HomeMy WebLinkAboutMiscellaneous - 272 BRIDGES LANE 4/30/2018b
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ApriI13,2017
Donald Belanger, Inspector of Buildings
Building Department
Town of North Andover
120 Main Street
North Andover, MA 01845
Re: Permit #262-2017
272 Bridges Lane
North Andover, MA 01845
Linda A Hibbs/Arthur R. Hibbs
Dear Mr. Belanger:
This is a follow up to my email to you on 4/12/17 regarding our pool permit number 262-2017. As you
requested last fall, we are letting you know that we started our project by moving the shed, fencing and will
be digging the pool within the next two weeks.
We have also put the permit on our front window.
Please let us know if there is anything else we need to do.
Regards,
Art & Linda Hibbs
272 Bridges Lane
North Andover, MA 01845
978-686-4521
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Date. � I !� 1 \171--
............
TOWN OF NORTH ANDOVER
X PERMIT FOR GAS INSTALLATION
H(AA- NA2APoex-
This certifies that ...........................................
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has permission for gas installation .........
in the buildings of ..... ... . br�!� .........................
at
FeebD. Lic. No.91"�! ....
Check # 715-M
8195
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Call betw6dp 8:15-9:30a.m. for same day insp4ctioin (781) 286-8196
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
MA DATE PERMIT#
_J
CITY
6-
JOBSITE ADDRESS F OWNERSNAME
& r -j— Az
FAX[:_
G OWNER ADDRESS
TYPE OR M M E RC I AL EDUCATIONAL RESIDENTIAL
PRINT OCCUPANCY TYPE CO PLANS SUBMITTED: YES E] NOE]
CLEARLY NEW: RENOVATION: REPLACEMENT: 03
APPLIANCES -1 1 FLOORS— 2 3 4 5 6 7 8 9 1 10 12 13 14
BOILER
BOOSTER
CONVERSION BURNER
7111
COOK STOVE
DIRECT VENT HEATER
DRYER
r
FIREPLACE
FRYOLATOR
F'
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN . . .......
7
POOL HEATER
ROOM / SPACE HEATER
ROOF TOP UNIT
TEST
UNIT HEATER
UNVENTED ROOM HEATER ..... .....
WATER HEATER
OTHER
INSURANCE COVERAGE
1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES [JNO Ll
I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY L
BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee joes 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 )R AGENT wledge
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 kno
and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision ofthe
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
LICENSE SIGNATURE
PLUMBER-GASFITTER NAME
MP 5?j""M"GF 0 JP E
j JGFEJ LPGIL] CORPORATION LLC
PARTNERSHIP[2
ADDRESS
COMPANY
STATE Ky 7"��TEL
CITY Y�fVJ! Z I PE
0:jr� _0
FAX CELL==EMAIL
L
Date � z— - -
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ........................
has permission to perform . 1 .
plumbing in the buildings of --4.A �4 ...............
at ..... �'i 2, . , Ort Andov M SS.
Fee4-.j'-P . . . Lic. No.1)51 .... MO. ......
PLUMBING; INS TOR
Check #
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM. PLUMBING WORK
CITY &ddey —eA— j MA DATE PERMIT#
JOBSITE ADDRESS OWNER'S NAME 1V
V
POWNER ADDRESS 5aij d TEL L06L] FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL El EDUCATIONALE] RESIDENTIAL Efl—'
PRINT
CLEARLY NEW:E] RENOVATION: 5X4 REPLACEMENT: 0 PLANS SUBMITTED: YESE] NO[]
FIXTURES -1 FLOOR— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
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
A—
INTERCEPTOR (INTERIOR)
KITCHEN SINK .......... . . . . . . . ....
LAVATORY
ROOF DRAIN
...... . ..... .... ........ ......
SHOWER STALL
SERVICE MOP SINK
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .
TOILET
URINAL
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES . .. ... . . . . . . . . . . . .
