Loading...
HomeMy WebLinkAboutMiscellaneous - 144 GRANVILLE LANE 4/30/2018 144 GRANVILLE LANE 210/106.C-0073-0000.0 i I 355 Date IDC-;L- .r.c—. pf NpRTM TOWN OF NORTH ANDOVER ,a.1't'O p= a• n p� PERMIT FOR MECHANICAL INSTALLATION h P h �9SSAC'HU9ESt This certifies that .L . . . . . . . . . . . . . . . . . . . .`' -. . .. . . . has permission for mechanical installation .4 v'�_...., .+. in the buildings of . .D -N. . . . . . . . . . . . . . at . . .?'( r! r�/,� . . . . . .. North ndover, Mass. � - Fee. . . Lic. No.. . /� . . . . . . . . . ��A GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer 0 Commonwealth of Massachusetts Sheet Metal Permit Date: Permit# �. Estimated Job Cost:$ ��,6(;3 0Permit Fee: $ ,T Plans Submitted: YES NO Plans Reviewed: YES NO Business License# �'�a�j Applicant License# �j Business Information: Property Owner/Job Location qq Information: Name: ng fj g K i G4. 1�L Name: Street: 41/v( 5-k*,) � ) Street: W j (:�V'Cf l�/�U( t City/Town: ( �((,Q,C , Mfg., OM3 City/Town:OWth ft4dVyQom' t� Telephone:D�k U 902 Telephone: 9 '1511 D— Photo I.D.required/Copy of Photo I.D.attached: YES NO Staff initial J-1 /C-1unrestricted 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 X. Multi-family Condo/Townhouses Other Commercial: Office Retail. Industrial Educational Institutional Other Square Footage: under 10.000 sq. ft. y over 10,000 sq. ft. Number of Stories: y 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: I INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which.meets the requirements of M.G.L.Ch.112 Yes V"L' 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 E] OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best f 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 Final Inspection Date Comments Type of License: By ;Master Title L _ ❑Master-Restricted City/Town ❑Journeyperson Permit# ❑Journeyperson-Restricted $ cense Number.Signature of Licensee Fee L (� Check at www.mass.gov/dpi Inspector Signature of Permit Approval 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ti www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �1 Please Print Legibly Name(Business/Organization/Individual): TR Ped AddressA(a ( S-� City/State/Zip: Q. D 6 0183Phone Are on an employer?Check the appropriate box: Type of project(required): 1 I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. F1 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. F-1 Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. F1 Building addition [No workers' comp.insurance comp.insurance.1 required.] 5. 0 We are a corporation and its 101-1 Electrical repairs or additions 3.1:11 am a homeowner doing all work officers have exercised their 1.1.[]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no t/, f � employees. [No workers' 13.7�' X7 Other ,/ comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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. f Insurance Company Name: (9 V I(3,d l G aa,p,-Ci.t( - Policy#or Self-ins,Lic.#: )n� d Expiration Date:bg/0 P l `b Job Site Address:I''tg 6 City/State/Zip: North yovxx q l 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 and penalties ofperjury that the information provided above is true and correct. Si nature: Date: ®9 Phone#: ��� �'.�7� �6�_ Official use onbl. 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#: 3-roo. CoviiQofew- 3 iq �X Mitsubishi Warranty Updates _ __ . _ , Page 3 of 3 Jesse Farren Beftimons C0IAPANIE $ HNA@- REFRIGERATION PLUMBING c�rri�w.rerin BellSimons Beverly 364 Rantoul St. Beverly MA 01915 Phone: 978-922-1920 Fax: 978-922-5230 farrenua-belisimons.com httnc�//mail.awl.cnm/wehmail-ctrl/en-nc/PrintMeccaue 4/24/�.