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Miscellaneous - 15 PEACH TREE LANE 4/30/2018
h Pee, u.-�� L.3 CU60)- l BUILD114G FILE Iw VCkO+ Date / TOWN OF NORTH ANDOVER 0 9 PERMIT FOR-WIRING SSACHU5� This certifies that . n0/j,-/rL . ............�.......<......f....C....,.�...r....%.J.�.. .f..../.... .................................................... haspermission to perform ..../................................../.................................................................. wiring in the building of....( ., G G l7�✓�f �/�/ ....................................... at ..........................:.............................................................................. North Andover,Mass. .' ...Lic.No. ................. Fee. .........................................:............::... n / ELECTRICAL INSPECTOR Check# �� 3 1264 Commonwealth of Massachusetts Official Use Only r Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leaveblank 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 XNINK OR TYPE ALL INFORMATION) Date: 9 " I / 5, 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) 1 j &�c h T-r-2� G, . <o t Z, _ Owner or Tenant _�1/' H i it G r Telephone No. Owner's Address [ t1 p l cf Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service ZOO Amps ZO/Zt-1olts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency Lighting rnd. rnd. Batter Units j No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons g No.of Waste Dis osers Heat Pump Number Tons J.KW No.of Self-Contained p Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal [I Other Connection uritNo.of Dryers Heating Appliances KW SecNo.of Systems:* or Equivalent No.of Water No.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total IV Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cove ge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Pr BOND ❑ OTHER ❑ (Specify:) Xcertify, under thepains an penalti s of erjury,thatthe information on this application is true an ti complete. FIRM NAME: . t (, i C Ser l LIC.NO.: a/ y6? Licensee: Signature f ,✓ LTC.NO.: Z 1 6�rT / (If applicable enter "exempt"i i the licens nu ber(ine.� Bus.Tel.No.:I % —4 791) Address: (#glsvl 6 l , C e 11 V r t`) alerv, )M o3or lt.Tel.No.: *Per M.G.L c. 147,s. 7-61,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/Agent6u Signature Telephone No. PERMIT FEE:$JP 7 Q ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166,§32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall,bo limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: r SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: G Date: FINAL INSP CTIO : . Pass �! �(f Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: ;,f Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com I I w The Commonwealth of_1Vlassachusetts r. _ Department of IndustrialAceidents I Congress Street,Shite 100 Boston,MA.02114-2017 www mass.gov/dia dtM SV�v` Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WTTH THE PERNIITTING AUTHORITY. Elease,Print Le •bl A Ocan IL ( / Name(Business/Oigabization/lndividual- —. t �'` 7 e v c Address: S, 60 111/c 6 17 36 7 q Phone City/State/Zip: Q elf/l ;. .:. .. . Are you an employer?Check the appropriate box: Type of project(xecuired); 7 1,l�I am a employer with _employees(frill and/or part-time).* 7. ElNevsi'donstru ction _LL2.❑I am a sole proprietor or partnership and have no employees vvorking forme in 8. Remodellhg any capacity.[No workers'comp.insurance required.] 9, E!Demolition ./ 3..I am a homeowner doing all work myself,.[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are solo 4 ,,.o- la.M.Plumbing repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13: Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.0.Other 6.❑We are a corporation and itsofficers have exercised their right of exemption per MGL c. 152,§1(4),and'we have rio employees.[No workers'comp.insurance required.] *Any applicant that checks box A must also fill out the section below showing their workers'compensation policy information. Homeowners who sub affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose.entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy ar2d job site information. Insurance Company Name- Expiration Date:. Policy#or Self-ins.Lic.