WATER PIPING ............. A
OTHER
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES F-7r`N-0
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
Q ."
LIABILITY INSURANCE POLICY W", OTHER TYPE OF INDEMNITYEI 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 smignature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER [] AGENTE]
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 compliance with all Pertinent provision ofthe
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME LICENSE # SIGNATURE
MP U4--' ip [I CORPORATIONEJ#[=PARTNERSHIPEj# LLCE1#
COMPANY NAME Ni =1� ADDRESS
CITY STATE ZIP TEL
FAX CELL EMAIL
The Commonwealth ofMassachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibi
Name (Business/Organization/Individual):KNP,,k-, �hcfckj ep— �0 -
Address:
City/State/Zip:�� &wL" , MA 0 1506 Phone#: q1? 0
Are yoyan employer? Check the appropriate box:
1A 9
[9'farn a employer with 4. D I am a eneral contractor and I
employees (full and/or par�-time).* have hired the sub -contractors
2. 0 1 am a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. 0 1 am a homeowner doing all work
myself [No workers' comp.
insurance required.] t
listed on the attached sheet
These sub -contractors have
workers.' comp. insurance.
5. F� We are a corporation and its
officers have exercised their
right of exemption per MGL
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
I �0.0 Electrical repairs or additions
11 - ��I�bing repairs or additi ons
12.n Roof repairs
1311 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 subrfiit a new affidavit indicating such.
lContractors 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 isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site
information.
Insurance Company Name:
s;U'A Avy-�-
Policy # or Self -ins. Lic. #: UJ (, C 50 10 9 40tCo I Z 0 1 _L_ ' _ Expiration Date: 6 -
Job Site Address: ;�"T kU i, 61,frYe City/State/Zip: �,vd6\ieg_ tv% &�14
U
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 under thepains andpenalties ofperjury that the information provided above is true and correct.
rig
IN
_15 -
Official use only. Do not write in this area, to be completed by city or town official
City or Town: PermitfLicense #
Issuing Authority (circle one): I
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
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State Agencies A -Z Topics
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Approved Plumbing Products Online System
By the Division of Professional Licensure
Table. ONLINE PLUMBING PRODUCT.S SYSTEM: SEARCH RESULTS
There are 4 record(s) in our database
Search Criteria: fitting your search criteria. PLease note that
Type: Plumbing if your product is not displayed in the
Manufacturer: Maax Bath Inc. search results, you can refine your search
Product: stamina criteria.
Model: 101141
Description: shower Displaying page 1 of I search resuLts
New Search pages
Requested products per page: 50
PRODUCT, APPROVAL
DESCRIPTION, MANUFACTURER MODEL APPROVED EXPIRES CODE
APPROVAL
CONDITION
Stamina 60
Acrylic shower with Maax Bath Inc. 101141 8f7/2002 8/4/ZO13 P3-0810-60
roofcap
7/L2112 1:20 RM
Mass.Gov
ONUNESERVICF,S
Check a License
Locate a Licensed
Professional
Online Address Change
Contact the Agency
tittp: fificiense.reg.state.ma.u5/pubUc/ PLProducts) pb_search.asp7typ.-- +Bath+ 1"cAmOdel= 10114 1&product=stamina&descripT10n =5howe APsiz— 50 Page I of 2
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101141
Trade
Name:
Stamina 60-1
Shower, 2 -seats Maax Bath Inc.
Stamina
8Y2!2006 8/4/2013 P3-0810-60
60-1
Trade
Model:
101141
101141
Trade
Stamina 60-1
Name:
Shower, seat + Maax Bath Inc.
Stamina 8/2/2006 8/4/2013 P3 -G810-60
footrest
60-1
Trade
Model:
101141
101141
Trade
Name:
Stamina 60-1
Stamfna
Shower, no seat Maax Bath Inc.
