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Miscellaneous - 2110 TURNPIKE STREET 4/30/2018
Date ..........7"..r.2. .. .. .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ................................................................. .................................................... has permission to perform .........�e t(j 14DUS z:— � ........................................................................................ wiring in the building of....... 5....... . .................................................... ...... 5; . -- A. .... .. . �. I North Andover, Mass. ....................................... ..... ... . ............ Fee Lic. No. .. ...................... ... , ...... ...... . ELECTRICAL PEC . FOY.... Check# 10,5-6 Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 117 7,0 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] peaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASEPRINTININKORTYPEALLINFORMATION) Date: 7' 13 City or Town of: NORTH ANDOVER To the Inspector of *Wires: By this application the undersigned pi o f his or her intention to perform the electrical work described below. Location (Street &Number) I—V* h 0 t L(D vl Owner or Tenant 1 Owner's Address Telephone No. Is this permit in conjunction with a building permit? ales V No U (Check Appropriate Box) �\ Purpose of Building Utility Authorization No. -1 A b gA9B4 Existing Service � Amps / Volts New Service Amps / Volts Overhead Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion ofthe followine table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA N�. of Luminaire Outlets No. of Hot Tubs Generators KVA I� of Luminaires Swimming Pool Above ❑In- E] No. of EmergencyLighting . rnd. grnd. Battery Units 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 Tons No. of Alerting Devices No. of Waste Disposers Heat Pump I Number Tons "."'.........................""...'"....... I KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: 4 Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP 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 covera is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) X certify, under the pains and penalties of perjury, that the information on this application is true and complete FIRM NAME: _ g A W l �, S Z0 tj LIC. NO.: Licensee: Signat a LTC. NO.: (If applicable, rater "exempt" in the license numb r 1' e.) Bus. Tel. No.: 7 — � Address: — Alt. Tel. No.• *Per M.G.L . 147, s.57-61, security work requires Depa of Public afety "S" License: Lic. No. � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: � Signature Telephone No. a ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/DAte,Closed: Trench Inspection Pass M Failed 1 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: �- 2 l Inspectors Signatu e: Date: PARTIAL ROUGH INSPECTION: Pass n Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROU H SPECTION: Pass K Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: D ?— 7, Inspectors Signature: Date: FINAL INS TION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: �� Date: F—If DEB WEINHOLD/ ... TOWN OF ME IMAC, MA. ........ dweinhold@townofmerrimac.com The Commonwealth of Massachusetts Department of IndustrialAccWhts Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): A) o S Z D Address:_ S t ' IJV &�2 wl�)t ®V - AT JOA�J U City/State/Zip: Phone Are you an employer? Check the appropriate box: 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 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL fi myself. [No workers' comp. c.152, §1(4), and we have no insurance required.] t employees. [No workers' t comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any dplicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up 1'6 $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 certunder the pains a dpenalties o er'ury that the information provided above is true and correct. Signatur . Date: ,14,-/ IC 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 i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire," express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or loeal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or, town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tei, # 617-727-4900 at 406 or 1-877:MASSAFE Revised 5-26-05 Fax # 617-727-7749 www-mass,gov/dia A 10021 Date TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. �/�%�!