2.❑ 1 aill a sole proprietor or partner- listed on the attached sheet_ 7. ❑ Remodeling ship and have no employees These sob-contractors have 8. E] Demolition working [br ale in any ci:ipacil.y. employees and have workers' [No workers' con)p. insurance comp. insurance.t 9• E] t3uilding addition required.] 5. ❑ We are it corporation and its 10.0 Electrical repairs or additions 3.❑ I and it h0111cOWlie"doing all work officers have exercised their1 I.❑ Plumbing repairs or additions myself. [No workers' comp. right ofexenlption per MGL 12.❑ Roof repairs insurance rccluired.] i c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other C01111). insurance required. Any applicant That checks box 111 Must also I'll]out the scclion below showing their workers'compellsatloll policy Irllol'lll;llion. I.I lonicownel:s who submit(his'all'idavil indiatling they arc doing;ill work and then hire oulside colli, ors Illtlst subnll(a Ile\v; ACORD, CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YVVY) PRODUCER 978 887 4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION3 Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. 0, Box 457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Topsfield, MA 01983 INSURERS AFFORDING COVERAGE _.SU ..._.__...-- ----------- --- _-.._._._-------- NAIC 1! INSURED J&] Ilea & Air Conditioning, Inc. - j INSURERA: Great American Alliance Ins Co ].7 Arlington Street wsURERB: Safety Insurance Company 39454 Dracut, MA 01826 INSURERc: A.I.M. Mutual Insurance Co. INSURER D: INSURER E: COVERAGES l'FIE POI_ICII=S OP INSLIRANpFim HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY 13EOUINEMEN"F,TERM F ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURABY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POUCII_S.AGGREGATE LIMHAVE BEEN REDUCED BY PAID CLAIMS.LTR NSR TYPE OF INSUPOLICY FFFECTTVE POLICY FXPIRATION POLICY NUMDFR DATE MM DD VVVY DATE MM DD YVY LIMITS GENERAL LIADIU7Y PAC6418906-07 06/01/2013 06%01/2014 EACH OCCURRENCE $ 1,000,000 X C:OMMPRCIAL GENERAL LIABILITY DAMATE 10 RENTED CLAIMS MADE OCCUR PREMISES Eo occurronco)_ $ 300,000 I-X l A MED EXP(Any one person) _ $ 10,000 — -- - '"---'------ PERSONAL 6 ADV INJURY $ 1,000,000 _.-.-..._.._..._.....__._._..____.__.._....................... GENERAL AGGREGATE $ 2 000 00 GEN'L AGGHEGAl1=I,.IMI'F APPIJES PER: -' —_ P01_ICY --_-- JECT I.00 PRODUCTS-COMP/OP AGG $ 2,000,0000 AUTOMOBILE LIARILITY 2434550 06/01/2013 06/01/2014 ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) A _ 1,000,000 ALL OWNED AUTOS --- X II SCI II-DULEDAUTOS BODILY INJURY $(Per person) X HIRED AUTOS — X NON-OWNE1.)AUTOS BODILY INJURY $ -- (Per accident) -------- ----- PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANV AUTO AUTO ONLY-EA ACCIDENT $ -" OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELUA LIAB UMB6419958-05 06/01/2013 06/01/2014 EACH OCCURRENCE $ 2,000,000 .X_-�OCCUR CLAIMS MADE AGGREGATE $ 2,000 00 - I)EDUG,'IBI_E RFTENTION $ WORKFr13 COiiTFNSA T1 Ni AND rMPLOVF.RS'LIARILII-Y WMZ-800-8006553-2013A 06/02/2013 06/02/2014 X TORY LIMITS ER ANYI'ROPRIF..7pI11PARTNI=n/FXECU'rIVF-(Y N - C OFFI(.FR/MFMRI_R EXCLUDE.)? I�-JI E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NIQ �I yes, or,", IV,under E.L.DISEASE-EA EMPLOYEE $ 1,QQQ,00 .;PECIAl-PROVISIONS br..low -- — OTIIFR E.L.DISEASE-POLICY LIMIT ], 000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CEf?TIFICATE FIOLDEft CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence of ]Insurance AUTHORIZED REPRESENTATIVE ACORD 25 009/01 Peter Sennott/AAM ©1980-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Y./ ��4 SI`'A'C�l[,><J I;�B" DRIVER'S LICENSE r,15� kiA Ra ENo"D 4d NUMIRER 05-0M zo�� " �''S99655871 fy I,y§-. � AI FJIP ,t I DOR i I I 1:: `. KRM-41055 „?�2r 016 05'zZZ�l9 �Q r. h Y f1 EIASS 12 REST 1 SEX M �fT I1g wt" lI l{DM NONE t.;KLINE' z ERIC RJ 1��bd'kkl§e4'` � ' a 83 LONG DR d y " DRACUT,MA 01826-2048 5 DD0SO42011 Rev 0710008 '�/ COMMONWEAE_TH OF MASSACHUSETTS. USETTS d 43. SHEET ME T o.