60-1 812/2006 8f4/2013 133-0810-60
Trade
Model. -
101141
7/L2112 1:20 RM
Mass.Gov
ONUNESERVICF,S
Check a License
Locate a Licensed
Professional
Online Address Change
Contact the Agency
tittp: fificiense.reg.state.ma.u5/pubUc/ PLProducts) pb_search.asp7typ.-- +Bath+ 1"cAmOdel= 10114 1&product=stamina&descripT10n =5howe APsiz— 50 Page I of 2
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proved Plumbing Products Online System by Massachusetts Board of Registration of Plumbers and Gas Fitters
4 . � 0
7j12/12 1:21PM
WIT,
Division of Professional Licensure
Mass.Gov
State Agencies A -Z Topics
Home ) Division of Professional Licensure ) Board of Registration of Plumbers and Gas Fitters ONLJNE- SERVICES
Check a License
Approved Plumbing Products Online System Locate a Licensed
Professional
By the Division of Professional Licensure Online Address Change
Contact the Agency
Table. ONLINE PLUMBING PRODUCTS SYSTEM: SEARCH RESULTS
There are 2 record(s) in our database
Search Criteria: fitting your search criteria. Please note that
Type: Plumbing if your product is not disp[ayed in the
Manufacturer: Maax Bath Inc. search results, you can refine your search
Product: criteria.
ModeL: 10011751
Description: Displaying page I of I search resuLts
New Search pages
Requested products per page: .50
PRODUCT, APPROVAL
DESCRIPTION, MANUFACTURER MODEL APPROVED EXPIRES
APPROVAL CODE
CONDITION
OPT -10078-)=
3/4' pre -plumbing Maax Bath Inc.
system
10011751-
752
Trade
Name:
OPT- 11/512008
10078 -XXX
Trade
Made(.-
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10078-XXX
8/4/2013 P3-0810-60
OPT -1 0078 -XXX
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system 10011752;
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that
/ ......................
has permission to perform /P'/ ....... ..
wiring in the building of ... .............................
at....".7,7F ..... North Andove Mass.
v
Fee ... Lic. No.
EkeCTRICAL INSPECTOR
Check#
.' 11102
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Ifemononwealdt ol Madsacludstb
Apartmed'olgire Servicj
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Pcnnit No. I / / 0
Occupancy and Fee Checked
[Rev. 1/07) (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLEA SE PRINT IN INK OR TYPE, A LL INFORMA TION) Date: 4/)7/"
Cityorl'ownofi -LV
6r1A A,,d,,,, To the Inspectoi of Wires:
By (his application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number) 171 13,Ld
ks to
Owner or Tenant - �-IQW!2 F;mn Telephone No.60 . �1-377- log
Owner's Address -'2 7 2 arlAcc All -(".Ip AIA -151r(C/C 7
Is this permit In conjunction with a building permit? Ves 'NOE] (Check Appropriate Box)
Purpose of Building PV �0 /It 1� Utility Authorization No.
Existing Service Amps Volts Overhead 0 Undgrd El No. of Meters
NM Servieg Amps Volts OverheadEl Undgrd [:1 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: R66C
f9tvat 7cff Y,,p1-QC 4-ie4
No. of Recessed Luminaires
No. of Cell.-Susp. (Paddle) Fans
"Cr W"Im" YY tau I 'c','r9j Wires.
NO. oY7 igo-;af
Transformers KVA
No. of Lundualre Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above-
arad. :0 =r;d.
INO. of r1me My-fiffn
Rt,,,y Uurgency 9 9
Its
No. of Receptacle Outlets
No. of Oil Burners
_ - �
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
No� -oflTe—tcellon and
Iniflatinit Devices
No. of Ranges
No. of Air Cond. Total
Torts
No. of Alerting Devices
No. of Waste Disposers
IKW
............ . . .....
01 beff.uontallu
No.---- - ed
Detection/Alertim! Devices
No. of Dishwashers
Space/Arcit Heating KW
Municips
Local Ll Connection El Other
No. of Dryers
No. of Water
Heaters KW
Heating Appliances KW
N 0.- -of No. of
Signs Ballasts
Security -
Nn- al uIvalent
Data Wiring:
No. of Devices or Equivalent
No. Ilydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
of Devices or Equivnient
-No.