#: City/State/Zip: Job Site Address: ompensation policy declaration page(showing the policy number and expiration date). Attach a copy of the workers' c Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Date: Signature: `�- Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I w 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 defuied as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprise,and including the legal representatives of a deceased employer,or the receiv f&trustdd dan 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 b6 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 whd 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 r Please fill out the`workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of.Industrial Accidents for confumation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the,application for the permit or license is being requested,not the Department of Industrial=Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-A4ASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia i. 12- COMMONWE�►LTH OF MASSACHUSETTS ' � 0 0 0 • o 0 BOAFp'OF E�_ECT'RICIANS - I SSUES THE FOLLOWING LI CENSE AS A.; REGISTERED MASTER ELECTRfCIAN - ROBERT F CHANDLER 5 A AVE �� ' ui tom, SALEM` NH 03079-25 21468...A'' Y 07/3 />16 53470 ' 0 ` Date.....e5`.. ..; TOWN;OF NORTH ANDOVER ti 9 PERMIT FOR PLUMBING �Ss�cHus�� This certifies that. ............................................................./. .......... . .. ............................................................. has permission to perform........................... plumbing in the buildings ofG?c 7�,l-'o ................................................................... at........:...:......................................................................................... North Andover, Mass. Fee/Q��::.:.:.Lic. No. ..................... ...........:................................................................... PLUMBING INSPECTOR Check# 72 ��' .............. 4 RY 0 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ss C c HU 44, This certifies that ..... ..1..... ... ............................................................ has permission for gas installation ............................................................................ in the buildings of... 5A.... ........................................................ at.................................................................................................. North Andover, Mass. t......- Lic. No. .......................... ..................................................................... GAS INSPECTOR Check# 10140 IV AN. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ MA DATE PERMIT# JOBSITE ADDRESS OWNER'S NAME a POWNER ADDRESS I TELT— 1FAX TYPE OR OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: , RENOVATION:El REPLACEMENT:® PLANS SUBMITTED: YES NO© FIXTSURES t FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE C DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM _ __.( ___C _. I ____..I w,_,_,( T_� _. _ __JI_ ___f __-.J ___JI DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER ( _ _C __j _ __ _J _—I DRI N ING FOUNTAIN ___C ....___....0 FOOD DISPOSER FLOOR/AREA DRAIN IN TERCEPTOR(INTERIOR) C 1 ..--_._._C KITCHEN SINK LAVATORY I - =_i .._ f --_-__I .—f 1 f J f ..__._J :_..__! J i ( -____I ROOF DRAIN C SHOWER STALL SERVICE MOP SINK _J __—J __J ._._.J _.__J ___. _I ___ _ .__�{ C .___j TOILET ( ___... I _-----I URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER lL INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES i NO Q IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND �f 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 E-11 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 compliance :ertinent provision of the Massachusetts State Plumbing Code and Ch pter 142 of the General Laws. PLUMBER'S NAME1:. IILICENSE# I SIGN E IMP JPQ CORPORATIONn# PARTNERSHIP S# LLC j COMPANY NAME ADDRESS CITY � ST �7� ZIP d TEL ?% _ FAXCELL��EMAIL GH PLQWG E ON NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECWNpOTES ef Yes No///fx,(-;(—/fl -:7/ THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Jr In.-A The Commonwealth of Massachusetts Department of IndustrialAceldents I Congress Street,Suite 100 _ Boston,MA 02114-2017 • S �t www.mass.gov/dia �Rhf J.V9 Workers'Compensation Insurance Affidavit:Builders/Contxactors/Electricians/Plumbexs. TO BE FILED WITH THE PEPJMTTING AUTHORI -Please Print Le 'bl A ' licant Information Name,(Business/Orgaiiization/Individual): Address: City/State/Zip: Phone 4: y i Type of project(required); Ase you an employer?.Check the appropriate box: J. em to full and/or part-time).' 7. ❑N6W'ConstruCtlon L[]I am a employer with � � P y ees( 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition 4 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 E]Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ❑ 11. Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 4 proprietors with no employees. 12.U Pr Mbing repairs or additions 5.❑I am a general contractor and T have hired the sub-contractors listed on the attached sheet. 13-.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14. Other 6fl We are a corporatiori and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and We have no employdes:[No workers'comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit•this affidavit indicating they are doing all work and then lire outside contractors must submit a new affidavit indicating such :;... tContrart.,s that check this box must attached an additional sheet showing the name c the sub-contractors and state whether or not those,entities ave employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'k 614 compensation insurancefor my employees. .Below isthepolicy and job site information. !Insurance Company Name: Expiration Date: Policy#or Self-ins.Lic.