►. WORKERS AS A MASTER-MUSTRICTED ISSUESTM:ABOVE I_IGU.NSF TO' ERIC R KLINE I �c' J J HEATING 17 ARLINGTON ST DRACUT MA 01826=393 ;- 1568 05/28/14 ]�; 4 I I I i COMMONVVEALTH OF MA$SACHU:SETXS `A$°A QUSINESS ISSUES THE BOVC i_icENS rO 1=.)4IARD AYOTTE. J J °11E.ATING .; /1T12 ' CID ND. :ITION,IN 1.7 ARL LaJGTON ;STR.E,E1 w:. N URACLJT MA U 182, 1315 ``.19G 01/19/14 ' 9527 i - wrightsoftm Load Short Form Joe: Oct o2013ne Entire House By: J&J heating and Air Conditioning 17 Arlington st, Dracut,ma 01826 Phone:978 454 8197 For: Kindred home Lorranie av, North Andover, Ma s Htg Clg Infiltration Outside db (°F) 12 88 Method Simplified Inside db (°F) 68 75 Construction quality Tight Design TD (°F) 56 13 Fireplaces 1 (Average) Daily range - L Inside humidity (%) 50 50 Moisture difference (gr/Ib) 43 28 HEATING EQUIPMENT COOLING EQUIPMENT Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 80AFUE Efficiency 0 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 1280 cfm Actual air flow 1280 cfm Air flow factor 0.038 cfm/Btuh Air flow factor 0.044 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.88 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) Living room 304 3891 3697 148 161 Kitchen 250 3223 1668 122 73 powed room 70 878 1069 33 47 entry 176 1708 485 65 21 bedroom 3 153 3476 3543 132 154 bedroom 4 177 3276 3526 124 153 bedroom 2 151 3145 4056 119 177 bath 1/2 72 1239 1523 47 66 laundry 60 1053 2058 40 90 master bath 76 1247 1529 47 67 closet 51 588 184 22 8 master bedroom 469 9296 5799 353 252 2nd floor hall 118 716 285 27 12 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wri htsaft� 2013-Nov-14 07:09:36 9 Right-Suite@ Universal 2013 13.0.07 RSU05790 Page 1 ..rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N Entire House 2126 33737 29422 1280 1280 Other equip loads 4618 2389 Equip. @ 0.93 RSM 29457 Latent cooling 4313 TOTALS 2126 38355 33770 1280 1280 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wri htsoft" 2013-Nov-14 07:09:36 9 Right-Suite®Universal 2013 13.0.07 RSU05790 Page 2 ACCk ..rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N WC19�1tSOft® Building Analysis Job: 41 Lorranine Date: Oct,2013 Entire House By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 4548197 For: Kindred home Lorranie av, North Andover, Ma Location: Indoor: Heating Cooling Boston Logan Int'l AP, MA, US Indoor temperature (OF) 68 75 Elevation: 30 ft Design TD (OF) 56 13 Latitude: 420N Relative humidity 50 50 Outdoor: Heating Cooling Moisture difference (gr/lb) 42.7 27.8 Dry bulb (OF) 12 88 Infiltration: Daily rangeFS°F) - 15 ( L Method Simplified - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 ?Average) Component Btuh/ft2 Btuh % of load Walls 3.9 8820 23.0 Glazing 31.7 7606 19.8 yj Doors 21.7 607 1.6 Ceilings 1.6 2073 5.4 Floors 1.6 1269 3.3 W' % Infiltration 4.1 9717 25.3 Ducts 9.5 3643 Y" -4 Piping 0 0 Humidification 4618 12.0 Ventilation 0 0 Adjustments 0 Total 38355 100.0 Component Btuh/ft2 Btuh % of load Walls 0.9 2074 6.5 Glazing 56.2 13495 42.4 Doors 10.3 289 0.9 Ceilings 1.4 1865 5.9 Floors 0.4 288 0.9 Infiltration 0.9 2092 6.6 Ducts 4170 13.1 Ventilation 0 0 Internal gains 5150 16.2 Blower 2389 7.5 Adjustments 0 Total 1 1 31811 1 100.01 0. Latent Cooling Load 4313 Btuh e Overall U-value= 0.076 Btuh/ft2-'F Data entries checked. wrightsoft- 2013-Nov-14 07:09:36 Right-Suite@ Universal 2013 13.0.07 RSU05790 Page 1 ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N COMPO Constructions Job: 41 Lorranine wrightsofto Date: Oct,2013 Entire House By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 454 8197 For: Kindred home Lorranie av, North Andover, Ma Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) i Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2--F ft2-°FBtuh Btuh/ft2 Btu Btu h/ftz Btu Walls 12F-Osw: Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" n 96 0.065 21.0 3.61 347 0.99 95 gypsum board int fnsh,2"x6"wood frm a 432 0.065 21.0 3.61 1561 0.99 430 s 404 0.065 21.0 3.61 1460 0.99 402 w 516 0.065 21.0 3.61 1865 0.99 513 all 1448 0.065 21.0 3.61 5233 0.99 1440 15B-10sfc-2:Bg wall,light dry soil,concrete wall,r-10 ins,8"thk n 276 0.061 10.0 4.40 1215 0.78 216 e 264 0.061 10.0 4.39 1160 0.77 204 s 96 0.061 10.0 4.41 423 0.79 76 w 180 0.061 10.0 4.38 789 0.77 138 all 816 0.061 10.0 4.40 3587 0.78 634 Partitions (none) Windows 1D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, n 12 0.570 0 31.7 380 17.9 214 1/4"thk a 84 0.570 0 31.7 2662 59.7 5017 e 24 0.570 0 31.7 761 59.7 1433 s 12 0.570 0 31.7 380 31.7 380 w 84 0.570 0 31.7 2662 59.7 5017 w 24 0.570 0 31.7 761 59.7 1433 all 240 0.570 0 31.7 7606 56.2 13495 Doors 11 DO:Door,wd sc type a 28 0.390 0 21.7 607 10.3 289 Ceilings 1613-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 