OTIIER:
Ana addifionai detait ydesired, or els jequiredby the Inspector of 111res.
Estimated Value of Electrical Work: 2,0011 (When required by municipal policy.)
Work to Slatt:A- A, Insp ections to be requested in accordance with MEC Rule 10. and upon completion.
INSURANCE COVERAGE: Unless waived by the owner. 'to I)cf-Ink for (lie performance of electrical work inny issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of sanic to the pennit issuing office.
('111.iCKONE: INSURANCE D4 BOND r 011-1 ERE] (Specify:)
I certify, under the patios and penalties ofperjury, that the information on this applicatioll is trite and eonoplete.
FIRM NAME: LIC.NO.:a05jlA
Licensee: -&&�
J&k Signature IAC.N0.:Q1e'7TR,
(1fapplicable, enter "exenipt " in t1se ficense number lined --7114
Address-.- 211 8j,hLfAif% % A, . Is. Tel. No., — U517M-05
I)r VL;l(Ak�nAZ (AVI& -tdcmw -7 t. Tel. No.:-6j9-&M-(3VS-
*Per M.G.L. c. 147, s. 57-6 1, security Ark requires Department o ublic Safety "S" License: Lie. No.
OWNER'S INSURANCE WAIVER: I ani aware (hat (lie Licensee does not have the liability instifflUce coverage nonnally
required by law. By rny signature below, I hereby waive this requirement. I arn the (check one) El owner [-] ownces agent.
Owner/Agent
Signature Telephone PERMIT r,,Cr,: S
Murphy, Peter 0 1 -&
From:
Sent:
To:
Cc:
Subject:
To whom it may concern,
Matt Markham [mmarkham@solarcity.com]
Thursday, October 18, 2012 8:24 AM
Murphy, Peter
Nolan Richardson
Electrical permit arnmendment
1, Matthew Markham, have recently moved from my position as an install crew leader to a new position as a project
nianager. I will no longer be the electrician on site installing solar PV arrays. Please remove my name for the electrical
permit for Finn, Shawn of 272 Bridges Lane, and any other electrical permits that have been pulled in my name, as it will
be necessary for a different crew leader to perform the installs at each residence.
Thank you, Matt
Matt Markham I Project Manager I SolarCity I T:774-258-8505 I mmarkham(@solarcity.com I www.solarcity.com
Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more
information please refer to: hftl)://www.sec.state.ma.us/i)re/preidx.htm.
Please consider the environment before printing this email.
1
41' �'� )/
Date. .
TOWN OF NORTH ANDOVER
PERMIT FOR PLUOBING
zd�
This certifies that ... (3, F,. . lv,.�-. n ..................
has permission to perform .... R �n ^.,I �' �-+. -�"A ................
plumbing in the buildings of .... Y1. ......................
................ , North Andover, Mass.
at .... 4 X. -
Fee j Lic. No..(�. 3.1. .. ....... ........
�,LUIVIBING INSPECTOR
Check #
7708
!;I-lw
FIXTURES
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING ?
City/Town: N Oc-)C�DWC _,MA. Date: !J��9\bg Permit# :2,?,Q
Building Location: Owners Name: P�Y-s �\,o-r yA
'j
Type of Occupancy: Commercial r-1 EducationaIE] Industrial F1 InstitutionalE] Residential
New: Alteration:E] Renovation: Replacement: Plans Submitted: Yes F] NoE]
FIXTURES
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Check One Only Certificate #
Installing Company Name: B.F. Murphy Plumbi ng & Heating Inc.