#: . ��wp City/State/Zip: Job Site Address: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e.152,§25A is a criminal violation punishable by a fnib up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. Ido hereby cert" under tliepains d enalties of perjury tliat tlae information provided above is true and correct. Date: Si a e: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): L6.0ther ealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector on: Phone#: 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 k.' 4receive 'otrustee opan individualPartnershi ,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 occupani 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 b6 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(1)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the Workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a w'o'rkers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia � y y ' COMMONWEALTH OF.MASSACHUSETTS>; • 01MMUU012 Lei z PLUMBERS AND GASFIITERS` ISSUES THE FOLLOWI7JG` LICENSE w LICENSED A,S AkMASTER'PLUh1BER r� 4Y G— M 0 T H Y M0THY C COXLE v.( 4 CROWN HILL ROAD , J y AxKINSON NH 03811 2213 ON i y MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK j 1 CITY ° II MA DATE — — ERMIT# I JOBSITE ADDRESSOWNER'S NAME ' OWNER ADDRESS _ TEL — FAX TYPE OR OCCUPANCY TYPE COMMERCIAL _I EDUCATIONAL PST RESIDENTIAL CLEARLY NEW: RENOVATION:E] REPLACEMENT:® PLANS SUBMITTED: YES M- NO APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER I - - BOOSTER CONVERSION BURNER ..__�-I...-c...T-. _. _--�I—_-_—_I - __ ,. __I �. COOK STOVE DIRECT VENT HEATER - DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE ._-J 1 FRARED HEATER LABORATORY COCKS ~'MAKEUP AIR UNIT - OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST — _.- _. .. _ _....... UNIT HEATER UNVENTED ROOM HEATER WATER HEATER �- OTHER 1, INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY'A OTHER TYPE INDEMNITY (] BOND F 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 EI AGENT 0 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 compliance wi I Pert'rFnt pro ' ' n of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME _ T�LICENSE# IGNATU MP�U MGF El JP D JGF Q LPGI CORPORATION Fjl#I �PARTNERSHIP 0# LLC E]# COMPANY NAME: _ ADDRESS CITY STATE ZIP TEL� 1 FAX CELL __ EMAIL OUGH GAS INSPECT N NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSUPION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES ' Y' The Commonwealth of Massachusetts _ Department of IndustrialAccidents X Congress Sheet,Suite 100 Boston,MA.02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Buildexs/Contxactoxs/Electricians/Plwmbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Le 'bl A licant Information Name(Business/Orgabization/individual): �� I Address: j 9, Phone#: ty 3 / / Ci /State/Zi ,.«_. _ p: ed Are you an employer?Checl[tlie appropriate box: Type of project(requlr ); eo fiill and/or part-time).* 7. F1New'coristruct[on 1.'�I am a employer with._m tP yees( IF]1 am a sole proprietor or partnership and have no employees Working for me in 8. ❑Remo dellfig any capacity.[No workers'comp.insurance required.] 9. ElDemolition l 3.Q T am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical or additions ensure that all contractors either have workers'compensation insurance or are sole tricrepaixs proprietors with no employees- s. s. Plwnbing repairs or additions 5.❑1 am a general contractor'and T have hired the sub-contractors listed on the attached sheet. 13•.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance lt}.' s Other tion per MGL c. 6.❑We are a corporation and its,officers have exercised their right of'exemption 152,§1(4),and We have no employees:[No workers'comp.insurance required.] *Any applicant that checks.bbk#1 must also fill out the section below showing their workers'compensation policy information: I Homeowners who submit,tlus affidavit indicating bn dthey nal sheegshowing the name of the sub-contractorsen hire outside and state wrs must heth t a new or nnot tho edavit entitim have all work .,. $Contractors that check this box must attached employees. if the sub-con6ctors have employees,they must provide their workers'comp.policy number. X am an employer that is providingworkees'compensation insurance for my employees. MOW is the policy and job site information. Insurance Company Name:rd/ / Expiration Date:. Policy#or Self-ins.Lie.ih Job Site Address: City/State/Zip: Attach a copy of4WL&orkers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA,for insurance coverage verification. coverage certa under thepains an ofperjury that the information provided above is true and correct Date:Ido _" r v Si