-t ��� . •�• L/.L„ �j. has permission to perform ...�� . �? l >,- — , , , , , , .. • . , • • . . plumbing in the buildings of r� U.�,�, ,/< .. .. . . . . . . . ... . ..... . at.... p�/N•,.% . �,.-; , North Andover, Mass. Fee Lic. No. %f ................. ... PLUMBING INSPECTOR Check # -y p .wr FLOOR / AREA DRAIN INTERCEPTOR (INTEf KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL - � • • ��� itl���f��[��f��li�t��ll�l WATER HEATER ALL TYPES WATER have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES [T NO �! IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [Rr' OTHER TYPE OF INDEMNITY Q BOND Q OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY:; OWNER F-1 AGENT JQ 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 cgmpliance wjHi SII Pertinent pr ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i ( /1 A PLUMBER'S NAME o ? I"_0eK-)1" {LICEN SE# MP Wo JP EI CORPORATION [3# =PARTNERSHIP 0# LLC Ek COMPANY NAME �rGcJlo�. PL��+°ADDRESS AQ - CITY STATE /tJ, o j ZIP 6 3 T4 _ ; TELy 3.02 75� FAX F CE6F3 6S/.2.4 °EMAIL , In MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �T__M J4iv ©✓�,�.. MA DATE' .2 ? ^ s jj PERMIT # JOBSITE ADDRESS c'? I l Z1 7-0 K -A) t OWNER'S NAME[__:S-T7--:-- :S`Tc P P OWNER ADDRESS TELFAX t TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL QI RESIDENTIAL PRINT 11"RENOVATION: CLEARLY NEW: REPLACEMENT: ® PLANS SUBMITTED: YES D N00 FIXTURES Z FLOOR- BSM 1 2 3 4 5 6 7 8 9 :10 11 12 13 14 BATHTUB _I =-90 CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM I .___...__ E ------ ___.__1 i --------- ___1 DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN_-.._.. i FOOD DISPOSER _-J _;_ __I FLOOR / AREA DRAIN INTERCEPTOR (INTEf KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL - � • • ��� itl���f��[��f��li�t��ll�l WATER HEATER ALL TYPES WATER have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES [T NO �! IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [Rr' OTHER TYPE OF INDEMNITY Q BOND Q OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY:; OWNER F-1 AGENT JQ 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 cgmpliance wjHi SII Pertinent pr ision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i ( /1 A PLUMBER'S NAME o ? I"_0eK-)1" {LICEN SE# MP Wo JP EI CORPORATION [3# =PARTNERSHIP 0# LLC Ek COMPANY NAME �rGcJlo�. PL��+°ADDRESS AQ - CITY STATE /tJ, o j ZIP 6 3 T4 _ ; TELy 3.02 75� FAX F CE6F3 6S/.2.4 °EMAIL , In AW a The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Uf www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �(/�% � ��/� / 13 C PC U (V < Address: /.2 L L -,Lj City/State/Zip: VeuA_ZX) Vhl 039Sf Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I eluployees (full and/or part-time).* have hired the sub -contractors 2. [r am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. Rflumbing repairs or additions 1211 Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lie. #: Expiration Date. Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cera* under the paAand penalties of perjury that the information provided above is true and correct. Phone#: G& U 3 S 9o2'79a? Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the .bottom o the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massa..chusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 Tel, # 617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax # 617-727-7749 wwwmass,govfdia it 0 COMMONWEALTH OF MASSACHUSETTS. ....... ... PLUM BEIVS AND.GA'SFtTTERS UICENSED AS A JOURNEYMAN Plbl ISSUES THE ABOVE LICENSE TO ORMAND p BERUB-E l2 L1tVf -.