�15 Project Summa Job: ' Date: May 18,2015 Entire House By: Prefferd Air 461 Boston St,Topsfield,Ma 01982 Phone:978-750-8282 Fax:978-927-1683 Email:Pair8282@aol.com e For: Drew wilmont 144 Granville In, North andover, ma Phone: 978 590 1787 Notes: i - e • a Weather: Boston, MA, US Winter Design Conditions Summer Design Conditions Outside db 12 OF Outside db 87 OF Inside db 68 OF Inside db 75 OF Design TD 56 OF Design TD 12 OF Daily range L Relative humidity 50 % Moisture difference 26 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 38086 Btuh Structure 17202 Btuh Ducts 18127 Btuh Ducts 15139 Btuh Central vent (0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 56213 Btuh Use manufacturer's data n Rate/swing multiplier 0.92 Infiltration Equipment sensible load 29819 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 2099 Btuh Ducts 1758 Btuh Heating Cooling Central vent (0 cfm) 0 Btuh Area(ft') 4300 4300 Equipment latent load 3857 Btuh - Volume(ft') 34400 34400 Air changes/hour 0.28 0.15 Equipment total load 33676 Btuh Equiv.AVF (cfm) 161 86 Req. total capacity at 0.70 SHR 3.5 ton Heating Equipment Summary Cooling Equipment Summary Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 0 HSPF Efficiency 0 SEER Heating input Sensible cooling 0 Btuh Heating output 0 Btuh @ 47°F Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 1304 cfm Actual air flow 1304 cfm Air flow factor 0.023 cfm/Btuh Air flow factor 0.040 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.89 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. '9' wrightsoftf Right-Suite®Universal 2015 15.0.03 RSU15198 2015-May-18 09:04:12 Page agI ,4M ...ob\Documents\American StandardlDrew wilmont.rup Calc=MJ8 Front Door faces: N AED Assessment Job: < Date: May 18,2015 Entire House By: Prefferd Air 461 Boston St,Topsfield,Ma 01982 Phone:978-750-8282 Fax:978-927-1683 Email:Pair8282@aol.com For: Drew wilmont 144 Granville In, North andover, ma Phone: 978 590 1787 Location: Indoor: Heating Cooling Boston, MA, US Indoor temperature(°F) 68 75 Elevation: 30 ft Design TD (°F) 56 12 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference(gr/Ib) 42.9 25.7 Dry bulb (°F) 12 87 Infiltration: Daily range(°F) - 15 ( L ) Wet bulb(°F) - 71 Wind speed (mph) 15.0 7.5 MEE= • � • - • 111 • e Hourly Glazing Load 7,00 6,000 5,000 m 4,000 a 3,000-- 2,000-- 1,000-- 0 ,0002,0001,000 8 9 10 11 12 13 14 15 16 17 18 19 20 Hour of Day /Hourly /Average /AEDllmlt Maximum hourly glazing load exceeds average by 15.8%. House has adequate exposure diversity(AED), based on AED limit of 30%. AED excursion: 0 l3tuh JA- a 2015-May-18-1 8 09:04:12 wri htsoftRight-Suite®Universal 2015 15.0.03 RSU15198 Page 1 . � ...ob\Documents\American Standard\Drew wilmont.rup Calc=MJ8 Front Door faces: N J. Right-M Worksheet Job: Entire House Date: May 18,2015 By: Prefferd Air 461 Boston St,Topsfield,Ma 01982 Phone:978-750-8282 Fax:978-927-1683 Email:Pair8282@aol.com 1 Room name Entire House basement 2 Exposed wall 372.0 ft 186.0 ft 3 Room height 8.0 ft d 8.0 ft heat/cool 4 Room dimensions 50.0 x 43.0 ft 5 Room area 4300.0 ft' 2150.0 ft= Ty Construction U-value Or HTM Area (ftp Load Area (ftp Load number (Btuh/ft'-°F) (Btuh/ftj or perimeter (ft) (Btuh) or perimeter (ft) (Btuh) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6 12C-Osw 0.091 n 5.10 1.92 800 731 3725 1400 400 400 2038 766 -G 1 D-c2ov '0.570 :n,.. 31.92 12.70 48 0 1532 610 0 0 0 0 D_ 11 DO 0.390 n 21.84 10.16_ 21 21 459 213 0 0 0 0 12C-Osw 0.091 a 5.10 1.92 688 652 3323 1249 344 344 1753 659 11! -C 1 D-c2ov 0.570 a _31.92 42.63 36 0 1149 1535 0 0 0 0 L12C-0sw 0.091 s 5.10 1.92 600 743 3786 1423 400 400 2038 766 G_ 1D-c2ov 0.570 s 31.92 22.36 36 0 1149 805 0 0 0 0 D 11 DO 0.390 s 21.84 10.16_ 21 21 459 213 0 0 0 0 12C-Osw 0.091 w 5.10 1.92 688 664 3384 1272 344 344 1753 659 1 D-c2ov 0.570 w 31.92 42.63 24 0 766 1023 0 0 0 0 G 1613-30ad _ 0:032 1.79 1.59 . 