ature: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: J 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 ofthe 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 r'equuiked." Additionally,MGL chapter 152,§25C(1)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." ` Applicants j Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial•Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple 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 Department's address,telephone and fax number: The Commonwealth.of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASS.AFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia I • I I 08/31/2015 10:56 FAX 603 382 3387 JOSEPH HILLS AGENCY INC 1@002 TIM0001 OP ID: ST A�RD� CERTIFICATE OF LIABILITY INSURANCE 7018/3 1/2112/Y0155 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 certlflcate does not Confer rights to the certlflcate holder in lieu of such endorsement(s). PRODUCER CONTACT THE JOSEPH S.HILLS AGENCY INC NAME: Sharon J.Tones 129 MAIN STREET,PO BOX 300 °A/C.N v 603-382-9211 A/c Na:603-3B2-3387 PLAISTOW,NH 03865-0300 E-MAIL Sharon J.Tonas s;Sharon hlllslnsurance,com INSURERS AFFORDING COVERAGE NAIC 11 INSURER A:Hanover Insurance Company 22292 INSURED Timothy Coyle Plumbing& INSURER B: Heating LLC 4 Crown Hill Road INSURER C: Atkinson, NH 03611-2213 INSURERD: .INSURERE! INSURER F: COVERAGES CERTIFICATE NUMBER: 15-010 REVISION NUMBER: 001 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, AUGL,'�IJBH POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 CLAIMS-MADE a OCCUR OHV5726396 11/21/2014 11/21/2015 pR DAMAQE TO RF.NTV;D'- occurrence $ 300,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 4,000,000 X POLICY Ll PEC ❑ LOC PRODUCTS.COMP/OP AGO $ 4,000,000 OTHER $ AUTOMOBILE LIABILITY DMBINdEDISINGLE LIMIT & ANYAUTO BODILY INJURY(Per person)ALL $ AUTOS OWNED SCHEDULED BODILY INJURY(Per accldent) S HIRED AUTOSNON-OWNED PROPERTY OAMAE_ AUTOS Per accldent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAO CLAIMS-MADE AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION H_ AND EMPLOYERS'LIABILITY YIN X STATUTE A OFFICER/MEM ER EXCLUDED?ECUTIVE a N I A WHV7326127 06/18/2015 06/18/2016 E.L.EACH ACCIDENT $ 500,00 (Mandatory In NH) It EL.DISEASE-EA EMPLOYEE $ 500,00 DfYe Se,describe under CRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 800,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addltlonel Ramarks Schedule,may be attached If more space Is required) Plumbing residential and light commercial. Workers Compensation Policy 3A States: NH,MA Member Exclusion applies for Timothy Coyle on Workers Compensation policy, Job: 9 Peach Tree Lane CERTIFICATE HOLDER CANCELLATION NOANDVI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1800 Osgood Street Bldg#20 Suite 2-36 AUTHORIZED REPRESENTATIVE No. Andover MA 01845 ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD , 1 NORTH TOWN OF NORTH ANDOVER pf i«ao ,e1h0 aj 'a ., p` PERMIT FOR MECHANICAL INSTALLATION F p SSACNUSES•( 1 I This certifies that CAwe.(A . .� � �i�,�. ...n . has permission for mechanical installation in the buildings of . . • . • • • • • • . . . . . . . . . . . . . • •V�^ ' at North Andover, Mass. F .kb .,. . Lic. No.. 4� �'�. . �- •R.4--- -. . . . . GAS INSPEE CTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer t Commonwealth of Massachusetts 4 Sheet Metal Permit Date Permit# Estimated Job Cost: /®, a o Permit Fee:;$ Plans Submitted: YES NO k Plans Reviewed: YES NO Business License# L!EC) Applicant License# -7 Ct Business Information: Property Owner/Job Location Information: Name: Gk6 I'L 1 Name:ISO � �" /►'1 Q` 1�-��i�i"Z> Street: k IT Street: /5 P&A k-10—(C-ro'S rd City/Town: /UeWWrCity/Town: /UorA An��$'Q-� Telephone: ol 7 g - fc ' 8 7 U 3 Telephone: q79- 341 3 P _ Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family ✓ Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. 9/ over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC ✓ Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: le f 0 V a - P�a�� 9S 13 To A h r" JN J INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes 0'No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy IB/ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box0,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Inspections Date Comments Final Inspection Date Comments Type of License: L+�1' By Master Title ❑Master-Restricted x __ City/Town ❑Journeyperson Permit# ❑ Signature of Licensee Journeyperson-Restricted License Number: 7 / Fee$ El Check at www.mass.gov/dpl { Inspector Signature of Permit Approval i. Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet-metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required)and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all scams and connections welded airtight with properly located cleanouts. Proper 6161`ances,fire rated enclosures and pressure testing requiped. Z. _` Sei �:?ive � aint installL Exrli ;�e required'on equipment and.dl=._:. Duct penetrations in fi e'ratQ-twA:r and flaors sealed Metal roofing systems installed watertight'using proper materials and fasteners Flexible duct runs installed 6'-0"maximum length Ductwork installed using proper hanger spacing,hanger stock,threaded rod and,angle iron Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off) Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has / been provided V' All workers performing sheet metal work onsite has valid Massachusetts sheet metal license V All sheet metal work being performed with proper joumeyperson-to- apprentice ratios V. Equipment sized per heating/cooling load calculations +/ Duct work sized per manual"D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors 1/ Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" lei ed F x bI uc t runs installed 14'-0"maximum length ✓ Volume dampers installed for each supply air branch duct V Ductwork installed using proper gauges and hangers Ductwork/plenum connections scaled substantially airtight '✓ Ductwork insulated by means of external covering or internal lining ✓ New/clean-properly sized filter installed(final inspection) V✓ Testing and Balancing report complete(final sign-off) • Duct System Summary Job: wrightsoft. Date: May 28,2015 AIH 1ST FLOOR By: Project I • • For: PEACHTREE FARM, CASWELL MECHANICAL LOT 2, NORTH ANDOVER, MA Heating Cooling External static pressure 1.00 in H2O 1.00 in H2O Pressure losses 0.36 in H2O 0.36 in H2O Available static pressure 0.64 in H2O 0.64 in H2O Supply/ return available pressure 0.288/0.352 in H2O 0.288/0.352 in H2O Lowest friction rate 0.163 in/100ft 0.163 in/100ft Actual air flow 1208 cfm 1208 cfm Total effective length (TEL) 393 ft Supply Branch - Table Design Htg Clg Design Diam H x W Duct Actual Ftg.Egv Name (Btuh) (cfm) (cfm) FR (in) (in) Matl Ln (ft) Ln (ft) Trunk DINING h 3370 154 142 0.212 7.0 Ox 0 VIFx 46.0 90.0 st9 FAMILY-A c 3121 124 155 0.308 7.0 Ox 0 VIFx 13.5 80.0 st2 FAMILY-13 c 3121 124 155 0.349 7.0 Ox 0 VIFx 7.5 75.0 st2 FOYER h 2547 116 95 0.255 6.0 Ox 0 VIFx 33.0 80.0 st7 KITBRK c 3512 140 174 0.209 7.0 Ox 0 VIFx 43.0 95.0 st10 KITBRK-A c 3512 140 174 0.252 8.0 Ox 0 VIFx 29.0 85.0 st8 LAUND h 1384 63 45 0.164 5.0 Ox 0 VIFx 56.0 120.0 st12 LAV h 1147 52 21 0.190 5.0 Ox 0 VIFx 46.5 105.0 st12 LIVING h 4757 217 197 0.163 9.0 Ox 0 VIFx 21.5 155.0 MUD-A h 1683 77 50 0.189 6.0 OX 0 VIFx 52.5 100.0 st11 Supply - • - Trunk Ht9 9 9 CI Design Veloc Diam H x W Duct Name Type (cfm) (cfm) FR (fpm) (in) (in) Material Trunk st2 Peak AVF 991 1011 0.164 910 15.0 8 x 20 ShtMetl st12 Peak AVF 116 65 0.164 260 15.0 8 x 8 ShtMetl st11 st11 Peak AVF 192 115 0.164 433 15.0 8 x 8 ShtMetl SOO st8 Peak AVF 625 606 0.164 704 15.0 8 x 16 ShtMetl st7 st9 Peak AVF 486 432 0.164 625 15.0 8 x 14 ShtMetl st8 st10 Peak AVF 332 290 0.164 598 15.0 8 x 10 ShtMetl st9 st7 Peak AVF 742 701 0.164 742 15.0 8 x 18 ShtMetl st2 Boldrrtalic values have been manually overridden wri htsoft° 2015-Ott-0215:08:25 ,At 9 Right-Suite®Universal 2015 15.0.15 RSU02044 Page 1 ACCPrnents\wrightsoftHVAC\CASWELL-LOT2PEACHTREE.rup Calc=MJ8 FrontDoorfaces:N Return Branch Detail Table Grill Htg Clg TEL Design Veloc Diam H x W Stud/Joist Duct Name Size(in) (cfm) (cfm) (ft) FR (fpm) (in) (in) Opening (in) Matl Trunk rb12 Ox 0 293 316 141.0 0.250 906 8.0 Ox 0 VIFx rt5 rb9 Ox 0 241 250 101.5 0.347 716 8.0 Ox 0 VIFx rt4 rb10 Ox 0 124 155 89.0 0.396 444 8.0 Ox 0 VIFx rt3 rb11 Ox 0 217 197 71.5 0.493 622 8.0 Ox 0 VIFx rt1 rb8 Ox 0 192 195 213.5 0.165 559 8.0 Ox 0 VIFx rt5 rb3 Ox 0 140 94 216.0 0.163 524 7.0 Ox 0 VIFx rt5 Return Trunk Detail Table Trunk Htg Clg Design Veloc Diam H x W Duct Name Type (cfm) (cfm) FR (fpm) (in) (in) Material Trunk rt4 Peak AVF 866 856 0.163 974 15.0 8 x 16 ShtMetl rt3 rt5 Peak AVF 625 606 0.163 938 15.0 8 x 12 ShtMetl rt4 rt3 Peak AVF 991 1011 0.163 1011 15.0 8 x 18 ShtMetl rt1 rt1 Peak AVF 1208 1208 0.163 1087 15.0 8 x 20 ShtMetl Boldktalic values have been manuaW overridden 2015-00-02 15:08:25 wrightsoftw Right-Suite®Universal 2015 15.0.15 RSU02044 Page 2 AC0, ...n-ents\WrightsoftFNAC\CASWELL-LOT2PEACHTREE.rup Calc=MJ8 Front Doorfaoes:N I Duct System Summary Job: - wli°ightsoft� Date: May 28,2015 AIH 2ND FLOOR By: Project Inf• • For: PEACHTREE FARM, CASWELL MECHANICAL LOT 2, NORTH ANDOVER, MA Heating Cooling External static pressure 0.95 in H2O 0.95 in H2O Pressure losses 0.36 in H2O 0.36 in H2O Available static pressure 0.59 in H2O 0.59 in H2O Supply/ return available pressure 0.286/0.304 in H2O 0.286/0.304 in H2O Lowest friction rate 0.130 in/100ft 0.130 in/100ft Actual air flow 1127 cfm 1127 cfm Total effective length (TEL) 455 ft Supply Branch DetailTable Design Htg Clg Design Diam H x W Duct Actual Ftg.Egv Name (Btuh) (cfm) (cfm) FR (in) (in) Matl Ln (ft) Ln (ft) Trunk BATH c 1405 63 72 0.182 5.0 Oxo VIFx 27.0 130.0 st17 BATH h 508 20 7 0.130 5.0 Oxo VIFx 40.8 180.0 st17A BED RM 2 c 2601 103 133 0.151 7.0 Ox 0 VIFx 34.5 155.0 st5 BEDRM3 h 3691 143 