469 0.032 30.0 1.78 834 1.60 750 r-30 ceil ins 1613-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 857 0.026 38.0 1.45 1239 1.30 1114 gypsum board int fnsh 2013-Nov-14 07:09:36 wrightSOW Right-Suite(g)Universal 2013 13.0.07 RSU05790 Page 1 ACCK ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N Floors 19A-30bswp:Part floor,hrd wd flr fnsh,r-30 ins,frm flr,10"thkns 800 0.034 30.0 1.59 1269 0.36 288 V .: WCI htsoft 2013-Nov-14 07:09:36 9 Ri ht-Suite®Universal 2013 13.0.07 RSU05790 g Page 2 ACCA ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N wri htsoft- Component Constructions Job: 41 Lorranine g Date: Oct,2013 Living room By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 454 8197 ::�. - ®• ®^ 0 ,.,, .,z�': <5{s "`a" 7- _ For: For: Kindred home Lorranie av, North Andover, Ma 121�fi %'.. D. •. •. 0 < s.r s °,a 9 �,�, w<n as M;, 5 dt ix Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 '?Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/fiz-°F ft2-°F/Btuh Btu hN Btu Btuh/ft2 Btu Walm 12F-Osw:Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" a 148 0.065 21.0 3.61 535 0.99 147 gypsum board int fnsh,2"x6"wood frm s 112 0.065 21.0 3.61 405 0.99 111 w 16 0.065 21.0 3.61 58 0.99 16 all 276 0.065 21.0 3.61 997 0.99 274 Partitions (none) Windows 1 D-clow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, a 36 0.570 0 31.7 1141 59.7 2150 1/4"thk Doors (none) Ceilings (none) Floors 19A-30bswp:Part floor,hrd wd fir fnsh,r-30 ins,frm fir,10"thkns 304 0.034 30.0 1.59 482 0.36 109 I I jrF 2013-Nov-14 07:09:36 wrightsoft" Right-Suite@ Universal 2013 13.0.07 RSU05790 Page 3 ACCK ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N Component Constructions Job: 41 Lorranine wrightsoft- Date: Oct,2013 Kitchen By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 454 8197 � �. Emu �< For: Kindred home" Lorranie av, North Andover, Ma LA Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method , Simplified Wet bulb (°F) - 72 Construction quality Tiht Fireplaces 1 ?Avera Wind speed (mph) 15.0 7.5 Fire e p ( 9 ) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ftz-°F/Btuh Btuh/112 Btu Btuh/ftz Btu Walt`s 12F-Osw:Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" s 68 0.065 21.0 3.61 246 0.99 68 gypsum board int fnsh,2"x6"wood frm w 188 0.065 21.0 3.61 679 0.99 187 all 256 0.065 21.0 3.61 925 0.99 255 Partitions (none) Windows 1 D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, s 12 0.570 0 31.7 380 31.7 380 1/4"thk w 12 0.570 0 31.7 380 59.7 717 all 24 0.570 0 31.7 761 45.7 1097 Doors (none) Ceilings (none) Floors 19A-30bswp:Part floor,hrd wd fir fnsh,r-30 ins,frm fir,10"thkns 250 0.034 30.0 1.59 397 0.36 90 2013-Nov-14 07:09:36 - wrightsoft* Right-Suite®Universal 2013 13.0.07 RSU05790 Page 4 �� ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N wrightsoft- Component Constructions Job: 41 Lorranine Date: Oct,2013 powed room By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 454 8197 V at _z� A Nz For: Kindred home Lorranie av, North Andover, Ma F, Location: Indoor: Heating Cooling Boston Logan I nt'l AP, MA, US Indoor temperature (OF) 68 75 Elevation: 30 ft Design TD (OF) 56 13 Latitude: 42'N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/lb) 42.7 27.8 Dry bulb (OF) 12 88 Infiltration: Daily range (OF) - 15 ( L Method Simplified Wet bulb ( OF) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 ?Average) Construction descriptions Or Area LI-value Insull R Htg HTM Loss Clg HTM Gain W Btuh/112-ol` ft2-oF/Btuh BtuhM Btu h Btuh/ft2 Btu h Walls 12F-Osw:Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" w 44 0.065 21.0 3.61 159 0.99 44 gypsum board int fnsh,2"x6"wood frm Partitions (none) Windows 1 D-c2ow:2 glazing,clr outr,air gas,wd frm mat,cir innr,1/4"gap, w 12 0.570 0 31.7 380 59.7 717 1/4"thk Doors (none) Ceilings (none) Floors 19A-30bswp:Part floor,hrd wd f1r fnsh,r-30 ins,frm f1r,10"thkns 70 0.034 30.0 1.59 ill 0.36 25 2013-Nov-14 07:09:36 wrightSOft' Right-Suite®Universal 2013 13.0.07 RSU05790 Page 5 ACCP, ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N Component Constructions Job: 41 Lorranine - - wrightsoft� Date: Oct,2013 entry By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 4548197 For: Kindred home Lorranie av, North Andover, Ma LEE EM-77 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 ) Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Cig HTM Gain ft2 Btuh/ft2-°F ft�-°F/Btuh Btuh/ft2 Btu Btuh/ftp Btu Wales 12F-Osw:Frm wall,wd ext, 1/2"wood shth,r-21 cav ins,1/2" n 16 0.065 21.0 3.61 58 0.99 16 gypsum board int fnsh,2"x6"wood frm a 60 0.065 21.0 3.61 217 0.99 60 s 16 0.065 21.0 3.61 58 0.99 16 all 92 0.065 21.0 3.61 332 0.99 91 Partitions (none) Windows (none) Doors 11 DO:Door,wd sc type a 28 0.390 0 21.7 607 10.3 289 Ceilings (none) Floors 19A-30bswp:Part floor,hrd wd fl fnsh,r-30 ins,frm fl r,10"thkns 176 0.034 30.0 1.59 279 0.36 63 2013-Nov-14 07:09:36 ,„ wrightsoft°' Right-Suite@ Universal 2013 13.0.07 RSU05790 Page 6 )9M ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N wri htsoft- Component Constructions Job: 41 Lorranine Q Date: Oct,2013 bedroom 3 By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 4548197 a s a For: Kindred home Lorranie av, North Andover, Ma uv° ,,a,. - ,>x.. ,r ya . " p • • • • t u.,� �4 ,g?°:- s�v. `r y 1 7 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative.humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ft2-°F/Btuh Btuh/ft' Btu Btu h/ft2 Btu Walirs 12F-Osw:Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" a 96 0.065 21.0 3.61 347 0.99 95 gypsum board int fnsh,2"x6"wood frm s 88 0.065 21.0 3.61 318 0.99 88 w 16 0.065 21.0 3.61 58 0.99 16 all 200 0.065 21.0 3.61 723 0.99 199 Partitions (none) Windows 1 D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, a 24 0.570 0 31.7 761 59.7 1433 1/4"thk Doors (none) Ceilings 1613-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 153 0.026 38.0 1.45 221 1.30 199 gypsum board int fnsh Floors (none) wri htsoftA 2013-Nov-14 07:09:36 .� 9 Right-Suite@ Universal 2013 13..0.07 RSU05790 Page 7 ACCK ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N Component Constructions Job: 41 Lorranine wrightsoft� P Date: Oct,2013 bedroom 4 By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 4548197 For: Kindred home Lorranie av, North Andover, Ma Mill 121 ZW - r Location: Indoor: Heating Cooling Boston Logan Intl AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Dally range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Cig HTM Gain ft2 Btuh/ft%-°F ftz-°F/Btuh Btuh/ftz Btu ROM Btu Wale's 12F-Osw:Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" n 32 0.065 21.0 3.61 116 0.99 32 gypsum board int fnsh,2"x6"wood frm a 128 0.065 21.0 3.61 463 0.99 127 s 16 0.065 21.0 3.61 58 0.99 16 all 176 0.065 21.0 3.61 636 0.99 175 I Partitions (none) Windows 1D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, e 24 0.570 0 31.7 761 59.7 1433 1/4"thk Doors (none) Ceilings 16B-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 177 0.026 38.0 1.45 255 1.30 229 gypsum board int fnsh Floors (none) I I 1 -{d�} Wr1 htsoft° 2013-Nov-1407:09:36 x 9 Flight-Suite(P)Universal 2013 13.0.07 RSU05790 Page 8 '10M ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N I Component Constructions Job: 41 Lorranine W rightsoft� P Date: Oct,2013 bedroom 2 By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 454 8197 For: Kindred home Lorranie av, North Andover, Ma � •.�+ {0.r a 9��� ye."�� S` »,hga ..�.:c, a7'° �.d Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) s Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ft2-°FBtuh ROM Btu Btuh/ft2 Btu Wars 12F-Osw:Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" s 104 0.065 21.0 3.61 376 0.99 103 gypsum board int fnsh,2"x6"wood frm w 64 0.065 21.0 3.61 231 0.99 64 all 168 0.065 21.0 3.61 607 0.99 167 Partitions (none) Windows 1D-c2ow:2 glazing,cir outr,air gas,wd frm mat,clr innr,1/4"gap, w 24 0.570 0 31.7 761 59.7 1433 1/4"thk Doors (none) Ceilings 166-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 151 0.026 38.0 1.45 218 1.30 196 gypsum board int fnsh Floors (none) I i 2013-Nov-14 07:09:36 wrightsoft^ Right-Suite(g)Universal 2013 13.0.07 RSU05790 Page 9 ACCK ..rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N k Component Constructions Job: 41 Lorranine wrightsoft� Date: Oct,2013 bath 1/2 By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 454 8197 For: Kindred home A Lorranie av, North Andover, Ma ?,,' :,. Q • '0 iso 0 - v $ §t sk s Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain W Btuh/Rz-°F ft2-°F/Btuh Btuh/V Btu Btu h/ftz Btu Wal Ls 12F-Osw: Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" w 52 0.065 21.0 3.61 188 0.99 