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HomeMy WebLinkAboutMiscellaneous - 2150 TURNPIKE STREET 4/30/2018Date .�P.... Izz—...13 ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that -7 ....................................................................................................... has permission to perform ..41-- — II r__ - ............................... ....... ; ............................... ...... e ........... wiring in the building of ........ v C........... ............................... Inr . ...................... at ...... ....... .............. ,North Andover, Ma"iss. Fee .... L AL INSPE06R Check it commonwealth lwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. �S Occupancy and Fee Checked [Rev. 1/071 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: ��15 -1 j City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notic of his or her intention to perform the electrical work described below. Location (Street && Number) �` 1�*�rt' v►^IA01 Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes F No ❑ (Check Appropriate Box) r Purpose of Building Utility Authorization No. Ab 86\, - Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd ❑ Location and Nature of Proposed Electrical Work: AIC V_ ) No. of Meters No. of Meters Completion of the fnllowinatnhly mnv ha wnivail h„ thv hivnartnr nfWira.c 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- E] rnd. rnd. o. o mergency Lighting 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 Totals: Number ITons -•-'-"•'""'•*1 IKW ' **'•'•"'•'• No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Key Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent 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 cover is m force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) X certify, acnder the pains and penalties ofperjurp, that the information onthis application is true and complete. FIRM NAME:. I MJ ./1 LIC. NO.:�, Licensee: Signat a LIC. NO.: (If applicabl nter "ex t" in the license number line. a Bus. Tel. No..179. Address: i)ll G lv rtf ©3 9 1 l Alt. Tel. No.: Y3 *Per M.G.L c. 147, s. 57-61, security work requires Departm of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ J Signature Telephone No. � ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE SPECTION: Pass ? Failed Re- Inspection Required ($.) ❑ Inspector Com ents: Inspectors Signature: IV Date: PARTIAL ROUGH INSPECTION: Pass F?1 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INCTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: 17 FINAL INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: 0 Nellr i Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of InriustrialAccidents Office of Investigations 600 Washington Street .Boston, MA 02111 www.massgov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please.Print Legibly Name (Business/Organization/Individual): ' �L 0:1 Address: City/State/Zip: 4 J K I KUB1 Phone #: Are you an employer? Check the appropriate box: - Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub -contractors �• E] Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. g, El Building addition [No workers' comp. insurance 5. El We are a corporation and its 10.[] Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp, c. 152, §1(4), and wehave no 12.❑ Roof repairs required.] insurance . re uired employees. [No workers' 1311 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they ice doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is 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 ofMGL o. 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. De advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. X do hereby certio under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Offccial use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other - - - 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 legalentity, 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 employee, 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-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 cavy workers' compensation insurance. If an LT C or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confrmation 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 onlysubmit 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 Coi .onwealthofMassachv.:setts Department of Industrial Accidents Ofrice ofIavestigations. 6.00 Was hingtaxt Street Boston, M. 02111 i TQL # 617-727-4900 ext. 406 or 1.-877:;M.ASS.AFF, Revised 5-26-05 Fax# 6X7-7277749 XV1Vur.mace an -UM -in Date ... ....` .... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .............. `` .......... ... . has permission for gas installation .....v`."..." ...... . in the buildings of ... �,'� ...........`.............. . at.. ... �.!�?:N�,Q �u .:.... , North Andover, Mass. 1 °J 1586. Ob. . Fee .. ... Lic. No. ............:..... Check # 4�i i 8729 Y-� P GASINSPECTOR �w- i'r7 L+lzjplI3 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK % CITY MA _ _ /��e-` _ � � MA DATE.Q* ` _/ 3 I� PERMIT # JOBSITE ADDRESS oZ l D _7-U �/v!o/dLe i" OWNER'S NAME S 7;✓C, GOWNER __ ADDRESS _ _ ___.r...,..�.�- TE -F.3 G 6 d a FAX ., TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL El EDUCATIONAL I RESIDENTIAL CLEARLY NEW: RENOVATION: 01 REPLACEMENT: 0 PLANS SUBMITTED: YES 0 NO APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE _ .. J _ l _ T -J DIRECT VENT HEATER I DRYER FIREPLACE — :J _ �__1 _._ rJlr._=�I FRYOLATOR FURNACE) - --J ..___._ ._ ._._ L GENERATOR GRILLES INFRARED HEATER -f ( LABORATORY COCKSMAKEUP AIR UNITOVEN All --.POOL HEATER ROOM / SPACE HEATER �- _. 1T. I _. f --..-. L__. _. �. f _T _-�IF-. ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER - �m _)+ _ I : WATER THrEATER OTHER L___� INSURANCE COVERAGE n4've a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES I[] NO EJII 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAG BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [ OTHER TYPE INDEMNITY E 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 0 AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in come with all Pe nt proA 'on of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ! c -#Z!�ENSE # Al SIGNATURE MP GF El JP D JGF LPGI 0 CORPORATION jl# ��y� PARTNERSHIP D-#= LLC COMPANY NAME: ADDRESS{{ o (sTIC. d C! CITY STATE MZIP O cS ]TEL FAX CEL MAIL i0 / COD 0 El z C40D CL u w Gf) CO) Cl) CL w 0 9� w z 0 a a C.) E. CL IL Cd LU LL. rA 00 U rA h (ZIA k The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Invesfigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 99 Please Print Le0bly Name (Business/Organization/Individual): o(/d ✓�/�iq��. �'�'� �- Address: A'ol City/State/Zip: A) c who x) A.49, 453 7Sq_ Phone #• Co 6 3 -3 Far 7 5-2.9 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I Anployees (full and/or part-time).* have hired the sub -contractors 2. [V]" 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. ❑ 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 I L[Rllumbing 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 a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. 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 to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cert under the paid and pen.'ties ofperjury that the information provided above is true and correct 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): 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #: Informati®n 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 sucli employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the is or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple 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 Commmnwealth of Massachusetts Department of Industrial Accidents Office of favestigations 604 Washington Street Boston, MA 02111 Tel. # 617-727,4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 v WW.Mass,govldia COMMONWEALTH OF MASSAGHUSETT PLUMBERS AND GASFITTERS 4 � `LICENSED AS A..MASTER PLU_ MBEFa. �� r'ISSUES THE ABOVE UGENSE TO = " " } N3RMAND..P BERUBE, '+ z 1r2 LINCOLN RD 'tdEWTON ` NH °03858 310'3 = 1158 U5/01/.14 1717�J4 I l � Y COMMONWEALTH OF MASSA.CHLfSETt P,LU IVI.BERS L1ND.PRO GASFITTERS J '`LICEI�RSED AS A JOURNEYMAN PLUM ISSUES THE'"ABOVE`LIGENSE TO [ I «�' tJORMAND ?R t`BERUBE � �X r5 • x L ­INC .0 L N -ROAD NEWTON r Y N3858 310.3 I , Date ....�..1 ... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING is certifies that ....�''.�� �L'_ e4 ............. has permission to perform ."� (2,j .. �dvvtj— plumbing in the buildings of .. ... at. .. .�. R.�.? �,c ti •. , , North Andover, Mass. Fee . 3� � � Lic. No. LAO.. .0v..,(jam................. .. . Check # +� I i - PLUMBING INSPECTOR V;P "lay-(-� 41Zto113 P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ` °vim- `.... . I MA DATE, ^- 13—' PERMIT # JOBSITE ADDRESS o2 i S"6 T'v ni' IeG S'T OWNER'S NAME S P"d OWNER ADDRESS TEL �? _ ®fi t � IFAX OCCUPANCY TYPE COMMERCIAL 0I EDUCATIONAL Of RESIDENTIAL NEW: ff RENOVATION: El • REPLACEMENT: Ell FIXTURES'l FLOOR- BSM BATHTUB — CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _ DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK _ LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK j -- TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PLANS SUBMITTED: YES � NO Ell M0®= have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES F- �J NO IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY C' OTHER TYPE OF INDEMNITY []1 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER 0 AGENT 10 I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurat to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c pliance with P rtin R ovision of the FVlassachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME D6u�iq �C �c� C-1LICENSE #%s' I SIGNATURE MP UK JP Q CORPORATION R -f -f # _ _ PARTNERSHIP P# ( LLC —j COMPANY NAME ADDRESS% L s r J CITY(—ftJec�� :� z.1 �s STATE ZIP ) TEL ��, FAX - — -£ CELL X3'76 MAIL — - t — e aI I. The Commonwealth ofMassachusetts Department of IndustrialAccidints Office of Investigations 600 Washington Street Boston, MA 02111 kvi www.massgov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 99 Please Print Le0bly Name (Business/Organization/Individual): Address: lot City/State/Zip: �-,-- c (O:O A- j 6_376--6 Phone #: �o 6 3 3 8a ; 5-2.9 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I ^ployees (full and/or part-time).` have hired the sub -contractors 2. M 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. ❑ 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 I L[RPlumbing repairs or additions 12.❑ Roofrepairs 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 a're 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy 4 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 required -under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert under the pa1Aand penNties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License ,6-6-13 Issuing Authority (circle one): 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone '{?MMONWEALTH OF MASSAC;HUSE i!TS. - PLUMBERS AND GASFITTE�RS I .� LICENSED AS A. -MASTER PLUMBEF� � t " ISSUES.THE ABOVE LICENSE TO kNORhiAIJD P BERUBE:. A :� 12 LINCOLN RD t I I `NE ITON .--N`H x038.. _ 5$ 3103 E 11-588 05%O1/14' 17174? C0MM0NVVEALTH OF MASSACHU$tbTt S 4p 4 :3 • • • • • b -f PLUIVI6ERS AND,GASFtTTERS•' _`- L_11,ICENSED AS A.JOURNEYPJiAN PLUMB f ISSUES THEyABOVE'L'ICENSE 7O'' t+IORMAND. jF IBERUBE t 12L I'NC.OLN -ROAD L x tv'EWTO`N - NH r'O3858 3103 340 17. i95 z7 _ y� j This certifies that ]. ! Yy►i31 �!A-,dar^��cJY.. DJ Ot),... . has permission for gas installation ... �-... . in the buildings of .. at..: 7..�2 • • • • • • U• • �`? .�� Q . -o ........... North Andover, Mass. 1� .................... . Fee. ..... Lic. No(;"- GAS INSPECTOR Check.# �(21`��pO N. - MASSAOHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY N. Andover MA DATE 1 7122/2013 PERMIT #� JOBSITE ADDRESS 2150 Turnpike Rd OWNER'S NAME Stephen Smolak OWNER ADDRESS 762 Dale St 0 TEL 1 978-360 0215 FAX 0 OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL x0 PE 1OR . )PFrN-T NEW: L] RENOVATION: ❑ REPLACEMENT: E] PLANS SUBMITTED: YES[K] NO[:::] CLEARLY APPLIANCES FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATER FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MASEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER 5000G LP TANK WITH PIPING X INSURANCE COVERAGE I have a current Iiabili insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES X❑ NOF] IF YOU HAVE CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY X❑ OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER AGENT SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my kn wledge and that all plumbing work and installations performed under the permit issued for this application will be in complia e-wdrall-Pertinent f Massachusetts State Plumbing Code and Chatper 142 of the General Laws PLUM BE R-GASFITTER NAME Timothy Surdam LICE E # 103-J AT RE MP F] MGF ❑ JP:] JGF[!] . LPGIFj CORPORATION X]# 164 PARTNERSHIP [:]# LLC []# COMPANY NAME: Lorden Oil Co Inc I ADDRESS: 69 Fitchburg Rd, PO Bo)(669 CITY: Ayer STATE: MA ZIP 1432 TEL: 978-772-2000 ` FAX: 978-772-5956 CELL: EMAIL: N. - `� ��... . -? . ,Q tt GF5103-J brense, Na Commonwealth of Division C-fRegisir, soatu of PIVM64'= F- TIMOTHI 32 BEAVPIR X -J NASHUA, 05101/2014 004711 Expirmliran Dwe. SeriRl No. The Commonwealth of Massachusetts - Department of Industrud Accidents rig Office of Investigations 600 Washington Street Boston, MA. 02111 W. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nalrie (Business/Organization/individual):E7�j7- Address: City/State/Zip:- {MG d I ZbCt'hone Are you an employer? Check the appropriate bog: IN I am a em to er with 4. ❑ I am a general contractor and 1 p Y 'Type of project (required): ` - 6. C] New construction employees (fall and/or part-time),* 2111 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. ? 7. []Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12,❑Roofrepairs insurance required.] i employees. [No workers' 13.❑ Other comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew aff davit 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 f ob site information. Insurance Company Name: -T -(-CA � (5("s Policy # or Self ins, Lic. #:�� �„ ZExpiration Date: i �� a� q P �azA Z rob Site Address: Y , ity/State/Zip: I �A Attach a.copy of the workers' compensation -policy ileclaration 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 flue 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 cert jy Phone #: (97k�v2- ofperjury that the information provided above is true anti correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permif/1�icense # Issuing Authority (circle one): 1. Board of lf3ealth 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other - - - Contact Phone #: 218 Date.�i�i�....... TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION A q _ s This certifies that has permission for mechanical installation .............. E in the buildings of .. �'- �'�. `.L 1 1 _................. . at�'` .... �. "' !".:.... , North Andover, Mass, Fee .C; Lic. No ���.... ...................... (�e�L 46o GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer � t a Commonwealth ®f Massachusetts Sheet Metal Permit ` Date: 1 Permit # �I (� Estimated Job Cost/ a _e 0 , d 7 Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License # ga- S_ 3 Applicant License # I M�_ Business Information: Property Owner / Job Location Information: Name: au i� �1, �/��%.^!�����Name: JP G -A ' j hVX Street: � �./ %%i C ,'�eS14 Street: - 0, / 5 O / J �'rl�� i�r, City/Town: PpMPs` OP City/Town: Al. Telephone: 7 S a 3 Telephone: 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 Indu ial Educational Institutional 'a Building Cubic Footage: under 35,000 cu.p ft. 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: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No ❑ If you have checked Yes ' dicate the type of coverage by checking the appropriate box below: A liability insurance oticY 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 Progress Inspections Comments Final Inspection Inspector Signature of Permit Approval Comments Signature of Licensee License Number: Check at ywvw.mass.gov/dpi t' By Type of License: ❑ Master ❑ Master -Restricted ❑Journeyperson ❑Journeyperson-Restricted ❑ Title City/Town Permit # Fee $ Inspector Signature of Permit Approval Comments Signature of Licensee License Number: Check at ywvw.mass.gov/dpi t' Yes Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist 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. SFi�rait res, ainta instal 16d �/h&td rsquired 'ofr egtiipment and Duct penetrations in fire'rdt4-ivall and flo6rs sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct nuns 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 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) t "COMMONWEALTH OF MASSACHUSETTS SHEAT METALWORKERS AS `A MASTER-UNR_ESTRIC7ED BOVE itENSETO 'ISSUES,T�HE A rDDNALD J ..QUINTAL JR " 1'00 -K C. TA LANE I ij rt N.ANIPS:TEAD`�,, , NH 0384:1 5319 01/28/15 X1,0529 9253, , Fold Multiple Times Nong Perforations before Detaching r rig �jl Don Quintal Heating & Cooling 100 McIntosh Lane, Hampstead, NH 03841 MA 978-372-6503 NH 603-489-16/23 �)T%Vmlmv Date j Number (/ / o l E I Terms: / Please remittance !_ A Don Quintal Heating & Cooling UtQUI� �OU PInyTliistColmnt Don Quintal HVAC Load Calculations j J for Don Quintal Haverhill, MA Ovr i Q= TZ V 7 - +r,. a . 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. ( tZtivae stesrdentiat Lightomme`rcrsl iii/AC Loads .,Efate Software t�evelopm�nt, fnc Ttie f�6rttari8 {�`raup [ Btll'�nc ilbn QumtaU �I Proiec$ f?eport _ a, Project Title. Don Quintal Designed By: Jack Richards Project Date: Wednesday June 5 2013 j Client Name: Don Quintal Client City: Haverhill, MA Client Phone: 978-852-7207 Client E-Mail Address: dghc@comcast.net I Company Name: The Portland Group Company Representative: Jack Richards ! Company Address: 74 Salem Road j Company City: Billerica, MA Company Phone: 978-262-1487 Company E-Mail Address: jmr@theportlandgroup.com 1 Company Website www.theportiandgroup.com Reference City: North Andover MA I Building Orientation: Front door faces South Daily Temperature Range: Medium I Latitude: 42 Degrees Elevation: 57 ft. Altitude Factor. 0.998 Outdoor Outdoor Outdoor Indoor Indoor Grains t Dry lb Wet Bulb Rel.Hum Rel.Hum D[y Bulb Difference I s Winter: 0 -0.65 80% n/a 70 n/a Summer. 87 72 49% 55% 72 30 j Total Building Supply CFM. 1,590 CFM Per Square ft.. 0.875 Square ft. of Room Area 1,818 Square ft Per Ton 542 Volume (fig) of Cond. Space14,544 V(AR M � adr3�''.. '� ` t_: �F ,,; .f -c;�t_ ; ,r- .% '' s .i ' „y. 3 t �.'+'i ,�° rt. +.asp -. 3 _ n +:�t' ..�. �` -,.mss.. 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) 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. 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. r fif t I j 1 I I I C:\ .,.\Don Quintal -North Andover MA_rh9 Wednesday, June 05, 2013,10:24 PM El Building I System 1 Duct Latent Zone 1 - Clg.: 54%, Htg.: 56% 1 -Dining Roam 2 -Foyer 3 -Living Room 4 -Half Bath And Laundry 54Kitchen And Breakfast Zone 2 - Clg.: 46%, Htg.: 44% 6 -Bedroom 1 7 -2nd Floor Foyer 8 -Master Bedroom 9-Walkin 10 -Master Bath 11 -Full Bath 12 -Bedroom 1 of room airflows may be greater than system airflow because n has multiple zones. C:\ ...\Don Quintal -North Andover MA.rh9 Netft a; Sen i Lat Pled Sen i Hl V I g CIv` g Act Ton, /Toni Area! Gain? Gain i Gain Lossl CFM CFM CFM 3.35 542 1,818 34,913 5,342 40,255 65,624 854 1,590 1,590 3.35 542 1,818 34,913 5,342 40,255 65,624 854 15 ft' 1,590 2,590 2,590 949 23:111 1,322 24,433 37.055 482 >11053 1,053 182 3,714 137 3,851 6,792 88 169 160 3,930 71 4,001 5,323 69 19,: 179 247 4,986 162 5,148 8,916 116 moi" 227 60 889 81 970 3,315 43 '40 40 300 9,592 871 10,463 12,707 165 43%: 437 869 19,900 1,430 21,330 28 569 372 Via. 906 156 5,009 327 5,336 5,855 76 228 160 4,077 71 4,148 4,146 54 1; 186 221 5,569 552 6,121 6,685 87 2i 254 48 346 71 417 1.786 23 ';- 1 16 64 763 41 824 1,961 26 ''< -, 36 64 783 41 824 1,961 26S` 36 156 3,332 327 3,659 6,175 80 152. 152 Wednesday, June 05, 2013,10:24 PM Room or Source I.._ Velocity Mm Rough. ` Desi9n' Duch Act. Duct Duct Name ty Factor Llt00 toss VeI Flow FJ'g Length Qw. .__ _ _ System 1 Supply Runouts Zone 1 1 -Dining Room Built -In 450 750 0 0.1 430.8 88 ^ . 169 2-6 j 2 -Foyer Built -In 450 750 0 0.1 455.9 69 9 179 2-6 3 -Living Room Buift4n 450 750 0 0.1 385.5 116 „, ; 227 3-6 4 -Half Bath And Laundry Built -In 450 750 0 0.1 2061 43 40 1-6 5 -Kitchen And Breakfast Built -In 450 750 0 0.1 556.3 165WIN 437 4-6 � Zone 2 6 -Bedroom 1 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 54 „ „a 186 2-6 r 8 -Mash Bedroom Built -In 450 750 0 0.1 430.7 87 254 3-6 9-Walkin Built -In 450 750 0 0.1 80.3 231611 16 1-6 i 10 -Master Bath Built -In 450 750 0 0.1 181.7 26 ' 36 1-6 11 -Full Bath Built -In 450 750 0 0.1 181.7 26 x „ 36 1-6 t 12 -Bedroom 1 Built -In 450 750 0 0.1 386.5 80 - y 152 2-6 Other Ducts in System 1 Supply Main Trunk Built-in 650 900 0 0.1 795.1 854 'y,' 590 1,590 36x8 Summary System 1 Heating Flow: 854 Cooling Flow: 1590 C:1 ... Don Quintal -North Andover MA.rh9 Wednesday, June 05, 2013, 10:24 PM g t71%irac R!" 'W' 8 Lfgtrt_Comrtletcial 14VAC toads - - �rf� of r415evetarprr ernt, lr "tlte Pbrti�nd Gra�p-[ Blllenc. `` �`a b s Dbr� Qurtital i I Svs#em 9 Room Load Sommaq -; .STT Y',. tg',�,rr. 'n��,,� �; ...� K � �. ��'r,��•`a��v`�J'1�:"l�r; ^�'� -"� �k�� �. r � "'rr �:,���' 5..' Ti��y y� -t 7 s`. 55 �(•p + u r �t z gyp{'[}'/ a.- f -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 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 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 71 16 16 ! 10 Master Bath 64 1,961 3.3 1-6 182 783 41 36 36 11 Full Bath 64 1,961 3.3 1-6 182 783 41 36 36 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 1 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 cooling 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 the glass sensible gain for the zone is at its peak. Sensible gains at the system level are based on the "Average Load Procedure + Excursion" method. . x'Sx - � r" a h - c�'ty r' (` w.+c �"'•�, aF`,�t_.f,�i zsa l' it,� ?� i (i,dr„I`I`��s '.. • > ,5`, ;{+,..., ,7 1JY�,. , w n-�2Z+, ��3�iaf�T�ti ���"��+$���. Net Required: 3.35 87%/13% 34,913 5,342 40,255 .. �1 r.t Qt? Sa a. �.r � iIs ^vat;',, r;�k. t _ �� � s ts�11� .s'r �y 3 ; i cit �t �r";a"b't 1`i � ,. 3"L?� ,.n9.._,•.cz�,�.r '��.+w Heating System Cooling System Type: Natural Gas Furnace Standard Air Conditioner Model: Indoor Model: Brand: Efficiency: 0 AFUE 0 SEER Sound: 0 0 Capacity: 0 Btuh 0 Btuh Sensible Capacity: n/a 0 Btuh [[[ Latent Capacity: n/a 0 Btuh i i I r � C:\ ...\Dan Quintal -North Andover MA.rh9 Wednesday, June 05, 2013,10:24 PM JUN -13-2013 11:05 From:N.PINGREE INSURANCE 978 372 7182 To:19786889542 P.2/2 AcCIPRV® CERTIFICATE OF LIABILITY INFDA77TO3 /DOIYYYy) SURANCE 3/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS -CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the POlicy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, Certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s), PRODUCER CON ACT ME: _ J' 1 Parker PHONE ..N. Pingrce Insurance Agency, Tnc. Na.Extl. 97-/372-7771. A/cN�3 7-7182 E-MAIL 1.26 Merrimack Street L11 �: — H 8 V e f' }1 1 11 , MA 0.1830 PRODSTOMER ID ..— INSURED Donald Quintal Jr, 100 McIntosh Lane Hampstead, NH 03841 INSURER($) AFFORDING GOVERAgE ERA: Tudor YnsuL-anr_.e Co. INSURER D : INSURER E :VVrKAUts CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE. LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD INDICATED. NOTWII HSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 7FI13 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. ISR TR TYPE OF INSURANCE L S POLICY NUMBER POuCOY a r Y"MP�L pY EX GENERAL UABILRY M LIMITS A X COMMERCIAL GENERAL LIABILITY NPP 8 0 9 8 4 7 2 g 17 1 EACH OCCURRENCE 5 300 Q 0 Q— A O RFgTEir- 171 PREMWES (Ea ix=rmne1 S 5 0 Q 00 CLAIMS -MAUI L J OCCUR J } 7/13 MED FFP (Any w6nom() ()— GEN'L A('U REGATE LIMI'l APPLIES PER. PRO- LOC IEcT AUTOMOBILC LIABILITY ANY Al Il'L) ALL OWNED AUTOS SCHEDULED AUTO HIRED AUTO$ NON -OWNED AUTOS UMBRELLA WAD EXCESS LIAR Dmuc r1BLE WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY NHOPRIETOR/PARTNER r) OrFICEPA16MBER EXCLOOED? (Mandatory In Nil) OCCUR CLAIMS-MADF YIN ❑ N/A DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Artarrt ACORD 101, Addlllonnl Remarks SCI16dula. It mors aPaC* W required) Heating and Air Conditioning CERTIFICATE HOLDER Town of North Andovei- 1600 Osgood Street,-Bl.d, North Andover, MA 0-1.845 ACORD 25 (2009109) PERSONALBADV INJURY %300,000 GENERAL AOCREGATE $ 300,00 PRODI ICTS - COMP/01' AGG S 3 0 Q.000 E.L FJACH ACCIDENT Is E.L. DISEASE- FA FMPLOV6 C BEFOE 20, 5 r e . 2-36 I THE SHOULD LEXANY OF THEPIRATIION DATE DESCRIBED NOTICE 1 WILL GBE CDELIE VEBE RN ES ACCORDANCE WITM THE POLICY PROVISIONS. AUTHORiZvo CtJ 1988-2009-ACORD The ACORD name and logo are registered marks of ACORD ATION. All rights reserved. a COMBINED SINGLE LIMIT (Ea uCClJanh) $ BODILY INJURY (Por person) $ BODILY INJURY (Pur arridenl) $ PROPERTY DAMAGE (Por accidonl) $ S SACH OCCURRENI;t S E.L FJACH ACCIDENT Is E.L. DISEASE- FA FMPLOV6 C BEFOE 20, 5 r e . 2-36 I THE SHOULD LEXANY OF THEPIRATIION DATE DESCRIBED NOTICE 1 WILL GBE CDELIE VEBE RN ES ACCORDANCE WITM THE POLICY PROVISIONS. AUTHORiZvo CtJ 1988-2009-ACORD The ACORD name and logo are registered marks of ACORD ATION. All rights reserved.