2150 2150 3853 3409 0 0 0 0 F 19A-19bscp 0.049 2.15 0.47 2150 2150 4623 1007 2150 21501 4623 1007 I _ 6 c)AED excursion I 0 0 Envelope loss/gain 282081 14160 12206 3858 12 a) Infiltration 9878 1153 4939 576 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 3 690 0 0 Appliances/other 1200 0 Subtotal(lines 6 to 13) 38086 17202 17145 4434 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 38086 17202 17145 4434 151 Duct loads 48% 88% 18127 15139 48% 88% 8160 3902 Total room load 56213 32341 25306 8336 Air required(cfm) 1304 1304 587 336 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. '- wrightSOft' Right-Suite®Universal 2015 15.0.03 RSU15198 2015-May-18 09:04:12 ' ` ...ob\Documents\Hmerican Standard\Drew wilmont.rup Calc=MJ8 Front Door faces: N Page 1 Right-J®Worksheet Job: Entire House Date: May 18,2015 Prefferd Air By: 461 Boston St,Topsfield, Ma 01982 Phone:978-750-8282 Fax:978-927-1683 Email:Pair8282@aol.com 1 Room name 1st floor 2 Exposed wall 186.0 ft 3 Room height 8.0 ft heat/cool 4 Room dimensions 50.0 x 43.0 ft 5 Room area 2150.0 ftz Ty Construction U-value Or HTM Area (ftp Load Area Load number (Btuh/ft?°F) (Btuh/ft� or perimeter (ft) (Bt h) or perimeter Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6:i%LG 12C-Osw 0.091 n 5.10 1.92 400 331 1687 634 1 1 D-c2ov 0.570 n 31.92 12.70 48 0 1532 610 DI 11DO 0.390 n 21.84 10.16 21 21 459 213 12C-0sw 0.091 a 5.10 1.92 344 308 1570 590 1 1 � _G 1 D-c2ov 0.570 a 31.92 42.63 36 0 1149 1535 L12C-Osw 0.091 s 5.10 1.92 400 343 1748 657 1D-c2ov 0.570 s 31.92 22.36 36 0 1149 805 D 11DO 0.390 s 21.84 10.16 21 21 459 213 1(V 12C-0sw 0.091 w 5.10 1.92 344 320 1631 613 —G 1 D-c2ov 0.570 w 31.92 42.63 24 0 766 1023 C 168-30ad 0.032 1.79 1.59 2150 2150 3853 3409 F 19A-19bscp 0.049 2.15 0.47 0 0 0 0 11. I 6 c)AED excursion 0 Envelope loss/gain 16002 10302 12 a) Infiltration 4939 576 b) Room ventilation 0 0 13 Internal gains: Occupants @ 230 3 690 Appliances/other 1200 Subtotal(lines 6 to 13) 20941 12768 Less external load 0 0 Less transfer 0 0 Redistribution 0 0 14 Subtotal 20941 12768 15 Duct loads 48% 88% 9967 11237 Total room load 30908 24005 Air required(cfm) 717 968 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wri htsoftT 2015-May-18 09:04:12 9 Right-Suite®Universal 2015 15.0.03 RSU15198 Page 2 ` ...ob\Documents\American Standard\Drew wilmont.rup Calc=MJ8 Front Door faces: N i i ASSA EHi7SETTS DRIVERS- . - LICENSE p� 4a iSS 9e END 4d NUMBER Z-2013 NONE S19533 DOB 9973 09=10-1969.' rn 9D� ar'B T 15 SEX M 19 NAt 5.10 SMITH � 2ROBERTV B 15 LESLIE RD ROWLEY,MA 01969.2318 5 DD 08.14-2013 Rev 0715-2009 .. -COMMONWEAtTH OF N! SSACHi3SETCS - BafAF3�3�O1+ � l SHEf Mf C WORKERS ISSUES.THE FOLLOW)tGyI I;ENSE <..lA€:. ►5, I k'ASTERU. REST�CTED uf; ROBER2T V SMITH 15 LESLIE ROWLEY' ,K ot969-23t$ t633> 09/28/:x;5 }: 105771 Fold,Then Detach Along'All'Perforations . �t ' �COM�VIC�NW ALT �� � ACM13SE �x IJ Ir WOM SO 1 k,.,ekY r 4 Y �z,...... _.,, .,..._ 5/15/2015 ._....max: 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 c Dirtificate,does not confer rights to the certificate holder in lieu of such endorsements(s) PRODUCER CONTACT NAME ME TGA Cross Insurance,Inc. (n"C,No Ext): (781)914-1000 (AONE /CC No.:) (781)224-5577 401 Edgewater Drive,Suite 220 ADDRESS: Wakefield,MA 01880 PRODUCER CUSTOMER ID#: INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Atlantic Charter Insurance Company VDAC 44326 Preferred Air,Inc. INSURER