52 gypsum board int fnsh,2"x6"wood frm Partitions (none) Windows 1D-c2ow:2 glazing,clr outr,air gas,wd frm mat,cir innr,1/4"gap, w 12 0.570 0 31.7 380 59.7 717 1/4"thk Doors (none) Ceilings 16B-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 72 0.026 38.0 1.45 104 1.30 94 gypsum board int fnsh Floors (none) i 2013-Nov-14 07:09:36 - wrightsoft^ Right-Suite@ Universal 2013 13.0.07 RSU05790 Page 10 j ACCK ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N Component Constructions Job: 41 Lorranine wrighfisoft� Date: Oct,2013 laundry By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 454 8197 For: Kindred home Lorranie av, North Andover, Ma Location: Indoor: Heating Cooling a Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area LI-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ftz-°F ft2-°F/Btuh Btuh/ft2 Btu Btuh/ft2 Btu Wal°irt 12F-Osw: Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" w 36 0.065 21.0 3.61 130 0.99 36 gypsum board int fnsh,2"x6"wood frm Partitions (none) Windows 1 D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, w 12 0.570 0 31.7 380 59.7 717 1/4"thk Doors (none) Ceilings 16B-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 60 0.026 38.0 1.45 87 1.30 78 gypsum board int fnsh Floors (none) t Wrl htSoft° 2013-Nov-14 07:09:36 9 Right-Suite®Universal 2013 13.0.07 RSU05790 Page 11 AC-CP. ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N wri htsoft- Component Constructions Job: 41 Lorranine 9 Date: Oct,2013 master bath By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 4548197 �,a�'., • O godly; For: Kindred home Lorranie av, North Andover, Ma J Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 ) Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dr bulb F 12 88 Y ( ) Daily range (°F) - 15 ( L ) Infiltration: Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area Ll-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ftz-°F/Btuh Btuh/ftz Btu Btuh/ft2 Btuh Walis 12F-Osw: Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" w 52 0.065 21.0 3.61 188 0.99 52 gypsum board int fnsh,2"x6"wood frm Partitions (none) Windows 1 D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, w 12 0.570 0 31.7 380 59.7 717 1/4"thk Doors (none) Ceilings 16B-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 76 0.026 38.0 1.45 110 1.30 99 gypsum board int fnsh Floors (none) QZ; wri htsoft� 2013-Nov-14 07:09:36 Ri ht a 9 SutteO Universal 201 1 i ..... 9 3 3 0.07 RSU05790 Page 12 ACCP. ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N Component ComConstructions Job: 41 Lorranine wrightsoft� P Date: Oct,2013 closet By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 4548197 For: Kindred home Lorranie av, North Andover, Ma 711 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ftz-°F ft2-°FBtuh Btuh/V Btu Btuh/ftz Btu Waits 12F-Osw: Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" w 48 0.065 21.0 3.61 173 0.99 48 gypsum board int fish,2"x6"wood frm Partitions (none) Windows (none) Doors (none) Ceilings 16B-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 51 0.026 38.0 1.45 74 1.30 66 gypsum board int fnsh Floors (none) I I i Wrl htsoftW Right-Suite0 Universal 2013 13.0.07 RSU05790 2013-Nov-14 07:09:36 Page 13 ACCA ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N I Component Constructions Job: 41 Lorranine W righfisoft� pp Date: Oct,2013 master bedroom By: J&J heating and Air Conditioning 17 Arlington st, Dracut,ma 01826 Phone:978 454 8197 For: Kindred home Lorranie av, North Andover, Ma a,,�.�.,; 'tom • • • • "e' .f"4-° s i%3.v%°s •, �' Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Cig HTM Gain ft2 Btuh/ft2°F W-T/Btuh Btuh/ft2 Btu Btuh/ft2 Btu Waiis 15B-10sfc-2:Bg wall,light dry soil,concrete wall,r-10 ins,8"thk n 276 0.061 10.0 4.40 1215 0.78 216 e 264 0.061 10.0 4.39 1160 0.77 204 s 96 0.061 10.0 4.41 423 0.79 76 w 180 0.061 10.0 4.38 789 0.77 138 all 816 0.061 10.0 4.40 3587 0.78 634 Partitions (none) Windows 1D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, n 12 0.570 0 31.7 380 17.9 214 1/4"thk a 24 0.570 0 31.7 761 59.7 1433 w 24 0.570 0 31.7 761 59.7 1433 all 60 0.570 0 31.7 1902 51.4 3081 Doors (none) Ceilings 166-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 469 0.032 30.0 1.78 834 1.60 750 r-30 ceil ins Floors (none) 2013-Nov-14 07:09:36 wrightsoft" Right-Suite®Universal 2013 13.0.07 RSU05790 Page 