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Miscellaneous - 245 MARBLERIDGE ROAD 4/30/2018
Date................................................... TOWN OF NORTHANDOVER PERMIT FOR GAS INSTALLATION This certifies that'jc .......... has permission for gas installation .... .................................................................... in the buildings of ......... . at .......Q..Lf 5Z....... 0.'� ..... e..4.V.,.ae.J North Andover, Mass. Fee(A�7> . ...... Lic. No . ...... a..-3. ....... ... . . ................................................... GAS INSPECTOR Check wl�� 9442 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY N. Andover MA DATE 7131/2014 PERMIT # �`1Z JOBSITE ADDRESS 245 Marble Ridge Rd OWNER'S NAME GOWNER ADDRESS I TEL[— —IFAX�_� TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑ PRINT CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: ® PLANS SUBMITTED: YESE] NO n, APPLIANCES 7 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 FRYOLATOR FURNACE GENERATOR I GRILLE INFRARED HEATER LABORATORY COCKS i MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER -----------------------L-3 Re lace 1 Gas Meters x and Associated Piping INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES Q NO ❑ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com liance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Joseph Marino LICENSE # 8736 SIGNATURE MP ❑ MGF ® JP ® JGF ® LPGI ® CORPORATION Q# 3285C PARTNERSHIP 0# LLC ❑#� COMPANY NAME:j RH White Construction Co ADDRESS 141 Central St CITY Auburn STATE MA ZIP 01501 TEL 508 832-3295 FAX 508-926-4347 CELL 508-832-4614JEMAIL JMarino@RHWhite.com Ntlk� ROUGH GAS INSPECTION NOTES I THIS PAGE FOR INSPECTOR USE ONLY I FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES V •I: � .: 1,:. ri15•� c_ r. ri ;'fejryEtl�iSµyn+ ::Fi �.,. ... ,car is '`1,;.�;" �.�,•,:.�t •;; r,:ts'ti,YIf�,P!t•,i!r=!�i(.�•:' ''! i;+:f +��� "'y`�': Y1 F51 iil., -,ti, i; !i,l• .t ? "''1, :i ' ri LU B V1Ytt z' o N <4F- v- 61. qR :Ey r -t Ln LU �� vi •" i- ,.�K."::1 • 'i %'.d", i. .r a::(�''ri; f`j;jl:i,r<'..•.�°, �tl � ¢;it`�.}� •;�; :-1'li`t'iP.tQ,1i-,I � 1�.3i„�i 'li:i:, f. 'I+�y::....{,;•-..S.,J..:...!..l.t,. ._.°J':1,..::rr. tf't:E9.'f.?:i. f Ii QRV Ac CERTIFICATE OF LIABILITY TY INSi �MNCE PATE(M9/20 3 ,., �+ V 1, V page 1 oQ z oa/2g/2oi3 THIS OERTIFICATE IS ISSUED ASA 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 poliey(ies)must be endorsed. If SU IBROGATION IS WAIVED, su b)ect to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does notconferrlg hts to the Certificate holder in lieu of such endorsement(s), williq 04 MaesnebueAtte, Inc. c/o 26 CBntury Blvd. P. 0. Box 305191 NhChville, TN 37230-5191 R. X. White ConakruOtion Company, Inc. 41 Central 6treet, P. 0. Boz 257 Auburn, MA 015 al C INSURERA:The Chartor Oak Firo Snsuranpg INSURERS: Tr2LVQ1Are Properey Casualty Co INSURERC: Nati4ndl, Union Firq Zaeurnnea NSURERD, Travelers Ind&=jty. Company NAIL tt Uy 25615-001 of Am 25674-003 Y o£ 19445-001 25659-D01 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. TYPE OF 114 A GENERAL LIABILITY tMrRCIAL GENERAL LIABILITY CLAIMS^MADE OCCUR PER; AUTOMOBILE LIABILITY X ANYAUTO nl,t.OWNEDESCHEDULEI AUTO$AUTOS X HIREDAUTOS NON-OWNECo DeflAUTOS x CQJJ Ped C UMBRELLA LIAR OCCUR EXCESS UAB CLAIMS VTC2000 977R9948-13 9/1/2013 '9/1/2014 EACNOCCURRENCE p rr�� TO RENTF,p P 18�5(Eeoceu,an�.:1 MED EXP (Anyone person). PERSONAL &ADV INJURY GENERAL AGGREGATE PRODUCTS-CoMPlOPAGG VT.TC,AE 977R955A-7.3 /1/2013 9/1/2014 �OME3�NEDSINGI,F.I.IMIT BE8766140 9/1/20139/1/2014 BODILY INJURY(Perpamon) IS BODILY INJURY(Peraccldent) 3 21000, 00a DED IX IRETENTIONS -- AGGREGATE $ 9, 000, 00C Z0, 000 S D AND YEERVLSATIONILIT i1TRKTJB 820SA105-13 9/1/207.3 9/1/207,4 X O - AND EMPLOYER8' LIABILITY TJJI3Y (J, D OFFICERNY RIETORIPARTNF.RIb(ECUIIVE NIA VTC2IiUB A203A71A-13 9/7 /20Zj 9/1/2014 @.L.EACHACCIDENT $ 11000 000 OFFICERrMEMSEREXCLUDI=DTI—" f UMvandato �lbaun E.L.DIAEA9E-EAEMPI:OYF.E $ 1,000,000 e�t;Kiill UN uF GPFRATION8 below FELL. DISEASE POLICYLIMIT S 11000,000 Evidence of Inmurance epeca SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Co1144197604 xp1:1694012 Corts20267680 ©1988-2010ACORD CORPORATION, All rights reserved, CORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Date.. �/.. TOWN OF NORTH ANDOVER A ~ p PERMIT FOR PLUMBING A -.-I ) � P/vI4 This certifies that 0" '��.�:1.... . has permission to perform. plumbing in the buildings of p%J? `?-..p�� .�i .l� ......... .11-i& -je, . .. , North Andover, Mass. at6x x.... F f O4 / PLUKABING INSPEC R Check # 7781 C MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locationarr S 11 I( � ('j(,Q 0Owners New ri Renovation (Print or type) Installing Company Name Address Name of Licensed Plumber: Insurance Coverage: Indic, of Occunancv , i Replacement ❑ FIXTURES Plans Submitted Yes Date 4 L8 _ Permit # Amount No Check one: Certificate ElCorp' Partner. Firm/Co. —.; `u{. Lyres V1 "LaLL.a1,L� �vycragc oy cneckmg the appropriate box: Dab ility insurance policy Other type of indemnity ❑ Bond ❑ Insurance Waiver: I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and 'nstallations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa et s State Plu g Code and Chapter 142 of the General Laws. By: igna ure o1 i—lic-0-11seum er Title �t'm ense City/Town (ce❑ APPROVED (OFFICE USE ONLY Master Journeyman o ll ao Ll CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) PRODUCER 6/16/2008 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Circle Business Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 247 Newbury StHOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Y . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Danvers, MA 01923 978-777-7030 INSURERS AFFORDING COVERAGE NAIC# INSURED puffin Plumbing & Heating INSURERA: Western World Ins.. INSURER B: 57 E Southern BLVD INSURER C: Plum Island, MA 01:x;:_ INSURER D: 978-255-2816 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVI'= 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DDS E POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 XCOMMERCIAL GENERAL LIABILITY kUL TO RENTED PREMISES Ea occurence $ 50,000 CLAIMSMADE CI OCCUR MED EXP (Any one person) $ 10,000 A NPPI111643 05/25/08 05/25/09 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 F PER: tiEN'L AGGREGATE LIMIT APPLIEPRO- PRODUCTS •COMP/OP AGG $ 1,000,000 POLICY71 JECT F-1S JECT LOC AUTOMOBILE LIABILITY ANYAUTO i COMBINED SINGLE LIMIT $ (Ea accident) ' ALL OWNED AUTOS SCHEDULED AUTOS BODILYINJURY $ (Per person) HIRED AUTOS NON-OWNEDAUTOS BODILYINJURY $ (Peraccident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR C CL/AIMSMADE AGGREGATE $ $ DEDUCTIBLE $ _ I RETENTION $ WORKERS COMPENSATION AND STATU- OTH- EMPLOYERS' LIABILITY - YLIMITS ER ANY PRIOPRIETOR/PARTNER/EXECUTIVE .. ACCIDENT $ OFFICCWMEMBER EXCLUDED? 