s: INSURER C: 461 Boston Street,Unit A3 INSURER D: Topsfield,MA 01983 INSURER E: INSURER F: COVERAGES: CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF 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 ADDL SUER POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR WVD DATE(MMIDDIYY) DATE(MMIDDIYY) (In Thousand) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES F7❑ Ea EXP(nce $ CLAIMS MADE ❑ OCCUR MED EXP(Any one person) $ PERSONALBADVINJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY ❑PROJECT ❑LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea Accident) BODILY INJURY ALL OWNED AUTOS (Per person) $ ❑ SCHEDULED AUTOS ❑ BODILY INJURY $ (Ea Accident) HIRED AUTOS PROPERTY DAMAGE $ NON-OWNDED AUTOS (Ea Accident) IUMBRELLA ❑ OCCUR LIABILITY EACH OCCURRENCE $ •— EXCESS LIAB❑ CLAIMSMADE AGGREGATE $ DEDUCTIBLE $ ❑❑ $ RETENTION WORKERS COMPENSATION AND WCV00971103 08/01/2014 08/01/2015 X STATUTORY OTHER E� EMPLOYERS'LIABILITY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? N/A policy Coverage State:MA EACHACCIDENT $ 1,000,000 Mandatory in NH If yes,describe under SPECIAL PROVISIONS below DISEASE-POLICY LIMIT $ 1,000,000 DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER ❑❑ DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CEt#Tf 1 ATE HOLD1rR CAN�IWLLATION 3 ' 77 'I .�1.aa•:�.s'� ,.. - <.F ... ..a 1 ....:. ..- •: nt. . ,�pp Ams :...e tefiwn+>. . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of North Andover EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1600 Osgood Street 12 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Building 20,Suite 2035 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover,MA 01845 UTHORIZED REPRESENTATIVE ACORD 25(2009109) r Page 1 of 1 CERTIFICATE HOLDER COPY ©1988.2009 ACORD CORPORATION. All rights reserved. DA (MMIDDIYWY ACERTIFICATE OF LIABILITY INSURANCE 5/15/2015 ) 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(ies)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 CONTACT NAME: Kelly Sturtevant, CIC,CISR TGA Cross Insurance, Inc. PHONE (781)914-1000 AX No;(781)246-2601 401 Edgewater Place E-DMAIE .switchboard@tgacross.com .Suite 220 INSURERS AFFORDING COVERAGE NAIC# Wakefield MA 01880 INSURER AArbella Protection 41360 INSURED INSURER B Preferred Air, Inc. INSURER C: 461 Boston Street, Unit #3 INSURER D: INSURER E: TO sfield MA 01983 INSURERF: COVERAGES CERTIFICATE NUMBER:CL14112423864 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. INSIR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE Fx_]OCCUR 8500025668 8/1/2014 8/1/2015 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYFX JFcT El PRI LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNEDSCHEDULED 1020003133 /1/2014 8/1/2015 AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X AUTOSWNED P.rracEciRdentDAMAGE $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,.000 AI EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED I X I RETENTION$ 10,00C 4600037647 8/1/2014 8/1/2015 $ - WORKERS COMPENSATION VJC STATU- OTH- AND EMPLOYERS'LIABILITY Y/NER ITORY LIMITSANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED9 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. , Bldg 20 Suite 2035 AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Thomas Gregory/KS6 ' ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD Location ¢ ¢ ►2�1 r.