14 ACOA ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N wri htsoft- Component Constructions Job: 41 Lorranine 9 Date: Oct,2013 2nd floor hall By: J&J heating and Air Conditioning 17 Arlington st, Dracut,ma 01826 Phone:978 4548197 For: Kindred home Lorranie av, North Andover, Ma ,W �-® � e, • 0 ',+ t�' ���. ��'���,`est"`��°4z°', �y�'� �a�� ��� �� h%3>:"; Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btu h/ft2-°F ft2-°F/Btuh Btuh/ft2 Btuh Btuh/ftz Btu Wars 12F-Osw:Frm wall,wd ext,1/2"wood shth,r-21 cav ins,1/2" n 48 0.065 21.0 3.61 173 0.99 48 gypsum board int fnsh,2"x6"wood frm Partitions (none) Windows (none) Doors (none) Ceilings 1613-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 118 0.026 38.0 1.45 170 1.30 153 gypsum board int fnsh Floors (none) 2013-Nov-14 07:09:36 wrightsoft" Right-Suite®Universal 2013 13.0.07 RSU05790 Page 15 rF ACCK ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N Project Summar Job: 41 Lorranine wrightsoft� y Date: Oct,2013 Entire House By: J&J heating and Air Conditioning 17 Arlington st, Dracut,ma 01826 Phone:978 454 8197 RE• • _ For: Kindred home Lorranie av, North Andover, Ma Notes: Weather: Boston Logan Int'I AP, MA, US Winter Design Conditions Summer Design Conditions Outside db 12 OF Outside db 88 OF Inside db 68 OF Inside db 75 OF Design TD 56 OF Design TD 13 OF Daily range L Relative humidity 50 % Moisture difference 28 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 30093 Btuh Structure 25252 Btuh Ducts 3643 Btuh Ducts 4170 Btuh Central vent (0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 4618 Btuh Blower 2389 Btuh Piping 0 Btuh Equipment load 38355 Btuh Use manufacturer's data n Rate/swing multiplier 0.93 Infiltration Equipment sensible load 29457 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Tight l Fireplaces 1 (Average) Structure 3848 Btuh Ducts 465 Btuh Heating Cooling Central vent (0 cfm) 0 Btuh Area (ft2) 2126 2126 Equipment latent load 4313 Btuh Volume (ft3) 17946 17946 Air changes/hour 0.18 0.06 Equipment total load 33770 Btuh Equiv.AVF (cfm) 159 151 Req. total capacity at 0.80 SHR 3.1 ton p Y Heating Equipment Summary Cooling Equipment Summary Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 80AFUE Efficiency 0SEER 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 1280 cfm Actual ctua air flow 1280 cfm Air flow factor 0.038 cfm/Btuh Air flow factor 0.044 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.88 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2013-Nov-14 07:09:36 -f - wrightsoft" Right-SuitOD Universal 2013 13.0.07 RSU05790 Page 1 ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N AED Assessment Job: 41 Lorranine - - wrightsoft� Date: Oct,2013 Entire House By: J&J heating and Air Conditioning 17 Arlington st,Dracut,ma 01826 Phone:978 4548197 ,12 For: Kindred home Lorranie av, North Andover, Ma ' ��..�., ® - •� 0 � 0 __ � x.- f �� 4� � .fit+ _ Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature °F 9 p ( ) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range °F) - 15 ( L ) We bulb (°F - 72 Wind speed (mph) 15.0 7.5 Gm5 y i,. }� ® w...• .. . 0 e p .'3� Y�.� y&:a-j�q k�1.a :b,� #s����...ii^+4�. y Hourly Glazing Load 16.000- 14,000-- 12,000-- 10,000-;;,, 6,00014,00012,00010,000 8,000-- 6,000-- 4,000-- 2,000-- 0 ,0006,0004,0002,0000 8 9 10 11 12 13 14 15 16 17 18 19 20 Hour of Day Harty /Average /AlD limit Maximum hourly glazing load exceeds average by 24.5%. House has adequate exposure diversity(AED), based on AED limit of 30%. AED excursion: 0 Btuh wri htsoft° 2013-Nov-14 07:09:36 w, 9 Right-Suite®Universal 2013 13.0.07 RSU05790 Page 1 ACCK ...rightsoft HVAC\Crabtree lot 43 Elderberry 2.rup Calc=MJ8 Front Door faces: N 10205 Date L`hL t - TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING j This certifies that . . . . � 4. .pill. . . . . . . . . . . . . . has permission to perform . . :.?�-C}.�a. . .440-\1Z-- , plumbing in the buildings of. gat . . . . . . Pi. . North Andover Mass. Fee,?�.3- . Lic. No. . . . . . . . . . . . . . . . . . . . . ` PLUMBING INSPECTOR Check# �2 0A113 t ^i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK J CITYN'D�v�� MA DATE 0 O PERMIT# f JOBSITE ADDRESS O OWNER'S NAME f..0 POWNER ADDRESS I TEL FAX T TYPE OR OCCUPANCY TYPE COMMERCIAL © EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: i ENOVATION: REPLACEMENT: Q PLANS SUBMITTED: YES M NO El FIXTURES-1 FLOOR--> BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE i DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM 1 _.71 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER ( ..._...