-,0 L N ROAD fo NEWTON NH 103858-3105 '171-795 C�M�I6N.WEALTH OF MASSACHUSETTS IT. MBERS AND GASFITTERS A,MASTER PLUMBEF UES THE ABOVE LICENSE TO: NORMAND p BERU13E LINCOLN -RD NEWTON NH 03858-1310 -34 588 -.05/01/141 1 9 1 1 1794 This certifies that ... has permission for gas installation ... . , . G -.,_.e.,...,, ........ . in the buildings of ... ,��,.`��,�.4,,,,,,,,,,,,,,,,,,,,,,, at ... %� j/ ...,! �.� , .� , J/ -.... , North Andover, Mass. Fee . /0.7).42. Lic. No.. J%i� . ./L . ,/d. ................. . GASINSPECTOR Check # IV 8761 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY L j MA DATE�o? 7— r3 PERMIT # JOBSITE ADDRESS %21.t t3 �77J �ocl 'r f.GSr 4 7— OWNER'S NAME GOWNER ADDRESS_ TE 3 to e a r s- FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL L] RESIDENTIAL PRINT CLEARLY NEW: L RENOVATION: []_J REPLACEMENT: Ej PLANS SUBMITTED: YES F-11 NO Q APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 1 9 10 1 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1- �. _ _... I. ... I DIRECT VENT HEATER11 DRYER J FIREPLACE- FRYOLATOR J== FURNACE __ _r _:.z1 --- - ----- - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT_ -- OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT__:_ . T-- TESTLA IT HEATER _ _._ U VENTED ROOM HEATER __ II it -..__j _ --I _ WATER HEATER : ��I —� OTHER INSURANCE COVERAGE MGL. Ch.142 YES `NOD have a current liability insurance policy or its substantial equivalent which meets the requirements of 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E] BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY:. OWNER 0 AGENT SIGNATURE OF OWNER OR AGENT 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 of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli a with all Perynpnt provisigoofthe Massachusetts State Plumbing Code and Chapter 142 of the General LLaws..-- �/' `` PLUMBER-GASFITTERNAME !�C�'j?fQX��e-_1��NSE# /�5..- SIGNATURE MP vleMGF __ J JP - JGF I LPG] CORPORATION j# _ !PARTNERSHIP El#= LLC # COMPANY NAME:e!t.V to G_ r `t-� ADDRESS CITY STATE ZIP _ cS TEL FAX CEI 4\1 4 0 w F O z oM �r w C ❑ �Z O N w } � ~ w LU z W 3 CO w 55 ® > a a w � a w o a a a U J a IL Q �r C w = w f- LL W H °z (-v 0UK H U W a . a The Commonwealth of Massachusetts - Department of IndustrialAccidints Office of Investigations vy 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): Address: �2 L /:Y) L6 L _..c) heA City/State/Zip: V-1) d; .V S -Y Phone #: Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ❑ I am a general contractor and I e}ployees (full and/or part-time).* have hired the sub -contractors 2. [ram a sole proprietor or partner- listed on the attached sheet t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.[�flumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *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 aie doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and joh site information. Insurance Company Name:. Policy # or Self:-ius. Lic: .- -Expiration Date: - - - Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP- WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance covetage verification. I do hereby cer.* under the pal Mand penalties of perjury that the information provided above is time and correct Phone #• G & U 3 s 9,:) -2,9a ? Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit/License # csL? —/ 3 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 M K MAONMAONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS -,:..:.LiCENSED,AS A MASTER PLUMBEF' *UES THE ABOVE LICENSE TO: NORMAND P BERUBE 12 -L I NCO L.N RD NEWTON NH 03858-31:03 11588 05/01/14 .171794 I 217 Date. ����!I��......... TOWN OF NORTH ANDOVER A�\pl PERMIT FOR MECHANICAL INSTALLATION This certifies that has permission for mechanical installation .... ! ..t. !I .............. . in the buildings of SA `'.^�.,�!