ER Corporation 2903C
Address: 72 Holten Street City/Town: Danvers state: MA
El Partnership
Business Tel: 978-774-3174 Fax: 978-774-8709
El Firm/Company
Name of Licensed Plumber: Brian F. Murphy
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes El No El
If you have checked Yes,, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy [:] Other type of indemnity [I Bond 0
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 El Agent
Sionature of Owner or Owneft Aaent
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 compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License: amaTLL� 22QYJ-��
Title El Plumber Signature of Licensed Plumber V
Cityrrown ER Master License Number: 9325
APPROVED (OFFICE USE ONLY) Eliourneyman I
Date..i�z- ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
Thiscertifies that ..... ........ �:n .......................................................
has permission to perform .......... ...................................................................
wiring in the building of ........... ............................
74x-�-
,2 1:
at ......... ;7.2- ...... ;;e ......... . North Andover, Mass.
...................
Fee—.k-'�' .............. ic. ............
LE
Check #
0mcial Use 0 ly
Flpennit No
occup Cy
.3"VIC'" !� and Fee Checked 35
occupancy
REGULATIONS cv. IN I I leave
SOARD OF FIRE 9REVENTION. EU.CTRICALwoRK
N% - '2*'w
Code ( '27
PERFORM IE ' 12.00
- kTION FOR PERM11 "Elcmicwd '
e with the Muwhu'aft
APPLICAf work to be Vedortned in accOrdanc Datet ct r o Wires:
7 ALL INFORMATION To the,,:Ins 8 0 . W r�k e_sc�ribc-d below -
SE.pRINT IN INK Olt TYPE 1111p/ All 41) left. 0
, 11 , � 11", dormm the electrical
(PLEA verforrm t*he
City or Town ofi.
ac undersigned es notice of hi or her ii-tentiOn to
By this application t] umber) O� Telephone No. i2E�111`
Location (street & N
owner-orTenant No (Check Appropriate Bo%)
Owuergs Address Yes a No.
Conjunction with a building permit? utility Autholrindo
Is this permit 'n 14 d 0 No. of Meters
purpose of -BAding Overhead 0 Undgr
volts 0 Uudgrd 0 No
of meters
Existing Service — Amps Volts Overhead
Amps
N_ew Service ---- . 7 . .....
Number of Feeders audAmPaclty
sed Electrical Work' ectol aLm"es.,
Location and Nature of Propo taQL
_rAA. rallowift table may be waived b the 1�
0
the licensee gravid P— ov Kis tin orce, an is true d contplefe.
gned appikation
,ertifies that such C, ovER 0 (Specify'
undeni BOND 0 the inforntatio" 0" LIC. NO-'-
C1,ECy
ONE,. INSURANCE nald4z ofperjury, tha I t
r the p ins a I LIC NO'
1 cerdfY, unde e_ Signatu e Bus--ret.-�O.-.E_
FIRM NAME -
kit. Tel. No
Ce ge n m r ine.) NO -
Licensee' U.Mpt, in t i 11�
ublic Safet!y,,S License'- a.crage nortrially
licable. enter t'V insurance
(if app 47,- AJO X Departine- sa c
Add - i sec Liccnsce does not have the liabili xner 0 owner
reSS' nt. I arn the (check on�) 0
*Per tA.G.L. c. 141, S. 57-61, ER: I arn aware that the me
OwNiR'S INSU . NCEW-k I hereby waive this require pERMIT FEE: S
required by law my signature below, T elephone NO-
ownerjAgent
Signature
No. of CeIL-SusP- (piddle) Vans 'Transi4ji &B.- - kcVA
No. of Recessed Luminaires
Generators
No. of yAot Tubs 0 In gency ng
No. of Lum'n aire Outlets
e 0 A- 0 Boitte Units
swimming Pool FIRE ALARMS NO. Of zones
0. Of Luminaires
No. of oil Burners 0.0 on an
n De ces
No. of Receptacle 0"I"'
No. of Gas Burners of Alerting Devices
0 No. I
No. of Switches
No. of Aar Coud- Tons 0.0 on e
ons OViAlertin D c'"
No. of Ranges
mp um r Doe
LocalC uu C] Odw
I Ot . i Conneca a
No. of Waste Disposers
S cejArej Heating ecunty stems. uivalent
. evices or E
No. of Dishwashers
Heating Appliances KW No. of
Da iring' E ulvalent
No. of Dryers
0.0 I NO. of Devices Or
0.0 Ballasts Ons
e ecommunica uivs eat
E
0.0 ater KW
Beaters
Si ns
T tal HP No. of Devices Or
No. Hy*dromussage Bathtubs
No. of NlOtors
$ "I'll" - r aws required by 1 e Inspector of W"Ires-
detail if desirW
OTHER.