__J FLOOR/AREA DRAIN ,...–...._I ....._---1 f __.� i __._-..� ___--JE-E .._.._.___.I ____.� ..___._� ___.---� ------) _.. INTERCEPTOR(INTERIOR) __-! --__ 1 .._.__.-.1 _-_.__ f . i KITCHEN SINK ( -- ----1 ---- -- -- ( -----� ---- f -----,J LAVATORY ! - ( ----_--� __------� -----( ------� ---__I -----! ------( .-___J -_----( __----_.-� -_.--- ( I ---_J ROOF DRAIN SHOWER STALL ._—I _-_._-__l —_i SERVICE/MOP SINK TOILET URINAL _ _.J �_ WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER J 77 _ INSURANCE COVERAGE: 6 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES !0 ._; E YOU CHECKED YES,PLEASE INDICATE THE TY F COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D BOND _f 4 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 If---]I 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 IMassachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMEIILICEN$E# _ / _- SIGNATURE MPE11 JP D CORPORATION FJI# PARTNERSHIP Q#®LLC #I j COMPANY NAMEe /[��,P �ADDRESS _ I CITY STATE 1 J ZIP 1932- TEL ] ; r I✓AX 4 CEL 869 yi7/ EMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No PASS THIS APPLICATION SERVES AS THE PERMIT E] F]���$�i 3 f� r FEE: $ PERMIT# PLAN REVIEW NOTES • r' - x t I Date.. /ZI0"*/*" 3................... - �NORTIy TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ......... :�s -^/!.. ....'p� .................................................... has permission for gas installation ...��cA. .......�`A. ...................... in the buildings of....... .C.. c. v, 9v3..e ±............................................. at... 4.m.e�.&......1.4,.,e ..., North Andover, Mass. Fee./ ."l... Lic. No. A24Y...... ..........................:............................... GASINSPECTOR Check# `2 8918 -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ."t%' � ��' _ _ MA DATES i PERMIT#-LJr�x CT' JOBSITE ADDRESS . OWNER'S NAME ,,, GOWNER ADDRESS TEL =FAX TYPE OR OCCUPANCY TYPE COMMERCIAL[7-11 EDUCATIONAL ® RESIDENTIAL PRUN-T CLEARLY NEW:((�„r..-RENOVATION: REPLACEMENT:® PLANS SUBMITTED: YES 0 NO APPLIANCES 7 FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR II - - FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER _ _ ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER MATER HEATER Z I rA ER � — - - INSURANCE COVERAGE Y have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES JEJNO _0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE 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. CHECK ONE ONLY: OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 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 com liance ZwithgWerntine�nt-pro ' ' n'of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ,�,�t/ _ LICENSE# SIGNATURE MP __ GF JP D J G F LPGI 0- CORPORATION[�# PARTNERSHIP©# LLC[ # COMPANY NAME: .ti°S�lll�` ° ��+, _ j ADDRESS CITY y fLc I STATE.�ZIP TEL - FAX _ CELL _ EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES 10-1jib Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ ��` .2jD FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts - - Department oflndustriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensations Insurance Affidavit:Builders/ContractorsfElectricians/Plumbers Applicant Information - Please Print Legibly Name(Business/Organizationgndividual): Address: d,<zI City/State./Zip:_ tea_ Phone#: Are you nn employer?Check the appropriate box: Type of projec (required): L❑ I am a Y emP to er with 4. ElI am a general contractor and I 6. w construction emp19y�(full and/or part-time),* have hired the sub-contractors 2. m a sole proprietor or partner- listed on the attached sheet.x E]Remodeling ship and'have no employees These sub-contractors have 8. 