�n `r •! t, • .............. . at .. .11 t�... i . b�.? - ��' .. • • North Andover, Mass, Fee.W'�. Lic. No CI�2'73.... ...................... GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer V Commonwealth of Massachusetts Sheet Metal Permit Date: �� 3 �/ Permit # Cost: a oo Permit Fee: $ �Q Estimated Job C � � L� Plans Submitted: YES NO Plans Reviewed: YES NO Business License # 9 O�� � Applicant License # q715�. Business Information: Property Owner / Job Location Information: Name: ® i.TPL C,V4Name:I 1 U Street: _% d o %n C,-,,.•ro,� j�,ioye Street: �.,1 1 % ✓ / r ��i i City/Town: PaM47 J }'J4, Ogg y/City/Town: IV► 19 Telephone: d ��� �� Telephone: / 7 -' 75L-6 55)3 Photo I.D. required / Copy of Photo I.D. attached: YES NO Building Type: Multi -family Residential: 1-2 family Y Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft.y over 35,000 cu. ft. 01 Sheet metal work to be completed: New Work: r Renovation: HVAC Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: d c r 0. INSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box , I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date By_ Title Cityrrown Permit # Fee $ Inspector Signature of Permit Approval Progress Inspections Comments s y Final Inspection Comments Type of License: ❑ Master ❑ Master -Restricted ❑Journeyperson ❑Journeyperson-Restricted Signature of Licensee License Number: Check at www.mass.gov/dpi A 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 joumeyperson-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 seams and connections welded airtight with properly located cleanouts. Proper clea;`ances, fire rated enclosures and pressure testing required: 'Se.i ?:ric resliaintb installed3i d`" required'oin equipment and d ktv; Ork, _ — Duct penetrations in fire's cel-Evall:, and floors sealed Metal roofing systems installed watertight' using proper materials and fasteners Flexible duct pins 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 dampers installed for ly branch duct each su air Volume supply p 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 All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) e ) a 4 Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal 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 joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) Don Quintal Heating & Cooling 100 McIntosh Lane, Hampstead, NH 03841 MA 978-372-6503 NH 603-489-1623 -57--6� /a � A 2 Terms: Please detach and return with your remittance Number Id A Don Quintal Heating & Cooling �tiacnle �OU PIYThisCoumnt Don Quintal HVAC Load Calculations for Don Quintal Haverhill, MA fir' r + r - Prepared By: Jack Richards The Portland Group 74 Salem Road Billerica, MA 978-262-1487 Wednesday, June 05, 2013 Rhvac is an ACCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. Outdoor Htikac -Residential i�l fifCommercial - __N VA--C'C d FS Elft'Softare Developimnt, ln�- ,,tland Group [Billeric ThePor Don. Quintet �MA QIO�Z Page 2] DU Bulb Winter: 0 Wet Bulb -0.65 rot pgrt n/a 70 n/a Project Title: Don Quintal Designed By: Jack Richards Project Date: Wednesday June 5 2013 Client Name: Don Quintal Client City: Haverhill, MA Client Phone: 978-852-7207 Client E -Mail Address: dqhc@comcast.net Company Name: The Portland Group Company Representative: Jack Richards Company Address: 74 Salem Road Company City: Billerica, MA Company Phone: 978-262-1487 Company E -Mail Address: jmr@theportiandgroup.com Company Website: www.thepordandgroup.com - —6a Reference City: North Andover MA Building Orientation: Front door faces South Daily Temperature Range: Medium Latitude: 42 Degrees Elevation: 57 ft. Altitude Factor. 0.998 Outdoor Outdoor Outdoor Indoor Rel.Hum Indoor Dry Bulb Grains Difference DU Bulb Winter: 0 Wet Bulb -0.65 Rel.Hum 80% n/a 70 n/a Summer. 