121 0.170 7.0 Oxo VIFx 48.7 120.0 st17 BEDRM4 c 2601 79 133 0.159 7.0 Oxo VIFx 15.0 165.0 st5 BEDRM5 c 2927 134 149 0.172 7.0 Oxo MtFx 31.1 135.0 st17A HALL2ND h 520 20 16 0.163 5.0 Oxo VIFx 35.1 140.0 st17 LAUND2 c 1966 45 100 0.167 7.0 Ox 0 VIFx 21.0 150.0 st5 M,BED h 4432 172 115 0.217 7.0 Ox 0 VIFx 26.8 105.0 st18 M,BED-A h 4432 172 115 0.185 8.0 Ox 0 VIFx 29.5 125.0 st6 M.BATH c 1464 66 75 0.188 6.0 Ox 0 VIFx 17.0 135.0 st6 M.BAM+A c 1464 66 75 0.210 6.0 Ox 0 VIFx 21.3 115.0 st18 KWIC h 1164 45 17 0.150 5.0 Ox 0 VIFx 31.4 160.0 st5 SupplyDetail Table Trunk Htg Clg Design Veloc Diam H x W Duct Name Type (cfm) (cfm) FR (fpm) (in) (in) Material Trunk st18 Peak AVF 237 190 0.210 435 10.0 0 x 0 ShtMetl st6 st17 Peak AVF 381 366 0.130 485 12.0 0 x 0 ShtMetl st5 st17A Peak AVF 154 156 0.130 286 10.0 0 x 0 ShtMetl st17 st5 Peak AVF 652 747 0.130 952 12.0 0 x 0 ShtMetl st6 Peak AVF 475 380 0.185 604 12.0 0 x 0 ShtMetl J- IBo/drrtalk values have been manually overridden ^C wrightsoft- Right-Suite®Universal 2015 15.0.15 RSU02044 2015-0ct-02 15:08:25 Page 3 ACCA ...ments\wrightsoftHVAC\CASWELL-LOT2PEACHTREE.rup Calc=MJEI Front Door faces:N Table -Return Branch Detail Grill Htg Clg TEL Design Veloc Diam H x W Stud/Joist Duct Name Size(in) (cfm) (cfm) (ft) FR (fpm) (in) (in) Opening(in) Matl Trunk rb6 Ox 0 154 166 234.3 0.130 475 8.0 Ox 0 VIFx rt7A rb7 Ox 0 163 128 157.0 0.193 466 8.0 Ox 0 VIFx rt7 rb5 Ox 0 211 221 147.5 0.206 633 8.0 Ox 0 VIFx rt6 rb4 Ox 0 295 348 97.0 0.313 997 8.0 Ox 0 VIFx rt2 rb1 Ox 0 303 264 84.0 0.362 556 10.0 Ox 0 VIFx rt2 Return Trunk Detail Table Trunk Htg Clg Design Veloc Diam H x W Duct Name Type (cfm) (cfm) FR (fpm) (in) (in) Material Trunk rt7A Peak AVF 154 166 0.130 304 10.0 0 x 0 ShtMetl rt7 V Peak AVF 317 294 0.130 297 14.0 0 x 0 ShtMetl rt6 rt6 Peak AVF 529 515 0.130 494 14.0 0 x 0 ShtMetl rt2 rt2 Peak AVF 1127 1127 0.130 1054 14.0 0 x 0 ShtMetl I Bold/italic values have been manuaW overridden CWrl htSOft® 2015-Oct-0215:08:25 9 Right-Suite®Universal 2015 15.0.15 RSU02044 Page 4 ACCK ...ments\WrightsoftHVAC\CASWELL-LOT2PEACFFREE.rup Calc=MJ8 FrontDoorfaces:N a • The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,AM 02114-2017 www mass.gov/dia Porkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): C:q 5 Al e c Oct✓i Address: 3 G Rq f 4Z D City/State/Zip: /V ew B LAP,Y Pov-F A i q5 Phone#: 78 q G Are you an employer?Check the appropriate box: 'hype of project()required): 1.Vam a employer with C _employees(full and/or part-time).* 7. Mlgew construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12Plumbing repairs or additions 5.❑I am a general contractor and I Kaye hired the sub-contractors listed on the attached sheet. 13.FJ Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have not employees.[No workers'comp.insurance required.] *Any applicant that checks b6x#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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contraci&s have employees,they must provide their workcis'comp.policy number. I am an employer that is piovid6ig workers'compensation insurance for my employees.'Below is the policy and yob site information. Insurance Company Name: h d'Mo wk y G ct rd Policy#or Self-ins,Lic.#: C A'-,J C `�7 Expiration Date: .a Job Site Address: 1 5 P {gc1q f ve e f f"'15 �� 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un er thepains and penalties ofpeijuiy that the information provided above is true and correct. Si nature: Date: o CF 5 Phone#: q 7 7'�r 3 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#: Wr1�hItSOft® Load Short Form Job: " Date: May 28,2015 Entire House By: Project Information For. PEACHTREE FARM, CASWELL MECHANICAL LOT 2, NORTH ANDOVER, MA Design Information Htg Cig Infiltration Outside db(°F) 2 88 Method Simplified Inside db(°F) 70 74 Construction quality Tight Design TD (°F) 68 14 Fireplaces 1 (Average) Daily range - L Inside humidity(%) 30 50 Moisture difference(gr/Ib) 28 30 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref. n/a Coil n/a AH R I ref. n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load:sensible heat ratio 0 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ftp (Btuh) (Btuh) (cfm) (cfm) A/H 1ST FLOOR d 1367 26158 24194 1127 1127 A/H 2ND FLOOR d 1787 29079 22117 1127 1127 Entire House d 3154 55237 46312 2254 2254 Other equip loads 11501 2310 Equip. @ 1.00 RSM 48622 Latent cooling 4317 TOTALS 3154 66738 52939 2254 2254 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. .