�v LLQ �.4N� No. Date �4-/2 2 1q4- TOWN OF NORTH ANDOVER p Certificate of Occupancy $ * Building/Frame Permit Fee $ �ss�cHusEth Foundation Permit Fee $ v'v Other Permit Fee PL",i- $ � Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector 04/22/94 09:49 26.00 PAID Ya 7162 Div. Public Works PER3TST N�' LTi _ ✓ PAGE 1 � _ APPLICATION FOR PERMIT TO BUILD NORTH ANDOVER, MASS. MAP 4J0. LOT NO. 12 RECORD OF OWNERSHIP IDATE BOOK :PAGE ZONE SUB DIV. LOT NO. LOCATION PURPOSE OF BUILDING OWNER'S NAME, NO. OF STORIES I IZE LJl��L OWNER'S ADDRESS O] BASEMENT OR SLAB - ARCHITECT'S NAME .E SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN ' DISTANCE TO NEAREST BUILDING If w DIMENSIONS OF SILLS DISTANCE FROM STREET "" POSTS DISTANCE FROM LOT LINES-SIDES REAR "" "" GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST SEE BOTH SIDES ,,. 9 �1 EST. BLDG. COST 7 C/ PAGE 1 FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS 1 - 12 SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING $ APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED9 BOARD OF HEALTH SIGNATURE OF OWN OR AU HORIZED AGENT F E E OWNER TEL.# PLANNING BOARD ' PERMIT GRANTED CONTR.TEL. CONT?. LIC. BOARD OF SELECTMEN 7/�Z BUILDING INSPECTOR BUILDING RECORD 1 OCCUPANCY 12 SINGLE FAMILY STORIES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES _- LOT LINES AND EXACT DIMENSIONS OF BUILDINGS, WITH PORCHES. GA- APARTMENTS RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE 3 t 2 13 CONCRETE BL K. PINE BRICK OR STONE HARDWD _ PIERS PLASTER _ _ DRY WALL _ UNFIN. 3 BASEMENT 11 AREA FULL FIN. B-M'T' AREA _ '/. 1/1 3/1 FIN. ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WALLS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE ��_ WOOD SHINGLES EARTH ASPHALT SIDING HARD\'J D _ ASBESTOS SIDING COMtACN VERT. SIDING ASPH. TILE _ STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY ATTIC STRS. & FLOOR _ BRICK ON FRAME CONC. OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME _ SUPERIORI� POOR ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE I HIP BATH (3 FIX.) GAMBRELMANSARD TOILET RM. (2 FIX.) _ FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK _ SLATE NO PLUMBING _ TAR 8 GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING II 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL BMS. 8 COLS. HOT W'T'R OR VAPOR R WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2ndELECTRIC lst 13rd NO HEATING NORTM Town of Andover 0 No. 1 e, I iyi c 1 Zo - E ori dower, Mass., ��: CUC�'�iC HE WICK � 'opRATED . BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �► BUILDING INSPECTOR .THIS CERTIFIES THAT...................... ................. �..-......�..�•�x2�.�.N�'�'��.�................ .......................... • �tr— Foundation has permission to ereet...... V ............. buildings on .......� .... 14V.t `� ................. Rough •evo F-7- AOLt47�jo; Chimney tobe occupied as........ .................................................... ..... �./..1 ' ...................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 IN 6 MONTHS Final UNLESS CONSTRUCTI FARTS ELECTRICAL INSPECTOR Rough ....... ... .. . . ................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner - PLANNING FINAL CONSERVATION FINAL Street No. Smoke Det. SEWER/WATER FINAL DRIVEWAY ENTRY PERMIT a I I " Location No. /fid Date i' '- NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ �'�S'•••° E<�' cMuBuilding/Frame Permit Fee $ s� s -�' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ?/ Check # F I 18476 Building Insp v r TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: SIGNATURE: A4V Building Commissioner/I -or of Buildings Date SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: �04 • C � 3, (0C) 0 Map Number Parcel Number 1.3 Zoning hiformation: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ -Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT rn 1 Owner of Record Name(Print) Address for Service: Signature ,�! Telephone g"- 2404her of Record: Name Print Address for Service: O Z M Signature Telephone 9 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: 9 License be >f Address D Expiration Date ic Signature Telephone .r[ 3.2 Registered Home Improvement Contractor Not Applicable ❑ DWW Rooft M 9C7)(f&- Company Namem P.O.Box 637 Registration Number r Nor&Ring,MA Add:��, 2 '�01864 � /? / y yWExpiration ate Of ^� Si nature Telephone Y' �'0 U�C� I r SECTION 4-WORKERS COMPENSATION(M.G.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildingermit. Signed affidavit Attached Yes...... No.......❑ SECTION 5 Description of Proposed Work check allapplicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ FAlterations(s) ❑ it Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other &"Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OF#1CIAL USS+='ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e) X @I 4 Mechanical HVAC j 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Hereby authorize —D(W V^L /�pQ'-1`t )U 6 4GC to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner ! Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on thejt"pitgftlation are true and accurate,to the best of my knowledge and belief p•O.BOX 637 Noah Reaft MA Print Na � Ilk Si ature of Owner/Agent Date t NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TAMERS is 2ND 3RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH T ,'own of t , over No. �,o = - dover, Mass.,LA COCMICKEWICK y^ 7,ps RATED 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..... ......................... .. """"':: Foundation has permission to erect........................... ........... buildings on/yty... ... .......... ..... .......... Rough to be occupied as.. .. ... ..........:... Chimney provided that the erson acceptin is permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .................................. A061pollp..� � - Service ... . .................... I1117' INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of]Mfassaehumus Department oflndustrial Accidents office oflntrestlgadons 600 Washington Sired Boston,MA 02111 kip ,vww mass,govldia Workers'Compensation Insurance Affidavit:Bttifders/Contr ctors/Electricians/Plumbers A lican#Inf©rmatiou DUW RpO Please Print Legibly P.O.Bfftr Name(Susinesslor�zationitaaivittual): Nod►Resdin&1AA Address: JL� CilylStatelZip: Phone#:_ ? t97 Are ya n empleyerY Check the oLppropriate boa: Type of project(required): 1-02 1 ani a employer with 4. ❑ I am a general contractor and I 6. 0 New construction tnrtployecs(full and/or part-time).* have hired tDe svb-cstnuaaa� 7. ❑Remodeling 2.❑ 1 am a sole proprietor or partner- fisted on the anacD�street ship and have no employees 'These sub-contractors have 8. 0 Demolition working for me in any rapacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑We are a corporation and its - 10.0 Electrical repairs or additions 1 officers ban exercised their 3-0 1 am a bomeawner doigg all work rightof exemption per MGL 1 i.[]Flumbing rglaus tar additions myself.[No workers'carr. a. 152,$1(4),and we have no 12.0 Roof repass insurance required.}t avloyom[No 13.❑ Other comp.incuramee nnuired.) •Any a�f k=i dmt dw-cla box k 1 must also fill oat tlx section below showing their w~*03 tsetioa polity in rommion: t Hotr wvnms who wbrnh thio affidavit indicating tbey are doing all%v*=4 thea hire autide couUmI is mm tatbttdt SUM offedei&indicating each. tCenucctots that check this boa must steadied in edditionat sheet showier;the name ofthe ateb=tta0M mad dear workeas'caaip polar initsmvdiaa I am an employer"is providing twarkers'compemadon insurance for my employees. Below is the paliry and job sate info►matiam. f nsttrana Cot>zpany Naive: -�� Policy#or Self-ins.Lie.