7E.L.DISEASE Ifyes,'iescribeunder - EA EMPLOYE $ SPEC ;AL PROVISIONS below OTHER E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION PROOF OF COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE I c ACORD25(2001/08) ACORD CORPORATION 1988 a _r Thiscertifies that..........,.................................................................................. has permission to perform_..- �r..................................... wiring in the building of:..:J............................................... r, ............... .North Andover, Mass. at ............. ............................... Fee . �'.. �...... Lic. No f ..... ................ ........... ...: ..... ., ....:,,..., LEM CAL INSP G Check # 8241 Date......'� o E% ................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Commonwealth of Massachusetts Official Use Only TM' Department of Fire Services Permit No. w�Occupancy and Fee Checked kip BOARD OF FIRS E PREVENTION REGULATIONS [Rev. -1/07] (1Pa�P �iflrU� APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL'014TION) Date: p s� City or Town o£ NORTH ANDOVER To the I zectof Wires:. By this application the undersigned 've notice of his or her inten Location (Street &Number.) / c, -tion to erform the electrical ork described below. � � t, �t Owner or Tenant Ci luio y ©tJ Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes �--7� Purpose of Building l� No ❑ (Check Appropriate Boz) Utility Authorization No. Existing Service 900 Amps /,lv / K(; Volts Overhead ❑ Und d /i g � No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No, of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ' No, of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers f , of Dishwashers . of Dryers , of Water Heaters Com letion of the No. of Ceil.-Susp. (Paddle) Fans No. of Hot Tubs Swimming Pool Above grndln_ .ME No. of Oil Burners No. of Gas Burners No. of Air Cond. Total 4Heating ce/Area Heating KW Appliances KW KW of No. of Signs Ballasts . No. Hydromassage Bathtubs INo. of Motors Total HP V1 n table may be waived by the Ins ecto, No. of Total Transformers KVA Generators KVA =Ba mergency fig ting Units FIRE ALARMS INO. of Zones NO. of Deteetinn and . of Alerting Devices . of Self: Contained tection/AlertiE1 Devices ❑ Municipal Other Connection aunty Systems.* No. of Devices or Equivalent to Wiring: No. of Devices or Equivalent ecommunications firing; No, of Devices nr il.nnivato..r Wires. 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 '� /� fi Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liabi ' ' insurance including "completed operation" coverage or its substantial equivalent The 313undersigned certifies that such cov, a is in force, and has exhibited proof of same to the permit is office.. CHECK ONE: INSURANCE BONDE] OTHER ❑ (Specify-) I certify, under the pains andpenalties o P p ofperjury, that the information on this application is true and complete FIRM NAME: „�C, LIC. NO.: Licensee.' � - Signature ---- (If applicable, enter " mpt " ' the license number line. LIC. NO.: Address: tt l�! p S h r r a ,�����/ ,q tyl k yBus. Tel. No.: 9 .3 60 7 �,a *Per M.G.L c 147, s 57 61, secunty work requires D / Alt Tel. No.: epartanent 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 Signature Telephone No. PERMIT' FEE: $ .t I f r � The Common wealth of Massachusetts Department of Industrial Accidents Office of Investigations `4 600 Washington Street Boston, MA 02111 www massgov/dia . Workers' Compensation Insitrance Affidavit: Builders/ContractorsMectricians/Plumbers Applicant Information Please Print Ledblg NaMe(Bnsiness/Organizafion/individual):_ LGLL✓tJ'PwC;� EG C-7 X l G Address: <'i ,� 1*Gt ayI ✓1. i h /i' 7- krl- City/state/Zip:/A p Gi : WOOL, Of j YvPhone #: =( �� 36d 71 e i Are you an employer? Check the appropriate box: 1. ❑ 1 am a employer with 4. ❑ I am a general contractor and I employees (fid] and/or part-time).* . 2. ❑ I am.a.sole proprietor. or have hired the sub -contractors listed partner. on the attached sheet. - ship and have no employees These suis -contractors have working for me in any capacity, [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its . required.] 3. ❑ I am a homeowner doing officers have exercised their all work right of exemption per MGL Myself. [No -workers' comp. Q. 152, § 1(4), and we have no insurance required.] t .employees. [No workers' comp. insurance required-]. Type Of project (repaired): 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 - - t14, R, .„uai luau m: our me section below showing their workers' bompensation Policy information, omeowners who submit this affidavit indicating they are doing all work and then hire oulside contractors must submit a new affidavit indicating such. rContractors that check this box mustatrached an additional sheet showing the name of the sub -contractors and their workers' comp. Policy infnmistron. 1 am an employer that.is providcng:workers' compensation insurance for my. employees: information. Below isthe policy and job site Insurance Company Name: ' AJ,) oy' Fo / 4 Policy # or SaIf--ins. Lie. #:_� Expiration Date. Sob Site Address: Lfj fy(dt (p �(ol a City/state/Zip: /%J cam- oil, ? w Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify nder the airs and penalties of perjury .that the information provided above is trop and correct /_.-- Date• Phone #: --------------- Of, j`tcial 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 t1a N Contact Person; Phone #. Information and Instr`` ucfions 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 ofhire, 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'fomgoing 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 busiess 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 commonwealthnor 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-contmetor(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' cornpensation 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 signand date the affidavit. The affidavit should be returned to the cityor 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 tine. City or -Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hes 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 permittlicense number which will be used as a reference number. in addition, an applicant that. must submit multiple permitAicense applications in any given year, needd only submit. one affidavit indicating•current policy information (if necessary) and under "Job Site Address" the applicant shouldwrite "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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 Ext 406 or 1-8.77-MASSAFE Fax # 617-727-7744 Revised 5-26-05 rvww.mass.gov/dia f f t. �IIIh� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 378 !111161051 , Date: January 2. 2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 245 Marbleridge Road MAY BE OCCUPIED AS Single Family Dwelling IN ACCORDANCE WTTH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: William Barrett Homes PO Box 278 No�r't'h� Andover MsA�018�45 Building Inspector E, E Ut W d 40 w C C G cc j C V �r c ��� CU .r .0 mc m C— C m O N �= Oo` m swi c) o s cm N R � O � � N � •i=_N.. v J O � N COD cc H� w K m H m yt... O Of O �:�ot m ;' 0cm `o .: a o c m`�-:110, N m C .O S m -bar3o N H W= w m w •fNA d= O C Z c� m W �E ct'0 to O C.3 ID cm y d CCD � O Im ti = 00 w a M= O a O.rm I CO3 co .9 co CL CD c O co caM CO2 O .CL CO) C O O CO2 r�l 0 CD 3� Lftco � O C. cma cc CD S Z ca O. Cos C uj 0 Y/ w W W 19 LLIW N 40 w *� wu c CCU_'' (,J �,/ O GJ o w° cn w° tsj 5) cG° a cn cn C C G cc j C V �r c ��� CU .r .0 mc m C— C m O N �= Oo` m swi c) o s cm N R � O � � N � •i=_N.. v J O � N COD cc H� w K m H m yt... O Of O �:�ot m ;' 0cm `o .: a o c m`�-:110, N m C .O S m -bar3o N H W= w m w •fNA d= O C Z c� m W �E ct'0 to O C.3 ID cm y d CCD � O Im ti = 00 w a M= O a O.rm I CO3 co .9 co CL CD c O co caM CO2 O .CL CO) C O O CO2 r�l 0 CD 3� Lftco � O C. cma cc CD S Z ca O. Cos C uj 0 Y/ w W W 19 LLIW N s m I (A M tv 0/ V� CD yr CD EMS C.3 C=3 QI:2 4r ff- a -zo ca fti \0 CL= ED Clm 4D Cf) e. C" c coozip J2 =,Cc ca CA MI.L GO C2 f CD Jr. at ML ca CD No.. cr- CD 40 M sx-as 12 mo a .,Nwu - IQ Z IC -2 CD -CLD W CD 2 O r. c LU ci C4 C, C) CL WJ !9 ca co E co L- CL 0 O 03 C.3 m ;L CO2 Q R3 CL CO2 CD G) cc cc 'a CO3 1011 Z, co j 1�11` I 0fit 0 7. o IG ), �UZ � tt I q CD yr CD EMS C.3 C=3 QI:2 4r ff- a -zo ca fti \0 CL= ED Clm 4D Cf) e. C" c coozip J2 =,Cc ca CA MI.L GO C2 f CD Jr. at ML ca CD No.. cr- CD 40 M sx-as 12 mo a .,Nwu - IQ Z IC -2 CD -CLD W CD 2 O r. c LU ci C4 C, C) CL WJ !9 ca co E co L- CL 0 O 03 C.3 m ;L CO2 Q R3 CL CO2 CD G) cc cc 'a CO3 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit # 3 -7 S ADDRESS/LOCATION OF PROPERTY: a 4 Map �j Parcel Lot Number SUBDIVISION DATE REQUESTED FILED/READY FOR INSPECTION S91 n-7 CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE Permit Issued to: W i "&naE th CS Address CONSERVATION PLANNING DPW - WATER METER SEWERMATER CONNECTION NOTE ROUTING ® X131 v DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW File: Application for OC form revised Jan 2007 Date :7/ 164 ..... TOWN OF NORTH ANDOVER PERMIT FOR WIRING 0>114 �11115� This certifies that .... ...................... . I .............................. has permission to perform .............................................. wiring in the building of..... . ...................................................... at North Andover, Mass. Fee. e Lic. No... ........... iLECrItl . CA INSPECTOR # 6460 J ra f f ,0i rv. y ar 3.fit, rr• Per"A No. Occapang a Fes Checked APPUCATTON FOR PERMIT TO PERFORM ELECT ucAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELACMICAL CODE, 527 CMR 12:00 (PLEASE PRDff IN INK OR TYPE ALL BUIORMATION) Date a6 Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address �.,,I-b/e (-f To the Inspector of Wires: Is this permit in conjunction with a building permit; Yes El No ED (Check Appropriate Box) (� Purpose of Building S'i :^ 41Il rL t -e Ogg a Utility Authorization Nd. �2l Existing Service Amq..j...�V olts OverheadUnderground No. of Meters _ New 6 6 Ampa.2�.." rh Volts Oveead UndergroundC3 No. of Meters Number of Feedera and Ampacity LcsGadon and Nature of Proposed Electrical Work Np -j t; ri-d- No. of Lighting Oetisb No. of Hot Use _ No. Of Tran bnmw Told KVA No. of Lightiry F IUM Swimming Pool Above 13 Below Qmotoes KVA No. of RecepWM Oudeb No. of 00 Bursas No. of Ewegeory Lighting Banary Units No. of switch Oudeu . No of 0m Burner FIRE ALARMS No. of zones No. of Ranges No. of Air Coad. Told Taos Na of Dalscdon sed o%DispasM Na of Had Total Told Pa Toes KW InitialingDgvkn No. of Sounding Dedra No. of Dishwubets Spaoe Ann listing KW Na of self Coutehud Devim �Mwddpd 0 Connections Odw Na of Dryers Hesda Device KW No. of Water Heaters KW Na Of No. of slam Bailei No. Hydro Massae Tubs Na of Motors Totd HP tYrIM. huwaeCbretigW Pianttbtltete�frmrdMaaachtastaOmmlLaws 7hdk8aae�tIJ yisaiiaei YirxludrgCbmple� ori Ya4ri►irt Y� NO Ihtnest�triredveidpnddsenebfe0em Y$9 IyouhnedndedY®,pla f�etYRd��bY P61 RANCE BOND El an= 0 rg=,gP* BoWmDft WodcbStatt ltd `7l S t) j �g�� g.0 IlV t � ( C- 0-tr °fBemhlW6dr s find PaneFOMNAME d / CiarlteNo S 5 Um" 1—k,/SGS e /J�Q r" �i u►rt t7 Gt' �d,,,e 1 �.c clrr�.�— .. LioslseNo 24' zr �a� S k i � � � alt � •-�.� Busites'Ibt Na _ 4' ?�-`arF t; � CJWI�R'sIIV3fJRA1�EwA1VPl�IamawaefstlheLimee�heinRealoewtiv�aridst>t�yiti AL'I11Na a�tllorr�s�aemeiepmrit�picslianwahsfire�i®es e�m���,��� (Please cbeck one) Owner Q Apo Telephone No. FSB s `D 1' ., L . v� .�� lam- �-ate �� �� Date ............. TOWN OF NORTH ANDOVER PERMIT FOR WIRING V/ This certifies that has permission to perform ................ wiring in the building of../<: Z-0 .................... at -Z- North Andover, Mass. Fee.� ...... Lic. N ... (J2,A, � i&�& 'Sipo ELECTl CTO Check # 642_2 _ Commonwealth of Massachusetts (KfieiaiF j Department of Fire Services Per.nit N°. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9,05] (leayeblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK .111 %%ork to be performed in accordance with the N-lcissachusetts t:lectrical Code (\IEC). 52' LAIR 12.00 (PLE. ISE PRAT IN[N7KORTYPE, ILL NFORHITION) Date: ,2,— City or Town of: ./f rey�T/� �/ To the I17.speclor of lVir e,y By this application the undersigned gives notice of his or her intention to perform the eI ctric I work described below. Location (Street& Number) p2c/,�— Owner or Tenant Q �.j��/fid S Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building ees o clen 41- Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No. of Recessed Luminaires --- ../ •. •. ,•,.. ••.. ...ti No. of Ceil.-Susp. (Paddle) Fans ..,..r. ,r.,ry ,c r, ulYlu ,/V Illi II/.l /lilt// 1/I II (/ l� No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pnol Above ❑In- Elo. o rgency Lighting me rnd. rid. Battery Units No. of Receptacle Outlets No. of Oil Burners �rFIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tons l No. of Alerting Devices No. of Waste Disposers Heat Pump I Number Tons 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. Devices No. of Water KW No. of No. of of or E uivalent Data Wiring: "caters _ Signs Ballasts No. of Devices or Equivalent No. "ydromassage Bathtubs No. of Motors Total 1 -IP _ Telecommunications Wiring: No. of Devices or E uivalent (OTHER: /.SUr'Gj �af��trr7 Illuch addiliollal delail i/'dcSirrd, (W a.4 r'c',:/sil-ed /4 the illsIA 00)'t),` Wirc,. Estimated Value of Electrical Work: FC� • Op/ (When required by municipal policy.) Work to Start:,;? — /3— (a Inspections to be requested in accordance with N1EC' 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" cuvera_e or its substantial equivalent. `Ilse undersi ned certifies that such Covera e is in force, and has c'dliblted proof of same to the permit is_•uim, office. (TIEC'KONE: INSURANCE ❑ BOND ❑ (.)ff1ER ❑ (Specify:) 1 c•ertif,, wu1er the pains and penalties o/'perjurp, that the in%ur»ration on this upplic•ittion is true onil c•oinplele. FIRM NAME:,S(/�/U N-1 >` �}���ti1 LIC. NO.: 15VS- Licensee: 8vherf le9. j� ��� :Sit nature A01 LIC. N0.s;?;2 V -7.P lillllllh'1' lille./ Bus. Tel. INo. � Address:. 7 /Y%i ((/ G �i P//J X'% .�Av✓.�fit/=,cei���7i� Aft. Tel. No.:— �v dry Security System Contractor License required for this work, if applicabl , e� iter the license number here: OWNER'S INSURANCE WAIVER: I ana aware that the Licensee duos W)l huvC the liability insurance coverage normally required by law. By my signature below, I hcrcby waive this requirement. I am the (check onc) E]owner ❑owner's uyent. Owner/Agent :�i�YlatYlY'e Telephone No. PF R.WT FEE: S �� ✓� 09/- T g, /& - v 6, I z-G_v z Aw JA 03/03/2006 11:28 FAX Bradford Engineering Co. Memo Ta Bob Moore From Deter Mauritz CC: Dates 2128106 Re: Beam Inspection' 40 Marbleridge Road, North Andover, MA 10002/002 RSD As requested by you, Peter D. Mauritz, a structural engineer with Bradford Engineering Company has visited the above referenced property for the purpose of assessing the adequacy of a recently installed steel beam for a single family residence. This is at the request of the local Building Official. The beam in question is a W10x39 that clear spans 24'-2". The beam is flush framed with the second floor 2x10 floor joists. The beam supports the tributary area from a 24' wide second floor and load contributions of the attic above. The bedroom has been designed for a 30 pound per square foot live load as specified by the Massachusetts State Building Code. The beam is deemed to be adequately sized for the span and load in question. The beam is posted at the interior wall with (5)-2x4's below the flange and at the exterior wall with (6)-2x4's below. The posts have been checked for the axial capacity to support the beam's end reaction and the posts are considered adequate to support the imposed loads. I hope the above information adequately addresses your concerns. Should you have any questions or require any additional information, please do not hesitate to call. &60 f-m4e. 'rr•cpt 13/4 ,c 9t/i.a (.VL C7 -c. a¢ A4+1 - c> 4Z>,- 11,.3.E 6450^ is 1 HLocation� No. — V -Date NORTq TOWN OF NORTH ANDOVER • OL 9 Certificate of Occupancy $ sACHUBuilding/Frame Permit Fee $ Foundation Permit Fee $ .CSS Other Permit Fee $ TOTAL $z Check #� dI/ 18785 '— Building InspecfGi TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCTREP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: 3 1 DATE ISSUED: SIGNATURE: Building Commissioner/I r of Buildings Date • '0 SECTION 1 -SITE INFORMATION 1.1 Property Address: ;IL45 Marblertd Qe ()d • 1.2 Assessors Map and Pared Number: 0-70 I Map Number Parcel Number o -t 2 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lct Area Frontage tt 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide ReqWred ded Required Provided al 13q- 1.7 water Simply N L.C.4o. 34) 1.5. Flood Zone Fnfoimation: 1.8 Sew Disposal System: Public [y/ Private ❑ zone Outside Flood Zone ®, Municipal i7 On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District: Yes No W--- 2.1 Owner of Record l l` Oa e, i (moi-{ 4 Tear N gi V e S+ A)6. Pf A d®ver Name (Priv �� Address //for Service l.l2 O Oti Signature Telephone 2.2 Owner of Record: Name Print Address for Service: i Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: .W i I�tari. -(3arre At Licensed Construction Supervisor: I d cl 7—o r 1 1/ Address �- Signature o Telephone Not Applicable ❑ i O� 1 License Number 1 0� 1d 0 —7 Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone 00 M X Z O J P rn It SECTION 4 - WORKERS COMPENSATION (NLG.L. C 152 6 25c161 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildigg permit. Signed affidavit Attached Yes ....... No ....... ❑ SECTION 5 Descriptio f Proposed Work check all applicable) New Constructionm� , Existiiitg BiAlding ❑ Repair(s) ❑ Alterations('t E' a ' Addition El ,r Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Pdposed Wo:c;.+ ' wry : --10M e�' L ► o� 0, ar0" n d SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Com eted b permit a lican 1. Building(a) 00,0'/Multiplier }itlk'IGiAI Building Permit Fee 'y USE ONLY 2 Electrical DIX0 0 (b) Estimated Total Cost of Construction (/ 2 7 b U .V 3 Plumbing j Building Permit fee (a) X (b) 70 4 Mechanical HVAC 5 Fire Protection 000 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHO ATION O BE COMPLETED WHEN OWNERS AGENT OR CON OR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, ,rye 00, cc e' �'�" as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Name Si ature OPDate NO. OF STORIES SIZE `7 BASEMENT OR SLAB p� SIZE OF FLOOR TIlVIBERS aXJ1D 2ND d X I 3 GL X 16 SPAN 15' DIMENSIONS OF SILLS 14 X to DIMENSIONS OF POSTS S -'—� " i a m e�-\- e DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION go THICKNESS 10 " SIZE OF FOOTING i a'X a 14" X MATERIAL OF CHIMNEY 0 r ; 0 k• IS BUILDING ON SOLID OR FILLED LAND (, i IS BUILDING CONNECTED TO NATURAL GAS LINE $ i US a� O b s%—* 1 x A � 9 HO w X 3 0 Io Q U O x A � 9 HO w X i 04 p –co F coCw U c ACcil 0�2 Z cn du OO cn coo Us Q i¢ u CD mi 4� C,.S E :mm ru co �i O ; 'cam r.+ Qf cp = C y VJ cc rio. .=o COL Ca %, = o 40 s: CD p C �rCL m O m C .s Z0 o . Co S CL c Q` ••� ` m c o = m Vi N COD CD t Si c w gui MOS CLS Z • � v c O o W a 0.5 .0g F -yam Li i z O U 0 W y O C* a. O L c O CD w cc w_ ii COD O O. COD C O 0 co 3� a� C t o C:- v�Q c c O 'C O O Z CD CL CO) C C— C c H is LLI 0 U) LU0 W W LLIW U) 5 0 c o ` Cc y C cm c ACcil o CD y yam+ C I v: V O y :EE coo Us Q i¢ u CD mi 4� C,.S E :mm ru co �i O ; 'cam r.+ Qf cp = C y VJ cc rio. .=o COL Ca %, = o 40 s: CD p C �rCL m O m C .s Z0 o . Co S CL c Q` ••� ` m c o = m Vi N COD CD t Si c w gui MOS CLS Z • � v c O o W a 0.5 .0g F -yam Li i z O U 0 W y O C* a. O L c O CD w cc w_ ii COD O O. COD C O 0 co 3� a� C t o C:- v�Q c c O 'C O O Z CD CL CO) C C— C c H is LLI 0 U) LU0 W W LLIW U) FORM U - LG T RE-_ZASc F-0R::i IlyZ I RUC T ICN-: I ills form, IS used tC VefiT that all necasSarl approvaisilo effilltS fr1 cm, SGafds and Ceras mentS !laving 'Ufisuiction have been GDt=ine�. This does not relieve ii ie c�)CIIC !^ti ai iCICf laiiCGWnEf ii G,T! C :moi.{!ci C3 `HILI i cis;/ a�)Dl1Ca Ie or is'afc'Tie 1tS APP!-ICT F L' LS CUT Tc- SF-C7iCN LCC 1 T lCl1I: ,AS-cSsGiS it/laQ I�Uii�Cef I^1 h,'�,CCC�_ 1 l J SUEDIVL�.iCN. LCT (S) �. J GFF .iC�AL .USc ONLY R-=---CNIMEN- CATICNS OF TOWN /AC -V T S: CCNSE cVATiCN ACMINIST7RATCR CATE APPROVEC 11 / CATE R—EJEZ ED COMMENTS CGcsc:�. 1 1'!r� '- G� �r S f�'u C -i 14-� TO V*411P'--'kN N E CC MPill ENTS .,.L CATE APPRcOVE0 CATE REJECTED. i CCC INSrE . CR-r-iE1.LT H CATE APPRCVEC _.... J CATE REJECTEM C Rc-HEALTi; CATE APFRcGVE1 CATs REJECTEs-`. COMMENTS PUELIC WORKS - ScNERIWATE= CONNECTION CRIVEWAY PERMITi.�LtiCli1 F',RtiE 0E?ART- 7JE�IT � �'_�►._.-�'�!' ��'Z. /o/%z;Ids RE. ciVEC SY-UILID ING INSP T CR CATs Revised C -\?7 im l The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Leyibly Name (Business/Oreani-ration/Individual): 1 I j CV M �a r(°i Holm e' S Address: I 9I yr ✓V t0 f kc, S ' City/State/Zip: A)n . q/) dounC lq 018'�f,5 Phone #: 9 7 8'— VU, Are you an employer? Check the appropriate box: 1. E I am a employer with 4• ❑ 1 atn a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- 1 isted on the attached sheet. ship and have no employees These sub -contractors have working for the 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.ew construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F-1 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # I 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. / am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. j 1 Insurance Company Name: —T ra 1„2 -P,l ers �Ii ef emn i�0� co n a.) Policy # or Self -ins. Lic. #: G2 1 o(3 / 330 ig 9(p 9p5 Expiration Date:(P ``ll [� 01W5_ Job Site Address: "7� � Ci V_ �11Q,00U8 City/State/Zip:_A�. A-LY&(jf/ Attach a copy of the workers' compensation po cy 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 tine 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 certify ung r l p ins and penalties o ' er'u 1lrat the ti ormation provided above is true and correct. �;>Sienature: 2�0t�,� Date: f I f(� /Q'l Phone It: q 71 2� 61W a. _ 2: 3"A 0 — OjJicial 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 theiremployees. 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 ajoint 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-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 confinnation 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 till 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 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5 -26 -OS www.mass.gov/dia Date: 3/24/2005 Time: 8:33 AM To: Charlie @ 9197f6822397 pey Ins. Agency, Page: 001-002 Tar CO ARQM CERTIFICATE OF LIABILITY INSURANCE ATE (MMIDDIYYYY) 0 3/24/2005 PRODUCER (781)246-2677 FAX (781)224-0973 Tarpey Insurance Group Inc 442 Water St PO BOX 567 Wakefield, MA 01880-4667 THIS CERTIFICATE IS ISSUED AS A MATTER. OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Colonial Village Development, Inc. DBA: William Barrett Homes 1049 Turnpike Street North Andover, MA 31845 INSURER A: National Fire & Marine Ins. Co POLICYEFFECTIVE INSURER B: Safety Indemnity 33618 INSURER c. Travelers Indemnity Co of Conn 25682 INSURER 72LPE693330 INSURER E'. 10/01/2005 COVERAGES THE POLICIES OF INSURANCE LISTEE BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COND TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO V,/HICH THIS CERTIFI :ATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO 4LL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOV/N MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L I S TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION DATE (MI:; LIMITS North Andover, MA GENERAL LIABILITY 72LPE693330 10/01/2004 10/01/2005 EACH OCCL RRENCE $ 1,000,000 X COMMERCIAL GENERAL UABI( TY DAMAGE TC_REN 'ED 50,000 S -a L ran %-) MED EXP (Aiy one per: n) $ 5,000 CLAIMS MADE a C:CUR A PERSONAL ', ADV INA 2Y $ 1,000,000 GENERAL A 3GREGATI $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES F =R. PRODUCTS COMPIOF AGG $' 2,000,000 FRO - X POLICY JEC7 LOC AUTOMOBILE LIABILITY ANY AUTO 1900226 03/23/2005 03/23.!2006 COMBINEDANGLE LIN F (Ea arrident, 1,000,000 BODILY INJU?Y (Per person) $ B X X X ALL OWNED ALTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJU.,Y (Per accident $ PROPERTYI)AMAGE $ (Per accident . GARAGE LIABILITY AUTO ONLY EA ACCII -NT $' OTHER THAI I -A ACC $ ANY AUTO AUTO ONLY. A GG $ EXCESSIUMBRELLA LIABILITY EACH OCCL RRENCE $ OCCUR CLAIMS NADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND 6KUB7330A86505 03/24/2005 03/24/2006 X TORYSIAT - OT ER C EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE _ E.L. EACH A;CIDENT $ 100, 000 - E.L, DISEAS;: - EA EMF OYES $ 100,000 OFFICERnsEMSER EXCLUDED? Ifyes,deseribe under SPECIAL PROVISIONS below E.L. DISEAS : - POLICY -IMIT $ 500,00 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 V::HICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISION: E: 1423 Salem Street, North Andover MA CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001108) ©AC ORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREJF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS' IRITTEN N. )TICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of North Andover BUT FAILURE" O MAIL SU(:H NOTICE SHALL IMPOf,E NO OBLIGATION OR LIABILITY Town Hall OF ANY KIND L 'ON THE IP SURER, ITS AGENTS OF. REPRESI VTATIVES. AUTHORIZED REPGESENTATI'E North Andover, MA Kathleen Flunyon ACORD 25 (2001108) ©AC ORD CORPORATION 1988 A� . MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release la CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 11/08/05 DATE OF PLANS: 11/8/05 PROJECT INFORMATION: 245 Marbleridge rd. No. Andover COMPANY INFORMATION: William Barrett Homes COMPLIANCE: Passes Maximum UA = 586 Your Home = 560 4.4% Better Than Code Ceiling 1: Flat Ceiling or Scissor Truss Ceiling 2: Cathedral Ceiling (no attic) Wall 1: Wood Frame, 16" o.c. Wall 2: Wood Frame, 16" o.c. Window 1: Vinyl Frame, Double. Pane with Low -E Door 1: Solid Door 2: Glass Basement Wall 1: Solid Concrete or Masonry, 8.0' ht/6.0' bg/0.0' insul Basement Wall 2: Wood Frame, 6.0' ht/0.0' bg/6.0' insul Floor 1: All -Wood Joist/Truss, Over Unconditioned Space Furnace 1: Forced Hot Air, 86 AFUE Furnace 2: Forced Hot Air, 86 AFUE Air Conditioner 1: Electric Central Air, 10 SEER Permit Number Checked By/Date R Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA 1452 30.0 0.0 51 384 30.0 0.0 13 1680 13.0 0.0 138 1512 13.0 0.0 78 488 0.350 171 40 0.450 18 33 0.350 12 72 0.0 0.0 21 252 19.0 0.0 16 1260 30.0 0.0 42 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release Ia. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date qg © 5 BUILDING DEPARTMENT NORTH ANDOVER Tel: 978-688-9545 DEBRIS DISPOSAL FORM a condition of Building permit the provision of MGL c 40 S 54, o_bjn from this work shall be In accordance a p is that the debris resulting at: ro erly licl6nsed solid waste disposal facility as defined by MGL disposed of in a properly ter 148 Section S 150 A. required under Fire Prevention laws Chap Also, note Permits are 10A. The debris will be disposed of in: ZD, s CID0 G A`\ cation of Facility (Lo _ Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date i i REQUIREMENTS FOR BULDING PERMIT SIGNOFFS BY BOARD OF HEALTH To be filled out by the applicant and submitted with the Building Permit application 1. What is the proposed project? Deck pool addition new house other 2. Are plans attached? Yes No (For additions and new houses on septic systems, complete floor plans of proposed construction and any existing house must be submitted. For pools and decks, a site plan with location of pool or deck is required. Dimensions of deck are needed.) 3. Is municipal sewer available at this location? i Yes No 4. If sewer is available and a house already exists, is it tied in to the sewer? Yes No 5. Is the location served by private well? Yes No 6. If this project is an addition and the house is served by a septic system, has there been a Title 5 inspection done recently on the septic system? Yes No 'N A 7. If, yes, is the inspection report on file at the BOH? Yes No A) A OCT -04-2005 10:13 P.02i02 L— —F'1' 1 ...3 1 w MIR I l i Al '� i i 1 4 TOTAL P.02 OCT -04-2005 10:1?, 6" g PE gall, 0"N P.01/02 fs�41 In ILS Jo li Name Location l e Check # 747-1 Date Note: b -24// Z Bf'A RECciPT NO. 1431 WHITE: Applicant TOWN OF NORTH ANDOVER Sewer Mitigation Fee $ Sewer Connection Fee $ Water Connection Fee $ eo . epo Meter Fee $ Other $ TOTAL $ z 4� Div. Public Works CANARY: Department PINK: Treasurer GOLD: File h 121 h. eatilator The first name in fireplaces Models: N D3630/3933/4236/4842 N D36301/39331/42361148421 N D3630L/3933L/4236L/4842L N D 36301 L/39331 L'42361 L/48421 L Direct Vent Gas Appliance CAUTION Owner's Manual Installation and Operation DO NOT DISCARD THIS MANUAL Important operating and - Read, understand and follow • Leave this manual with maintenance instructions these instructions for safe party responsible for included. installation and operation. use and operation. I Is A WARNING If the information in these instruc- tions is not followed exactly, a fire may result causing property damage, personal injury, or death. Do not store or use gasoline or other flam- mable vapors and liquids in the vicinity of this or any other appliance. - What to do If you smell gas: Do not try to light any appliance. Do not touch any electrical switch. Do not use any phone in your building. Immediately call your gas supplier from a neighbor's phone. Follow the gas suppliers instructions. If you cannot reach vour gas supplier, call the fire department. installation and service must be performed by a qualified installer, service agency, or the gas supplier. This appliance may be installed as an OEM installation in manufactured home (USA only) or mobile home and must be installed in accordance with the manufacturer's instructions and the manufactured home construction and safety standard, Title 24 CF.R, Part 3280 or Standard for Installation in Mobile Homes, CAMICSA Z240MH. This appliance is only for use with indicated on the rating plate. A WARNING c tion 'Ao ROTI DO NOT TOUCH. SEVERE BURNS MAY RESULT. CLOTHING IGNITION MAY RESULT. Glass and other surfaces are' hot during operation and cool down. Keep children away. • CAREFULLY SUPERVISE children in same room as • appliance. Alert children and adults to hazards of high temperatures. • Do NOT operate with protective barriers removed or door open. Keep clothing,. furniture, draperies and other .._ • combustibles away. This appliance has been supplied with an integral barrier to i prevent direct contact with the Fixed glass panel. Do NOT I operate the appliance with the barrier removed. Contact your dealer or Hearth & Horne Technologies if the bar- rier is not present or help is needed to properly install one. In the Commonwealth of Massachusetts: • installation must be performed by a licensed plumber or gas filter. a CO -detector shall be installed in the room where the appliance -is - • installed. Installation and service of this appliance should be performed °v 'F, by qualified personnel. Hearth & Home Technologies suggests NFI certified or factory -trained 0 t professionals, or technicians supervised NboaEnegy MSTI'i11 Terhrtkvl 7ivur�.q by an NF! certified professional. Heatilator • Novus OV - 4031-117 Rev R • 05105 1 so Listing and Code Approvals A. Appliance Certification MODELS: ND3630/3933/4236/4842 N D36301/39331/42361/48421 N D3630L/3933 L/4236L/4842L N 036301 L/39331 L/42361 U48421 L LABORATORY- Underwriters Laboratories, Inc. (UL) TYPE: Direct Vent Gas Appliance STANDARD: ANSI 221.88-2002•CSA2.22-M98•UL307B This product is listed to ANSI standards for "Vented Gas Fireplaces" and applicable sections of "Gas Burning Heating Appliances for Manufactured Homes and Recreational Vehicles", and "Gas Fired Appliances for Use at High Altitudes". NOT INTENDED FOR USE AS A PRIMARY HEAT SOURCE. This appliance is tested and approved as either supplemental room heat or as a decorative appliance. It should not be factored as primary heat in residential heating calculations. B. Glass Specifications Hearth & Home Technologies appliances manufactured with tempered glass may be installed in hazardous locations such as bathtub enclosures as defined by the Consumer Product Safety Commission (CPSC). The tempered glass has been tested and certified to the requirements of ANSI Z97.1 and CPSC 16 CFR 1202 (Safety Glazing Certification Council SGCC# 1595 and 1597. Architectural Testing, Inc. Reports 02-31919.01 and 02-31917.01). This statement is in compliance with CPSC 16 CFR Section 1201.5 "Certification and labeling requirements" which refers to 15 U.S. Code (USC) 2063 stating-".-.. Such certificate -shall accompany the product or shall otherwise be furnished to any distributor or retailer to whom the product is delivered." Some local building codes require the use of tempered glass with permanent marking in such locations. Glass meeting this requirement is available from the factory. Please contact your dealer or distributor to order. Note: This installation must conform with local codes. In the absence of local codes you must comply with the National Fuel Gas Code, ANSI Z223.1 -latest edition in the U.S.A. and the CAN/CGA 8149 Installation Codes in Canada. C. BTU Specifications Model Max Input P BTUH Min Input P BTUH Orifice Size ND3630 / ND36301 20,000 14,000 .083 ND3933 / ND39331 22,000 15,000 .089 ND4236 / ND42361 25,000 17,000 .0935 N04842 / ND48421 30,000 20,500 .104 ND3630L / ND36301L 20,000 15.000 .052 ND3933L / ND39331L 22,000 15,000 .055 ND4236L / ND42361L 25,000 17,000 .058 ND4842L / ND48421L 30,000 20,500 .0635 D. High Altitude installations U.L. Listed gas appliances are tested and approved without requiring changes for elevations from 0 to 2000 feet in the U.S.A. and Canada. When installing this appliance at an elevation above 2000 ft; it may be necessary to decrease the input rating by chang- ing the existing burner orifice to a smaller size. Input rate should be reduced by 4% for each 1000 ft above a 2000 ft elevation in the U.S.A., or 10% for elevations between 2000 and 4500 ft in Canada. If the heating value of the gas has been reduced, these rules do not apply."7o identify the prop- er orifice size, check with the local gas utility. If installing this appliance at an elevation above 4500 ft (in Canada), check with local authorities. I A WARNING . Do NOT use this appliance if any part has been under water. Immediately call a qualified service technician to inspect the appliance and to replace any part of the control- system and any gas- control- which has- been --- under water. Heatilator • Novus DV • 4031-117 Rev R • 05105 3 Framing and Clearances Note: • Illustrations reflect typical installations and are FOR DESIGN PURPOSES ONLY. • Illustrations/diagrams are not drawn to scale. • Actual installation may vary due to individual design preference. Fire Risk Provide adequate clearance: • Around air openings. i For service access. Locate appliance away from traffic areas. 6 Heatilator • Novus DV •4031-117 Rev R • 05105 A. Select Appliance Location When selecting a location for your appliance it is important to Note: For actual appliance dimensions refer to Section 16. consider the required clearances to walls (See Figure 3.1). D 1 in. (25 mm) min. pipe to A 112 in. (13 mm) min. combustibles 1/2 in. (13 mm) F appliance to AMIML min. appliance combustibles to combustibles 7� \ !� g. ►� A Alcove D 8 Installation B Top Vent Rear vent One 90° elbow One 45° elbow Horiz Term Horiz Term " In addition to these framing dimensions, also reference the following sections: • Clearances and Mantel Projections (Sections 3.C. and 3.D.) • Vent Clearances and Framing (Section 6) No elbows Rear Vent SB ar Vent Horiz Term 90° elbow Two 90° elbows rt Term I`— B Horiz Term B E � C FI O 1 in. (25 mm) min. pipe to �-- combustibles fes— E C Model A B C D E F ND3630 inches 33-1/2 36 53-1/4 43-3/8 47 19-5/8 mm 851 914 1353 1102 1194 498 N03933 inches 35-112 39 53-1!4 43-3/8 47 19-518 MM 902 991 1353 1102 1194 498 ND4236 inches 37-518 42 53-114 43-3/8 47 19-5/8 MM 956 1067 1353 1102 1194 498 ND4842 inches 41-7/8 48 53-1/4 43-318 47 19-5!8 mm 1064 1219 1353 1102 1194 498 Figure 3.1 Appliance Locations WARNING D. Mantel Projections H max. V min. inches mm inches mm 3 76 5 127 4 102 5-1/2 140 5 127 6-1/4 159 6 152 7 178 7 178 7-3/4 197 8 203 8-1/2216 Appliance 9 229 9-1/4 235 10 254 10 254 11 279 10-3/4 273 12 305 1 11-1/2 292 13 330 12-1/4 311 14 356 13 330 15 381 13-3/4 1 349 16 407 14-1/2 368 17 432 15-1/4 387 18 457 16 406 Figure 3.3 Clearances to Mantels or Other Combustibles Above Appliance Top of Appliance drywall 1 in (25 mm) min. �I to perpendicular 48 in. max. wall (1219 mm) � I Mantel Leg Figure 3.4 Clearances to Mantel Legs or Wall Projections (Acceptable on both sides of opening) Heatilator • Novus OV • 4031-117 Rev R • 05/05 9 —t 30 in. minimum clearance to ceiling D6gagement minimum du plafond: H 762 mm V i Side View Measured from Of top of hood Appliance Mesure du Vue du cete dessus du capot de l'appareil Figure 3.3 Clearances to Mantels or Other Combustibles Above Appliance Top of Appliance drywall 1 in (25 mm) min. �I to perpendicular 48 in. max. wall (1219 mm) � I Mantel Leg Figure 3.4 Clearances to Mantel Legs or Wall Projections (Acceptable on both sides of opening) Heatilator • Novus OV • 4031-117 Rev R • 05/05 9 d © TERMINATION CAP Wall Shield Measure vertical clearances Heat Shield from this surface. E�f -11'l Measure hori /1Tem \tion Cap deararrces from this surface. I Rxed Closed —J T—�-K GAS METER (9)AIR SUPPLY INLET RESTRICTION ZONE (TERMINATION NOT ALLOWED) Dimension Descriptions A Clearance above the ground, a veranda, porch, deck or balcony - 12 in. (30 cm) minimum. * B Clearance to window or door that may be opened — 10,000 BTUs or less, 6 in. (15 cm) minimum; 10,000-50,000 BTUs, 9 in. (23 cm) minimum; over 50,000 BTUs, 12 in. (30 cm) minimum. * C Clearance to permanently closed window — 12 in. (30 cm) minimum - recommended to prevent condensation on window. D Vertical clearance to ventilated soffit located above the termination within a horizontal distance of 2 ft (60 cm) from the centerline of the termination —18 in. (46 cm) minimum. — E Vertical clearance to unventilated soffit - 12 in. (30 cm) minimum. ** F Clearance to outside corner - 6 in. (15 cm) minimum. G Clearance to inside comer - 6 in. (15 cm) minimum. H Not to be installed above a meter/regulator assembly within 3 ft (90 cm) horizontally* from the center line of the regulator (Canada only) I Clearance to service regulator vent outlet — 3 ft (.91 m) U.S. minimum and 6 ft (1.8 m) Canada minimum. * J Clearance to non-mechanical air supply inlet into building or the combustion air inlet to any other appliance — 9" (23 cm) U.S. minimum and 12 in. (30 cm) Canada minimum. ' K Clearance to mechanical air supply inlet - 3 ft (.91 m) U.S. minimum and 6 ft (1.8 m) Canada minimum. * L Clearance above a paved sidewalk or paved driveway located on public property - 7 ft (2.1 m) minimum. A vent may not terminate directly above a sidewalk or paved driveway which is located between two single family dwellings and serves both dwellings. M Clearance under veranda, porch, deck or balcony - 12 in. (30 cm) minimum. * Recommended 30 in. (76 cm) for vinyl or plastic. _Only permitted if veranda, porch, deck or balcony is fully. open on a minimum of 2 sides beneath the floor. * N Vertical clearance between two horizontal termination caps —12 in. (30 cm) minimum. O Horizontal clearance between two horizontal termination caps —12 in. (30 cm) minimum. Figure 4.4 Vertical Termination Minimum Clearances Electrical Service D' Clearances to Electrical Service P 6"- Non -vinyl sidewalls 12" -Vinyl sidewalls Q 18"— Non -vinyl soffit and overhang 42" —Vinyl soffit and overhang R 8 ft. U 6" min. - Clearance from sides of electrical service. — — W 12" min. — Clearance above electrical service. * As specified in CGA 6149 Installation Codes Note: Local codes or regulations may require different clearances. * Clearance required to vinyl soffit material — 30 in. (76 cm) minimum. Note: Location of the vent termination must not interfere with access to the electrical service. WARNING! In the U.S.: Vent system termination is NOT permitted in screened porches. You must follow side wall, overhang and ground clearances as stated in the instructions. In Canada: Vent system termination is NOT permitted in screened porches. Vent system termination is permitted in porch areas with two or more sides open. You must follow all side wall, overhang and ground clearances as stated in the instructions. Hearth 8r Home Technologies assumes no responsibility for the improper performance ofthe appliance when the venting system does not meet these requirements. CAUTION: IF EXTERIOR WALLS ARERN/SHED WITH VINYL SIDING, RIS SUGGESTED THATA VINYL PROTECTOR KXRBEINSTALLED . Heatilator • Novus DV * 4031-117 Rev R • 05/05 11 S min T max 1 cap 3 ft 2 IPS actual 2 caps E ft 1 x S actual 3 caps 9 ft 2/3 x S actual 4 caps 12 ft 1/2 x S actual S min = # tens caps x 3 T max = (2/# term caps) x S (actual) U 6" min. - Clearance from sides of electrical service. — — W 12" min. — Clearance above electrical service. * As specified in CGA 6149 Installation Codes Note: Local codes or regulations may require different clearances. * Clearance required to vinyl soffit material — 30 in. (76 cm) minimum. Note: Location of the vent termination must not interfere with access to the electrical service. WARNING! In the U.S.: Vent system termination is NOT permitted in screened porches. You must follow side wall, overhang and ground clearances as stated in the instructions. In Canada: Vent system termination is NOT permitted in screened porches. Vent system termination is permitted in porch areas with two or more sides open. You must follow all side wall, overhang and ground clearances as stated in the instructions. Hearth 8r Home Technologies assumes no responsibility for the improper performance ofthe appliance when the venting system does not meet these requirements. CAUTION: IF EXTERIOR WALLS ARERN/SHED WITH VINYL SIDING, RIS SUGGESTED THATA VINYL PROTECTOR KXRBEINSTALLED . Heatilator • Novus DV * 4031-117 Rev R • 05/05 11 0 6 Vent Clearances and Framing A. Pipe Clearances to Combustibles A WARNING Fire Risk Explosion Risk Maintain vent clearance to combustibles as specified. • Do not pack air space with insulation or other materials. Failure to keep insulation or other materials away from vent pipe may cause fire. 3 in. (76 mm) Drywall 1 in. (25 mm) i 2 x 4 or No combustible 2 x 6 " " framing to be header located within shaded area. 1/2 in. (13 mm) minimum to perpendicular wall Figure 6.1 Pipe Clearances B. Wall Penetration Framing • Frame a hole in a combustible wall for an interior wall shield (Figures 6.1 through 6.3) whenever a wall is penetrated. Use same size framing materials as those used in the wall construction. The wail shield maintains minimum clearances and prevents cold air infiltration. • If the hole being penetrated is surrounded by non- combustible materials such as concrete, a hole with diameter 1 in. greater than the pipe is acceptable. Note: Heat shields MUST overlap by a minimum of 1-1/2 in. (38 mm). Heat 3 in. (76 mm) Shield --i top clearance F IliHeat Shield \1 in. (25 mm) Wall clearance Shield bottom &sides t s •o WALL Figure 6.2 Horizontal Venting Clearances to Combustible Materials DO NOT PACK WITH Vent INSULATION OR framing OTHER MATERIAL. hole. The center of the framing hole is 1 in. (25mm) above the center of the horizontal vent pipe. f D. E' - Framing should be constructed of 2 X 4 lumber or heavier. ' To center of pipe. D E Model Tog Vent Rear Vent ND3630 ND3933 in. 39-1/2 23-1!2 ND4236 ND4842 mm 1003 597 Figure 6.3 Exterior Wall Hole 22 Heatilator • Nows DV •4031-117 Rev R • 05/05 r + E. Junction Box Installation If the box is being wired from the OUTSIDE of the appli- ance: • Remove the cover plate located on the outer shell - right side (see Figure 10.4). • Install the supplied RomexTM connector in the cover plate. • Loosen two screws on the Romex connector, feed the necessary length of wire through the connector and tighten the screws. • Make all necessary wire connections and reattach the cover plate to the outer shell. If the box is being wired from the INSIDE of the appliance: • Remove the screw attaching the junction box to the outer shell, rotate the junction box inward to disengage it from the outer shell (see Figure 10.4). • Pull the electrical wires from outside the appliance through this opening into the valve compartment. • Loosen the two screws on the Romex connector, feed the necessary length of wire through the connector and tighten the screws. • Make all necessary wire connections to the receptacle and assemble the receptacle and cover to the junction box. F. Wall Switch Installation for Fan (Optional) If the box is being wired to a wall mounted switch for use with a fan (See Figure 10.5): • The power supply for the appliance must be brought into a switch box. • The power can then be supplied from the switch box to the appliance using a minimum of 14-3 with ground wire. • At the switch box connect the black (hot) wire and red (switch leg) wire to the wall switch as shown. • At the appliance connect the black (hot), white (neutral) and green (ground) wires to the junction box as shown. • Add a 1/4 in. insulated female connector to the red (switch leg) wire, route it through the knockout in the face of the junction box, and connect to the top fan switch connector (1/4 in. male) as shown. o o e 36 Heatilator • Novus DV •4031-117 Rev R • 05105 Romex Minimum 14-3 AWG Connector with Ground R ^.wrote i to 1412WG Junction Box Cover Plate ® outside firebox Knockout e Figure 10.5 Junction Box Wired to Wall Switch or BC10 4 m� r 2 Y CD v Copper ire ground attached wox inside to GRN screw with C GRN wire Note: Do NOT wire 110 VAC to wall switch. Figure 10.4 Junction Box Detail o o e 36 Heatilator • Novus DV •4031-117 Rev R • 05105 Switch Minimum 14-3 AWG with Ground R ^.wrote Junction Box Switch Box o D Power Supply Wires Knockout e Figure 10.5 Junction Box Wired to Wall Switch or BC10 o o e 36 Heatilator • Novus DV •4031-117 Rev R • 05105 . r, I O I I m O� DD❑ I I I I LidLHI WII.I_ISM l3:°J�P��I`i' ppOJ��T 11iL�: 245 MARBLERIpCE RD SCALA: I�AT�: 11/14/05 S PRONT E L E VAT I ON nPAWN PY. Frol (T Mr scar : %fFf: WIL-L-IAM 245 MARIBLERIDGE RID 3/16'=1'-0" 11/14/05 13ULP�P-_ or FINF HOAAF- 5 11MM 13y: REAR ELEVATION �A W r— m n m r m O z v ppOJECr %F: SCALE: PATE: Sf ET: WILL- Izb\M 245 MARBLERIDGE RD 11/14/05 PUILPF-tP, OF 5NEEr iInF: n�AWN6Y: �IN� NOMAS SIDE ELEVATIONS i L_ L -----i I � I I Orn i I jos i I ` T O- r -d I far 41.-61 c� - �xv I° I I o I I - I I �nz00 I I 0 x n I I � r ---i I j I cm L__J i I I r i O I - m m 00 I I i L --J I jI • I I 9'-0'X 7'-0' I j OVERHEAD DOOR IL_____________ I __ LtJI 1 'll F �p I UmDuz I 84 - A m I I B X i7 I i I I r_J I � I OVERHEAD, DOOR I I --------------------------------- .31-01 _____________..._.___-____--__-____- 3'->a' 91-8a 9'-8'3,a ' -' M.O. M!V- . 8 24'-ol J LO PVOJF; T %F. 5CA-F: 19ATE: WI LA- IAM 245 MAR5LERIDGE RD 3/16 ° =1'-O° 11/14/05 PULPF-P, OF FINS HOMI�5 sf �tnn�: FOUNDATION PLAN 19PAWN13Y• el -----i I � I I Orn i I jos i I ` T O- r -d I far I I - �xv I° I I - I I �nz00 I I 0 x z I I I � p•i O� I j I cm i I I r i 'll F �p I UmDuz I 84 - A m I I B X i7 I i I I r_J I � I OVERHEAD, DOOR I I --------------------------------- .31-01 _____________..._.___-____--__-____- 3'->a' 91-8a 9'-8'3,a ' -' M.O. M!V- . 8 24'-ol J LO PVOJF; T %F. 5CA-F: 19ATE: WI LA- IAM 245 MAR5LERIDGE RD 3/16 ° =1'-O° 11/14/05 PULPF-P, OF FINS HOMI�5 sf �tnn�: FOUNDATION PLAN 19PAWN13Y• el 30'-0' '-0 3'-0' 5'-0' '-0' 16'-0' i 4'-0' 14'-0' 6'-0' rp,01Ct Mr: 5CALF: PAt : WI I. I, IAM u3AI�->r--r--r-" 245 MARBLERIDGE RD 3/16°=1'-0° 11/14/05 %w flu: PVAWN LN: 13UIL-PF-P,, OF FINF- HOMF-5 FIRST FLOOR PLAN �I i 9f ET: 74 - 5. 7 am 0 mpmmm-_ : I ------I I IL 24'-m" PME: WIL-L-IAM 245. MAR5LERIDGE RI)i 3/1ro"=1'-O" 11/14/05 PLILVF-p OF �IN� HOMC5 I �rrin�: SEGOND FLOOR PLAN I r7�wNr�Y. i WET: W i— 70 --<m-< -+-+ ;" x - X I X X -( D m w-Op_ X� I>- _0 �'•�DAn t11 �r m )>nprn3X)Nr N D C) UO rzcnQ3nm X -� �DOrX3V DU-+ A0i:A z-4cnz�_ ��tb@< D– � : T- G% mac' MAOI. Oin UDO iN nZmND m �0 ��� • �X ���. Prr�0 � -4 -n 0N0��1z _ zbNm3cn c�M(PJA _ z —4 : lo, j Or�z0 I~I z m N N e p. o ° a ni j1 W 4' 6X— r�. _w3 U) c a ' •� O �, n r m -i n (l O m , Ano P1>ul cNlD . r �r : OP In t7m �(P EO �1�'— mE O 7(J Q m D. U3 FnE19 N 3 ' lz N m Cl: -� 0 0 A, m X • N 11 CCl N 0 1 -r O ,ZAj t� ol • I'-I' 10' PFOJE;CT ME: 5CA-F: PAt: 5KFT: WIL—L—IAM 13AI�I���f"�I" 245 MARBLERIDGE RD AS NOTED 11/14/05 13 UPF-p OF FINF- HOMF-5 SEC,TIONs i6 I N \ rT-(,1 X\ 0 .Y. Dv —F O� O i � X17 N n � DO i6 I