� wrightSof " Right-Suite®Universal 201515.0.15 RSUP 02044 2015 May 28 1age 8 Page 1 ACCK ...ments\WrightsoftHVAC\CASWELL-LOT2PEACHTREE.rup Calc=MJB FrontDoorfaces:N Job: - - wrightsoft® Load Short Form Date: May 28,2015 AIH 2ND FLOOR By: Project Information For. PEACHTREE FARM, CASWELL MECHANICAL LOT 2, NORTH ANDOVER, MA Design Information Htg Clg Infiltration Outside db (°F) 2 88 Method Simplified Inside db(°F) 70 74 Construction quality Tight Design TD (°F) 68 14 Fireplaces 1 (Average) Daily range - L Inside humidity(%) 30 50 Moisture difference(gr/Ib) 28 30 HEATING EQUIPMENT COOLING EQUIPMENT Make Make Heil Trade Trade HEI L Model Cond N4A336A(G)KB3 AHRI ref Coil ENH4X36L17**++TDR AHRI ref 6417015 Efficiency 95AFUE Efficiency 11.0 EER, 13 SEER Heating input 0 Btuh Sensible cooling 28730 Btuh Heating output 0 Btuh Latent cooling 5070 Btuh Temperature rise 0 OF Total cooling 33800 Btuh Actual air flow 1127 cfm Actual air flow 1127 cfm Air flow factor 0.039 cfm/Btuh Air flow factor 0.051 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.87 ROOM NAME Area Htg load Clg load Htg AVF CIgAVF (ft2) (Btuh) (Btuh) (cfm) (cfm) M.BATH 163 3387 2928 131 149 t . BED RM 4 110 2044 2601 79 132 LAU N D2 68 1148 1966 44 100 Iy: BATH 2 63 1637 1405 63 72 t M M M,BED 425 8863 4520 343 230 BED RM 2 170 2654 2601 103 132 M.WIC 136 1164 328 45 17 is BED RM 3 162 3691 2381 143 121 BATH 3 54 508 136 20 7 BED RM 5 209 3463 2927 134 149 f HALL 2ND 228 520 324 20 16 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. J. wri htSoft- 2015-May-28 1Page 8 /� 9 Right-SuRe®Universal 201515.0.15 RSU02044 Page 4 ACCh ...ments\WrightsoftHVAC\CASWELL-LOT2PEACHTREE.rup Calc=MJ8 FrontDoorfaces:N A/H 2ND FLOOR d 1787 29079 22117 1127 1127 Other Equip loads 7336 1474 Equip. @ 1.00 RSM 23591 Latent cooling 3672 TOTALS 1787 36415 27263 1127 1127 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. .� �- wrightSoft" Right-Sufte®Universal 201515.0.15 RSuo2044 2015-May-28 11:25:28 t, Page 5 ACOA ...ments\WrightsoftWACCASWELL-LOT2PEACHTREE.rup Calc=MJB FrontDoorfaces:N i Load Short Form Job: wrl htSoft Date: May 28,2015 AIH IST FLOOR By: i Project Information For. PEACHTREE FARM, CASWELL MECHANICAL LOT 2, NORTH ANDOVER, MA Design Information Htg Clg Infiltration Outside db(°F) 2 88 Method Simplified Inside db(°F) 70 74 Construction quality Tight Design TD (°F) 68 14 Fireplaces 1 (Average) Daily range - L Inside humidity(%) 30 50 Moisture difference(gr/lb) 28 30 HEATING EQUIPMENT COOLING EQUIPMENT Make Make Heil Trade Trade 13 SEER N SERIES R410AAC Model Cond N4A336A(G)KB3 AHRI ref Coil EN(A,D)4X36*21**++TDR AH R I ref 5954038 Efficiency 95AFUE Efficiency 11.0 EER, 13 SEER Heating input 0 Btuh Sensible cooling 28730 Btuh Heating output 10 Btuh Latent cooling 5070 Btuh Temperature rise 0 OF Total cooling 33800 Btuh Actual air flow 1127 cfm Actual air flow 1127 cfm Air flow factor 0.043 cfm/Btuh Air flow factor 0.047 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.87 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) LAUND 51 1369 895 59 42 (. LAV 33 1134 416 49 19 s MUD 77 1665 997 72 46 KIT/BRK 402 6047 6991 261 326 =: LIVING 234 4705 3939 203 183 DINING 150 3333 2843 144 132 FOYER 75 2519 1901 109 89 FAMILY 345 5387 6213 232 289 ` - 7 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. 2015-May-2811:25:28 .-t - - wrightSoft- Right-Suite®Universal 2015 15.0.15 RSU02044 Page 2 ACCK ...ments\WrightsoftWAC\CASWELL-LOT2PEACHTREE.rup Calc=MM FrontDoorMces:N 'A/H 1ST FLOOR d 1367 26158 24194 1127 1127 Other equip loads 4165 837 Equip. @ 1.00 RSM 25031 Latent cooling 3785 TOTALS 1367 30324 28816 1127 1127 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. wri htSOW 201SMay 28 1Page 8 9 Right-Suite®Universal RSU02044 Page 3 ACCA ...ments\WrightsottwAcr-ASWELL-LOT2PEACKrREE.rup Calc=MJS FrontDoorfaoes: N N Level 3 M.BATH BED RM 4 LAUND2 BATH 2 BED RM 5 HALL 2ND KBED BATH 3 M.W C BED RM 2 OPEN TO BELOV BED RM 3 Job#: Scale: 3/32"= 1'0" Performed for: Page 3 PEACHTREE FARM Right-Suite®Universal 2015 LOT 2 15.0.15 RSU02044 NORTH ANDOVER,MA 2015-May-28 11:26:02 t HVAC\CASWELL-LOT2PEACHT.. N ' Level 1 basement Job#: Scale: 3/32" = 1'0" Performed for: Page 1 PEACHTREE FARM Right-Suite®Universal 2015 LOT 2 15.0.15 RSU02044 NORTH ANDOVER,MA 2015-May-28 11:26:02 t HVAC\CASWELL-LOT2PEACHT... N Level 2 LAUND MUD KIT/BRK LAV J FAMILY garage _T DINING FOYER LIVING Job#: Scale: 3/32" = TO" Performed for: Page 2 PEACHTREE FARM Right-Suite®Universal 2015 LOT 2 15.0.15 RSU02044 NORTH ANDOVER, MA 2015-May-28 11:26:02 t HVAC\CASWELL-LOT2PEACHT... t 1 C CASWELL-C�,) Estimate M E C H A N '1 C A 1.. KIRM-NIMIG-AMOMMINI Date Estimate# 3 Graf Road Unit 8 Newburyport,MA 01950 615/2015 2889 Mame i Address William McKay Construction Mgmt 4 Powdermiil Sq. Unit 101 Andover,MA 01810 Terms Project Void After 30 Days Peachtree Farm Lot 2 Description Ulm Cost Total The furnishing,fabrication and installation of two gas systems 22,800.00 22,800.00 with air conditioning units setup as one zone each.One serving the first floor and one serving the second floor using Heil equipment as follows: 1st Floor *One Heil 95%efficient single stage furnace model# % N9MSE0401712A. *One Heil 13 SEER 3 ton R410-A condenser model# N4A336AKB. *One Heil 3 ton evaporator coil model#END4X36L17A. 2nd Floor *One Heil 95%efficient single stage furnace model# N9MSE0401712A. *One Heil 13 SEER 3 ton R41 0-A condenser model# N4A335AKB. *One Heil 3 ton evaporator coil model#ENH4X36L17A. This includes two drains to suitable sites,two programmable thermostats.The main supply and return distribution trunk will be galvanized steel,insulated with FSK insulation and seated per MA code.All branch runs will be insulated flexible duct connected to ceiling and floor mounted boots.Also 6 containment pan with float switch will be installed,which will shut the unit down in the event the pan becomes plugged. Complete less gas piping and wiring. Phone: Fax: E-mail Web Site (978)462-8783 (978)462-5858 jeftnacaswellmechanical.com www.caswellmechanical.com Page 1 IP;W 1 CAW M EEstimate CHA N4"cALt. 8. Date Estimate# 3 Graf Road Unit 8 Newburyport,MA 01950 2889 6!5/2015 2889 Name/Address William McKay Construction Mgmt 4 Powdermill Sq. Unit 101 Andover,MA 01810 Terms Project Void After 30 Days Peachtree Farre Lot 2 Description U/M Cost Total Note:This home was sized as a HERS rated home with a cooling temperature differential of 14 degrees. Note:if the roof is not insulated with the attic space being outside the thermal envelope,the furnace in the attic must be enclosed within an insulated box to prevent condensate from freezing. Base price of plumbing;All waste pipe to be done with schedule 15,500.00 15,500.00 40 PVC pipe.All domestic water to be piped in Pax tube. Showers to be single function.Multiple functions not included in quote.Lavatories to be vanity style.Wall faucets not included in quote.(Please note price does not include fixtures). 4 Toilets. 5 Lavatories. 2 Tubs. 2 Showers. 1 Laundry hook-up. 1 Kitchen sink. 1 Dishwasher. 1 Ice maker. 2 Silcocks. Sparco thermostatic mixing valve if personal shower added to 400.00 400.00 soaking tub. Copper pan allowance for one pan. 550.00 550.00 75 Gallon natural gas power vented water heater. 1,975.00 1,975.00 Gas piping range,water heater,2 furnaces and fireplace.All 2,500.00 2,500.00 piping schedule 40 steel pipe. Phone: Fax: E-mail Web Site (978)462-8783 (978)462-5858 jeffaa caswellmechanical.com www.casvvelimechanical.com Page 2 ------ CASWELL Estimate 3 Graf af PURoadd Unit IBAt 8 Date Estimate# ni _ Newburyport,MA 01950 6!512015 2889 Name 1 Address. William McKay Construction Mgmt 4 Powdermill Sq, Unit 101 Andover,MA 01810 Terms Project Void After 30 Days Peachtree Farm Lot 2 Description UIM Cost Total Optional washing machine connection: 950.00 950.00 Base price of plumbing;All waste pipe to be done with schedule 40 PVC pipe.All domestic water to be piped in Pex tube.(Please note price does not include fixtures). Exclusions: Concrete cutting and patching. Cutting and patching of roof. Structural supports. Engineering. Affidavit forms. Meters. Backflow. Taxes. Permits. Electrical wiring. Balance testing and flow reports. Premium portion over time hours. Prevailing wage. Trenching. Backfilling. Fire stopping. Customer Acceptance of Estimate and P-916 t Schedule Date ` � 0 Phone: Fax: E-mail Web Site (978)462.8783 (978)462-5858 j&@'caswelhnechanical.com wtivw.caswelimechanical.com Page 3 a" o o • • O ct .y A;%, •3 BUREAU,OF'BUILDING SAF.EYV iCONSTRUCTJON-.:y' BOAR; SHEET LF1E,T%AL ' ORKERS :� ( § PLUMBING SAFETY SECTION ISSUESATHE FOLLO IN6 AS A BUS I ESS (� NAME:JEFFREY B CASWELL A. )E;F:FRfY B CASWELI LIC#:4671 M ' r.CASWELI h4ECHANICAL INC IZ; 3 GRAF`4RD r t` fi s i°' EXPIRES: 03/31/2015 UNIT 8. FF Y �< MA 019 0 NEWBURYPORT4. 33330 MAW ff COMMONWEALTIi OF ASSbCHIsETfs,:°;: State of New Hampshire • o • 701 p1guigglegob GAS FITTERS LICENSE ' ROARD OF SHE E ;JMETAL `WORKERS ! NAME• JEFFREYCASW.EI s ISSUES THE FO LL WINGL10ENSE * e3' x AS2*,—MASTER U R�ESTR I CTED i . � 1 ENDORSEMENTS: STN, SMTP � .-.. , DATE ISSUED: 03/05/2013 JEFFREY B CASWEL'C �� t ` 'y% DATE EXPIRES:03/31/2015 3 GRAF`Rbx STE 8, >� f :;. z LICENSE#:GFE0802900 <xNEWBI RYPORT. Y MA 019 0 4601 <= X79 ' a3/?8/1 183603 >' .:.ry...., tom.,,, z..w v d. r r , COMMONWEALTH W MA9.SJr1OH1., TS t. .iA640 OMM0NWEALTH OF MA$. Af✓Ht1SETTS k ' • o • • 13� • • • • �� a BQARD:OF �r 4 f PLUMBERS ND,�GA'SF fTTERSh Wk BOAR D.:OF ti 155UE5 TNEFOLLOWINC, LCIsEN5E LUM6ER,S-ANfI GASF TIERS § h s` 4 ISSUES THS,.FOLLOWI Nti >L f CENSE max, LI CENSfbAS A MASTR 'PLUMBER a a REG�1TSgTtiREb AS A PLUM• I NG "ORP JEFF�RE,Y B CASWELL F JEFFREY B CASWE`LLlu u "< -• ,5. d , 3 t, _Yfi,.�rx}'� t. -.fie .y, fCA�5WEWLL MEC#AtJ CAL INC *r, id 3 GRAF RD ,3GRATF 12D W UNIT 8 ' : 1W6l1YPORT MA3 01950 4601 r`NEWB�I w? 950 .4OA5PORT MA 01 4 x1 31 I+4 a05/O 1/1,6 ;r 199786 ' # ��CGOMMONWEAYiA.O,F MASSACHUSETTS y .,_v. r • • I RINE -PLUMB3 BOARD OF STATE OF ERS�`MV,UGASF ITTER•S� DEPT OF PROFESSIONAL&FINANCIAL REGULATION L? v PLUMBERS EXAMINING BOARD , : ISSUES THE FO.LLOW I NG I CENSE H2� LI CEN&ED A5 A JOURNEYMAN PLUMBERf. :' "o ° LICENSE#MS 0014390 JEFFREY B. CASWELL JEFfIZE'Y B CASWELL ^� LICENSED MASTER PLUMBER 3 GRAF RD M3• �r VT UNIT 8 ts, ISSUED Apr 01,2014 EXPIRES M 3r 31,2016 "=NEW URYPORT MA 01950 4601 '' _ ` 30841600 v 6 # X 199784 II