#:^--7 F1 13 3"��C l-' Expiration Date: (qh� Job Site Address: ^1' rf/j'r/lrt / City/5tateMp: 0 � Attach a copy of tate 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 ofcrb nbW penalties ora fine up to S 1,500.04 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a ropy of this statement maybe forwarded to the Offim of I ovestigations of the DIA rot insurance coverage verification. I do her+ehy certify ander the pains an d penabies of perjury that the information pr avided above is true and correct: Simtatttre G� Date' t Zs— Phone►t' 4 6 ,Z Official use only. Do not write in this area,to be compIded by city or town officid City or Town: PermitlUcense# Issuing Authority(eirde one): 1.Board of Health 2.Building Depanment 3.iity/Tewn Clerk 4.Electrical inspector S.Plumbing Inspector 6.Other Contact Person: Phone tt: Page No. of Pages • Builders License # 58443 Proposal Home Construction Reg. # 109288 O 0 o 00 DOO o (F8 1) 944-9994 (998) 664-2559 "The Areas Oldest Roofing Company" P.O. Box 637, North Reading, MA 01864 i PROP AL ET JOBNAME CITY,STATE AND ZIP CODE - JOB LOCATION ,r We hereby submit specifications and estimates for: Recommended Optional (Included in price) (Not included in price) aol Rip& Remove all shingle debris from roof&job site: ❑ 1 layer ❑2 layers ❑3 layers or more ,- Repair/or Replace any roof decking; not to exceed 50sq.ft. •,j Install 8"aluminum drip-edge/and rake-edge along entire perimeter. Choice of mill,white orbroWn; • Install ICE&WATER underlayment along horizontal eaves,valleys, sidewalls and sky-lights&chimneys Install premium base sheet underlayment between roof deck and roofing shingles • Install 25yr CertainTeed/GAF/Tamko or Owens&Corning traditional 3-tab roof shingles ❑30 year •% Install 30yr CertainTeed/GAF/Tamko or Owens&Corning architectural roof shingles ❑40 year ❑50 year ❑Lifetime 'See manufacturer warranty policy for more details •l Install new aluminum vent-pipe flange(s) Chimney(s)-counter-flash and re-step existing flashing ❑Cut& Install new lead flashing x' Ridge-vent/exhaust vent with low profile design, hidden by shingle caps , ❑Soffit-ventilation ❑ Roof louver-vents • Seamless style aluminum gutters-custom fabricated at job site ❑downspouts •I Other "Please Note:All items in roof attic should be removed or covered due to falling roof particles,at time of roof tear-off Price includes all items above that are checked only/others may be priced separately upon request. Pe ]Jroyase hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: �LI 3 Total price not including options. dollars($ < ). i Payment to be made as follows: 1 30 deposit required before ordering materials.Balance due in full upon day of completion. Please make all payments out to Kenneth Duval, mailed to: P.O. Box 637, No. Reading, MA 01864 Late charges of$50 per week for all outstanding bills due upon day of Authorized , icompletion. Signature Accepting proposal means agreeing to the terms of the enclosed binder Note:This proposal may be `y contract. Please sign contract&return top copy(white)with deposit. withdrawn by us if not accepted within .� ,� days I Board oC Building Regulations and Standards HOME IMjj,RO EMENT CONTRACTOR k Rm �sUatron.__109288 �tat3l ,,,r006 �p =.-DB A DUVAL ROOFING Kenneth Du•.' 72 NORTH ST N.READING,MA 01864 Administrator F NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with theP rovision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 10A. will be disposed The deb s posed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: ep v DumP ster Permit it Date i