0 Demolition workingfor me in an capacity. workers'comp,insurance. Y P tY• 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I L ]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. T Homeowners who submit this affidavit indicating they aie 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 their workers'comp.policy information. X am an employer that is providing workerscompensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name:. . " -' • s Policy#or Self-ins.Lic.9: ExpirationDate: a �' rob Site Address: /5r 4,V#M41-c1X'- r9{/ Pity/State/Zip:,,!!! Attach a.copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. XdOIZeYEby CEI'l undEYt/12p ins andpenalt' ofperjury thatflte informationprovidedabove is tr andcorrect. - Si ature: Date: e"" Phone#: T7,rl SOY lz/2/ 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.CitylTown Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other - - - ------ M,nr,,,,o44. i Information and Instructiolm"s 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 ofthe 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 ofits 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 fbr 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-andprinted IegibIy: The Depar6nent figs provided a space at the boftom 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 p ermiVlicens e applications in any given year,need only submit one affidavit indicating current Policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or'- permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc)said person is NOT'required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The C=3-4ox1woaltb o;FMassachj),9n is Department ofladustt ial Accidents ()face ofInvestigatioxts 600 Wasbington Street Boston?MA0211.1. Tel,#617-7274900 QYd 406 or 1:-877;MASSAFB Revised 5-26-OS Fax#617-727-7749 r 6*7 AS r5 €llT F 15SUES THE A60VE'LICENSE TO 1-� NIEL E-SL "MILLER r 'G 0 UD. !,►`ANKEE IRD . m, flA)=`RHIL.. MA. 03.83,2=1Q61 .''` F: 1288 05/01%3.4 147729: . i i III I Date.. Z�2v��i. .... .. NpRTIy TOWN OF NORTH ANDOVER • - X 'PERMIT FOR GAS INSTALLATION ,SSACHUSEI Oji ^, ' 1`� This certifies that . . .�'"`:. . .��r? . . . . . . . . . . . . . has permission for gas inst Ration � � . . . . . . . . in the buildin s of r !. . r . . . . . . . . . . . . . . . . . . . . . . . . at . . �r` ? � !.. . . . . ., orth Andever,ver, Mass. Fee �r�':oG. Lic. No. GASINSPECTOR Check# Z'5-3. 7972 -s- NIA.SSACHLS ETTS UNTFORNI APPLICATON FOR PERt�IlT TO DO GAS FiT'nNG (Type or print) Date NORTH ANDOVER,MASSACHUSETTS Building Locations Permit# � Antount Name Owner's Nae New❑ Renovation ❑ Replacement. Er Plans Submitted 0 wz �1 n O H H o r) D� o w x z z o z H w I�J w W to � t g a WW H A tom, `7 < > < a .F, >w+ a� W� z 0;r4z r) F Qom-' U a > A a SUB -BASEM ENT B A S E M ENT IST. FLOOR 2 N D . F L O O R 3RD. FLOOR 4TII . FLOOR 5 T H . F L O O R 6TH . FLOOR 7TH . FLOOR STH . FLOOR -4tfl I (Print ortype) 41 / n J� Check one: Certificate Installing Company Mame �G0 (/ 6� Corp. Address 3 ❑ Partner. Business Telephone � � � Firm/Co. Name of Licensed Plumber or Gas Fitter !S [INSURANC,LF COVERAGE Check one- SU have a currnt liability Insurance policy or it's substantial equivalent. Yes No f you have hecked yes, please indicate the type coverage by checking the appropriate box. iability 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 :Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Aaent 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 nt� knowledge and that all plumbing work and installation,hcrfo7nu:d under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas CO(le and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Ps Fitt City/Tw on � Gas Fitter L tc.(,n5c,-77 um e Master \PPROVED(OFFICE USE ONLY) �'Journeyman The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name (Business/Organization/Individual): Address: t,vT lq 0 2- City/State/Zip: IV "o Ve-JL ZL14 Phone #: % � c `7 77 Are an employer? Check the appropriate box: Type of project(required): I. I am a employer with n 4. ❑ I am a general contractor and I 6. ❑ New construction. employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. * Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition -[No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[] Electrical repairs or additions 3.❑ l 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.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other 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 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. N11q Insurance Company Name: Policy#or Self-ins. Lic.M Expiration Date: I Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Si nature: Date: Phone#: 2A' 7 77 Official use only. Do not write in this area,to be completed by city or town offrciaL 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#: