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Home My WebLink AboutMiscellaneous - 242 PLEASANT STREET 4/30/2018o � O N M OD r- O mm Q Z O Cn O � O o m m o mq irk STAR Heating Supply Co., Inc. Duct Leakage Test Form for MA Code Compliance Client Information Name: Address: City/State/Zip: Phone: Email: System #1 Location: 12 a Type of Test: O Total / O to Outside Approx. Floor Area Served: I CFM Leakage at 25pa: 1 Approx. % leakage for single system*: System # 3 Location: Type of Test: O Total / O to Outside Approx. Floor Area Served: CFM Leakage at 25pa: Approx. % leakage for single system*: IL System # 5 Location: Type of Test: O Total / O to Outside Approx. Floor Area Served: CFM Leakage at 25pa: Approx. % leakage for single system*: Building Information Address: a P `f i ' City/State/Zip: A MA Test Date: . Test Time: 10 ' +i Point of Construction: Rough O Final System # 2 Location: Type of Test: O Total / O to Outside Approx. Floor Area Served: CFM Leakage at 25pa: Approx. % leakage for single system*: System # 4 Location: Type of Test: O Total / O to Outside Approx. Floor Area Served: CFM Leakage at 25pa: Approx. % leakage for single system*: Combined Results Total Conditioned floor area: sq. ft. Leakage limit: O 3% 04% Leakage limit: cfm@25 Combined Leakage**: cfm@25 2009 IECC Compliance: O Pass O Fail *Approximations for single systems are for diagnostic use only. **Total combined duct leakage is required for 2009 IECC Compliance. I certify thp; this test was performed in compliance with applicable standards: :�d Tester's Rater Name: Developed by Advanced Building Analysis, LLC BSH: Network;Operotions;r=orms 3-15 Location -4z No. X 2p;-42ql, vw Date t%g 43 z'916 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check # pector Building Ins / F 4k Commonwealth of Massachusetts 1 , Sheet Metal Permit �{ Date 2 Permit # Estimated Job Cost: % (J Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License # Applicant License # 5�� Business Information: Property Ownerr/ Job Location Information: �•� t l t'.1 �C. l Name: � o kjk- Name: .... Street: 3' -� Street: 2-� o�. 1 "�� S4 '� r� .� �n� Z 2City/Town: City/Town: �n Telephone: l Iz - q r ��" ► 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 Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC Metal Roofmg Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: "buck- VjC1rl— 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, indicate the type of coverage by checking the appropriate box below: A liability insurance policy I/ 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 boxD, 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 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 Pro;;ress Inspections Comments Final Inspection Type of License: By— EJ Master Titl ElMaster-Restricted C' ❑Journeyperson ❑Jo urn eyperson-Restricted nspector Signature of Permit Approval Comments Signature of Licensee License Number: Check at www.mass.govldpl 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 v All workers performing sheet metal work onsite has valid Massachusetts sheet metal / license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation , _ Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper 6WWanees, fire rated enclosures and pressure testing required.. SF>�::�i xe��,:aintb installed=hrliew r quirecl 'on equipment and uat-A .. )i. _ Duct penetrations in fire'ratuj- ivall:3 and floors sealed y Metal roofing systems installed watertight using proper materials and fasteners ✓ Flexible duct runs installed 6'-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron fDuctwork / 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 --oft) Sheet Metal Residential Guidelines / Inspection Checklist Yes No NIA Detailed description and sketch of sheet etal system to be installed has been provided All workers performing sheet meta ork onsite has valid Massachusetts sheet metal license All sheet metalwork being pe rmed with proper journeyperson-to- apprentice ratios Equipment sized per heatin / cooling load calculations Duct work sized per man 1 "D" calculations Bath / shower rooms c tain mechanical exhaust fan vented outdoors Electric dryer exhaus properly installed maximum total run 35'-0", maximum flexible r 8'-0" Flexible ductrun nstalled 14'-0" maximum length Volume damper installed for each supply air branch duct Ductwork ins' led using proper gauges and hangers Ductwork / enum connections sealed substantially airtight Ductwork nsulated by means of external covering or internal lining New/cle - properly sized filter installed (final inspection) Testin and Balancing report complete (final sign -off) The Commonwealth of Massachusetts Department of Industrial Accidents w Office of Investigations ' d 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Milltown Plumbing & Heating, Inc. Address: 131 Stedman Street, Unit #6 Cl Chelmsford, MA 01824 Phone #: 978-453-4684 Are you an employer? Check the appropriate box: 1. ❑1 I am a employer with 22 4. EJI 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. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 3. ❑ 1 am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. [:1 Electrical repairs or additions 11.❑ Plumbing 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. lam an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Federated Mutual Insurance Company Policy # or Self -ins. Lic. #: 9354812 Expiration Date: 06/15/2017 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. do hereby certi�y under the pains and penalties of perjury 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: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Contact Person: Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Phone #: '4�® CERTIFICATE OF LIABILITY INSURANCE �'�� 08222016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT CONTACT A/CNNo. Ext): 888-333-4949 a/c No): 507-446-4664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURER(S) AFFORDING COVERAGE NAIC # 06/15/2016 INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 EACH OCCURRENCE $1,000,000 INSURED 247-960-8 INSURER B: MILLTOWN PLUMBING 8, HEATING INC INSURER C: 131 STEDMAN ST UNIT 6 PRODUCTS -COMP/OP AGG $2,000,000 CHELMSFORD, MA 01824-1868 INSURER D: INSURER E: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS INSURER F: N COVERAGES CERTIFICATE NUMBER: 119 REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YYYY LIMITS A X GEN'L NOTHER: COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR BUSINESS OWNER'S LIABILITY N N 9064734 06/15/2016 06/15/2017 EACH OCCURRENCE $1,000,000 PREMISES Ea occurrence RENTED $100+000 MED EXP (Any one person) PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT ❑ LOC GENERAL AGGREGATE $2,000,000 PRODUCTS -COMP/OP AGG $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS N N 9064735 06/15/2016 06/15/2017 COMBINED SINGLE LIMIT $1,000,000 accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE c' A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE N N 9064736 06/15/2016 06/15/2017 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 DED I RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA N 9354812 06/15/2016 06/15/2017 OTH- X PER STATUTE ER E.L. EACH ACCIDENT $500,000 E.L. DISEASE - EA EMPLOYEE $500,000 E.L DISEASE -POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) CERTIFICATE HOLDER CANCELLATION 247-960-8 1192 TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 120 MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER, MA 01845-2420 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ® 1986-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ISSUFM T. >OLLOWING LICI=NSE��Xi ::<fIFAS1'ER-.I,INRItSTFdICTE BOARD Of BflAI� 'tltF z PLUMBEi3$ AND GASFITTERS _ 37`'PA.INTUI~TSLVD PLUMBERS Ai±IC>' GASFITTEIS ISSUES THE FOLLOWING<LICENSE '`` `' ISSUES THE FOLLOWING LtCEpfSE -„ LIC NSE A JOURNEYMEN PLUMBER v,' REGISTERED AS A P4UM>31NG CORP FREDERICK L WESSAk; ` # FRED L WEBSTER 139 PAWTUCKET BLVD "E MILLTOWN PLB ,HTG INC M10677 TYNGSBC RO, MA 01879-22-16!-' r 131 STWI0AN'$TREET ! UNITS s 4 - �NELNISFORD, MA :01824-1867 16582 94/01/2018 29860 t•- 2253 �0510112018 29965 - ¢ COMMONW . TH OF MA HU SACHUS TTS aoARD o�M PLUMBERS'ANDGASFITTERS ;- '. - DR - DRIryVE�R ( LIMENS - - ISSUES T. "E FOLLOWING LICENSE • l *- `• "` LICENSED AS A MASTER PLUMBER -' - Dam m �uweEx � r' £ _ 1 NONE S241007W FRED L WEBSTER"..:' we '� ~- � � P. $ i$ a 03 23WPAWTUCKET BLVD � Z%-i94g__ TYNGSBORf'MA 018797921.0,:1.1ER NA a rick 10577 t�5/Q1/2018. 29964 L t TTYNPGSAg9 OR UGH, MA 01879 .�d+��swaa�aruroraa�s Wilr�eQr.^w ISSUFM T. >OLLOWING LICI=NSE��Xi ::<fIFAS1'ER-.I,INRItSTFdICTE <F:RRERICK L WEBSTER JR _ 37`'PA.INTUI~TSLVD = } '`` `' TYNGSDfi kb',`MA" �� • :' v,' 5528 O112 , 821 "E