87 72 49% 55% 72 30 �Total Building Supply CFM: 1,590 CFM Per Square ft.: 0.875 Square Volume (ft') of Cond. Space: 14,544 --------- FOP Total Heating Required Including Ventilation Air. 65,624 Btuh 65.624 MBH Total Sensible Gain: 34,913 Btuh 87 % Total Latent Gain: 5,342 Btuh 13 % Total Cooling Required Including Ventilation Air. 40,255 Btuh 3.35 Tons (Based On Sensible + Latent) LRhvac is an RCCA approved Manual J and Manual D computer program. Calculations are performed per ACCA Manual J 8th Edition, Version 2, and ACCA Manual D. All computed results are estimates as building use and weather may vary. Be sure to select a unit that meets both sensible and latent loads according to the manufacturer's performance data at your design conditions. C:1 ... XDon Quintal -North Andover MA_rh9 Wednesday, June 05, 2013,10:24 PM Aiwac-R-6-O'dinball �&Light _db_M__rMnerciaI L408ft I The Pomand'Gtoup I Bill[edc p_ca ill MA Load Preview Report IM OP n alit tal a I Dot] Paw 3 Net; ft.'" Sen; Lat I Ne U Sen: Htgi ys: Sys cig� Sys Act Scope Ton (ron Area Gain Gain: Gain I Loss, CFM� CFM CFM Building 3.35 542 1,8*18 34,913 5,342 40,255 65,624 854 1,590 1,590 System 1 3.36 542 1,818 34,913 5,342 40,255 65,624 854 1,590 1,590 Duct Latent 2,590 2,590 Zone 1 - CIg.. 54%, Htg, 56% 949 23,111 1,3?2 24,433 37,055 482 1,063 1,053 1 -Dining Room 182 3,714 137 3,861 6,792 88 169 169 2 -Foyer 160 3,930 71 4,001 5,323 69 170 179 3 -Living Room 247 4,986 162 5,148 8,916 116 227 227 4 -Haff Bath And Laundry 60 889 81 970 3,315 43 40 40 5-Kftchen And Breakfast 300 9,592 871 10,463 12,707 165 437 437 Zone 2 - Clq.: 46%, Htq,, 44% 869 19,900 1,430 21,330 28,569 372 9w 906 6 -Bedroom 1 156 5,009 327 5,336 5,855 76 We 228 7 -2nd Floor Foyer 160 4,077 71 4,148 4,146 54 IW 186 8 -Master Bedroom 221 5,569 552 6,121 6,685 87 254 254 9-Walkin 48 346 71 417 1,786 23 le 16 10 -Master Bath 64 783 41 824 1,961 26 38 36 11 -Full Bath 64 783 41 824 1..961 26 36 36 12 -Bedroom 1 156 3,332 327 3,659 6,175 80 162 152 1 Sum of room airflows may be greater than system airflow because system has multiple zones. C:\ ... Von Quintal -North Andover MA_rh9 Wednesday, June 05, 2013, 10:24 PM C Rhvac - WiW_O�� "IUQ_ht dommarcial VIVAC Loads The Portland Group [Billeric Don Quintal Page 4 Duct Size Preview Room or Source Minimum; Maximum; Rough. Design! SP, Loss! Duct! Velocity! Duct! Htg Cig i Length! Act Duct q Did Name I Velocity Velocity! Factor L/1001 . . ..... 19ytj .____flow Size System 1 Supply RurKxft Zone 1 1 -Dining Room Built-in 450 750 0 0.1 430.8 88 16' 169 2-6 1 2 -Foyer Built-in 450 750 0 0.1 455.9 69 179 2-6 34.Mrig Room Built -In 450 750 0 0.1 385.5 1116 22 227 3-6 4 -Half Bath And Laundry Buift-in 450 750 0 0.1 206.2 1 43 40 1 5 -Kitchen And Breakfast Built-in 450 750 0 0.1 556.3 ;165 U_TR 1 437 4-6 Zone 2 6 -Bedroom II Built-in 450 750 0 0.1 387.4 76 228 3-6 7 -2nd Floor Foyer Buitt-In 450 750 0 0.1 472.9 64 186 2-6 8 -Master Bedroom Built-in 450 750 0 0.1 430.7 87 254 3-6 16 1-6 9-Walkin Built-in 450 750 0 0.1 80.3 23 10 -Master Bath Built-in 450 750 0 0.1 181.7 26 36 36 1-6 11 -Full Bath Built-in 450 750 0 0.1 181.7 26 38 36 1-6 12 -Bedroom 1 Built-in 450 750 0 0.1 386.5 80 r 1§2gl 152 2-6 1 other Ducts in System 1 —Supply Main Trunk Built-in 650 900 0 0.1 795.1 854 1,590 _36x8 Summary System I Heating Flow: 854 Coolins Flow: 1590 C:% ... \Don Quintal -North Andover MA.rh9 Wednesday, June 05, 2013,10:24 PM V . ` � fthvae t�es�dentia18tight Comrr►erciai HVAC Loads:_....... :I -he Obrtland Group [ $illede t � B�lerica, MA,_01862 -� i L System Room Load Summary Htg otfm Area $eris czr Atuh Ware Deveto,pr►i9ht, ln1Don QuintaPge 1 Nom -Zone 1- 1 Dining Room 182 6,792 11.3 2-6 431 3,714 137 169 169 2 Foyer 160 5,323 8.9 2-6 456 3,930 71 179 179 i 3 Living Room 247 8,916 14.9 3-6 386 4,986 162 227 227 4 Half Bath And 60 3,315 5.5 1-6 206 889 81 40 40 Laundry i 5 Kitchen And 300 12,707 21.2 4-6 556 9,592 871 437 437 Breakfast Zone 1 subtotal 949 37,055 40.9 23,111 1,322 1,053 --Zone 2- 6 Bedroom 1 156 5,855 9.8 3-6 387 5,009 327 228 228 7 2nd Floor Foyer 160 4,146 6.9 2-6 473 4,077 71 186 186 8 Master Bedroom 221 6,685 11.1 3-6 431 5,569 552 254 254 9 Walkin 48 1,786 3.0 1-6 80 346 783 71 41 16 36 16 36 10 Master Bath 64 64 1,961 1,961 3.3 3.3 1-6 182 1-6 182 783 41 36 36 11 Full Bath 12 Bedroom 1 156 6,175 10.3 2-6 386 3,332 327 152 152 Zone 2 subtotal 869 28,569 31.5 19,900 1,430 906 Duct Latent 2,590 System 1 total 1,818 65,624 72.4 34,913 5,342 1,590 1,590 I System 1 Main Trunk Size: 36x8 in. Velocity: 795 ft./min Loss per 100 ft.: 0.101 in.wg Note: Since the system is multizone, the Peak Fenestration Gain Procedure was used to determine glass sensible gains at the room and zone levels, so the sums of the zone sensible gains and airflows for doling shown above are not intended to equal the totals at the system level. Room and zone sensible gains and cooling CFM values are for the hour in which "Average the glass sensible gain for the zone is at its peak. Sensible gains at the system level are based on the Load Procedure + Excursion" method. �CWii ysterrt cr�ctr,�n ry '` _ .� Cogltng Sensible aient 13fi h Net Required: _ 3.35 87%/13% 34.913 5'342 40 255 _ _ Type: Model: Indoor Model: Brand: Efficiency: Sound: Capacity: Sensible Capacity: Latent Capacity: Heatlno System Natural Gas Furnace 0 AFUE 0 0 Btuh n/a n/a Cooling System Standard Air Conditioner 0 SEER 0 0 Btuh 0 Btuh 0 Btuh 1 i i C:1 ... \Don Quintal -North Andover MA rh9 Wednesday, June 05,2013,10:24 PM JUN -13-2013 11:05 From:N.PINGREE INSURANCE 978 372 7182 To:19786889542 P.2/2 Alm RO® CERTIFICATE TE OF LIABILITY ���I��' FDATE(MMfuD"Yy)V1A A NSURANCE /r 3/ 13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.- , 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 bo endorsed. If SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy, certain pollcies may require an endorsement. A statemont on this CoKtlficate does not confer rights to the certificate holder In lieu of such endorsement(s), _ PRODUCER TnN�arr PHONE N. Pingrce Insurance Agency, Tnc. EMAg', 978/372-7771, w 72-7182 .1.26 Merrimack Street ADD"— Haver-hill, MA 0.1830 0TO ER - STOMCR ID.M INSURED rr. INSURER(8)AFFORDING COVERAGE ro INSURER A :_ Tudor Donald Quintal Jr, or insulanl-ems_ INsuR¢R B : _ 100 McIntosh Lane INSURERC Hampstead, NH 03841 INSURERD: INSURER E OVERAGES 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. NOTWII HSTANDING ANY REOUIRFMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 13E ISSUED OR MAY PERTAIN, THE INSURANCI_ AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT' TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED eY PAID CLAIMS. kILIBRI R TYPE OF INSURANCE L POLICY NUMDER PM/DDY 0 mML' GGNERAL LIABILITY LIMITS ffiXC9MMERCIAL(1.ENERALLIABILrrYACLAIM,"AUE 1-1 OCCUR LIMI I APPLIES PER. PRO- TECT LOC AUTOMOBILE LIABILITY ANY At ITO ALL OWNED AUTOS SCHEDULED AUTn$ HIRED AUT03 NON -OWNED AUTOS UMBRELLA LIAR _ OCCUR EXCESS LIAR CLAIMS DFDI•rc riBLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/CXEC 110-4.f— Iw MIAUTIV[ a OFFICCRiMEMBER EXCLUDED? N / A S NPPB()9�i472 g/17 /� (Ea as idem) EACH OCCURRENCE s 300 U00 AIJDiG'ETO RFATEi�— ' �'—L BODILY INJURY (Parpillcnn} $ / 17 / 13 f'REMIyES jE�pcCUrrnnce] 3c10 MED F,Xr (Por BecidonO $ Y_, one ernon An P 5 , l7 0 (_) PrKS.0 L 6 ADy INjuRY _$ 300,000 GENERAL A(;OREGATE $ 30 (] , O 00 PROriI.Ir;Ts . COMP/OP AGG ; Q2 Q Q (7 3 DEbCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attnrn ACORD 101, AddItIonnl Remarks S016dU10. N mote apoCo It required) Heating and Air Condi ri.on.ing CERTIFICATE HOLDER Town of North Andover 1600 Osgood Street, . E l.d , North Andover., MA 01.845 ACORD 25 (2009109) COMBINED SINGI•E LIMIT (Ea as idem) $ BODILY INJURY (Parpillcnn} $ BODILY INJURY (Per arrident) $ PROPERTY DAMAGE (Por BecidonO $ E.L F.ACMACCIDENT Is E.L. DISEASE - FA tMPLOYH $ DESCRIBED BE 20, Ste. 2 -36 I THE UEXANY OFPIRATIIONHDATE VT EREOF, NOTICE POLIC( WILL ES GBF_ CDELI ELLED ERED BEFOREINLD ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI2FD @ 1988-2009-ACORD C The ACORD name and logo are registered marks of ACORD TION. All rights reserved. Z 4c,s�.,� s