lach addi,717nat
'y ,Micipal policy.)
(When required t 10 .. d upon colnPletion' -
Rule - ss
unill
with MEC
W IV 'r cler issue
or trical work MW
tnc iested in Wcordmce arse al
-nit flir 'Qc Pcd0r"' substantial covalent. The
Estimated Value 6 �y - — tions to be req%
work to start`-�
W,,l' GE.
Uac. waived by the Owner' no pen coverage or its ffice.
li4ng0completed operation gemit issuing 0
to the
, C
INSURANCE f nf liability
-a inc f Of Sam
I 1__1 . .. eWbited PrOO
the licensee gravid P— ov Kis tin orce, an is true d contplefe.
gned appikation
,ertifies that such C, ovER 0 (Specify'
undeni BOND 0 the inforntatio" 0" LIC. NO-'-
C1,ECy
ONE,. INSURANCE nald4z ofperjury, tha I t
r the p ins a I LIC NO'
1 cerdfY, unde e_ Signatu e Bus--ret.-�O.-.E_
FIRM NAME -
kit. Tel. No
Ce ge n m r ine.) NO -
Licensee' U.Mpt, in t i 11�
ublic Safet!y,,S License'- a.crage nortrially
licable. enter t'V insurance
(if app 47,- AJO X Departine- sa c
Add - i sec Liccnsce does not have the liabili xner 0 owner
reSS' nt. I arn the (check on�) 0
*Per tA.G.L. c. 141, S. 57-61, ER: I arn aware that the me
OwNiR'S INSU . NCEW-k I hereby waive this require pERMIT FEE: S
required by law my signature below, T elephone NO-
ownerjAgent
Signature
/") - "9 1 , �) � V
Date ......................
TOWN OF NORTH ANDOVER
r 41
PERMIT FOR GAS INSTALLATION
..........
.............
This certifies that g ................
................
has permission for gas installation ...........................
in the buildings of ...............................
el
at c2 .................. 1��
...... North Andover, Mass.
7
FeeAr--`-5—'—. Lic.
GASINSP�5jOA
Check # R3c;v
I
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
North Andover Mass.
City, Town
Building
AT: Location 272 Bridges Lane
New Renovation F]
Plans Submitted Yes 11 No Z
Date: 10/9/2009
Permit#
Owner's
Name Linda & Arthur Hibbs
Type of Occupancy: residential
Replacement 1:1
(Print or Type)
Check One: Certificate
Installing Company Name: E. Osterman Propane, Inc. X Corp. 042553302
Address 22 Legate Hill Road El Partnership
Sterling, MA 01564 0 Firn-i/Company
Business Telephone 978-422-0204 Name of Licensed Plumber or Gasfitter
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 installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and
Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
SigmtmeofOwncr/Agent
I have a current liability insurance policy to include completed operations coverage.
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
G F 1,0'/8 7 L F
TYPE LICENSE:
Signature of Licensed
El Plumber Plumber or Gasfitter
LN Gasfitter
El Master
K t i Aff Jf AKI 0
(Print or Type)
Check One: Certificate
Installing Company Name: E. Osterman Propane, Inc. X Corp. 042553302
Address 22 Legate Hill Road El Partnership
Sterling, MA 01564 0 Firn-i/Company
Business Telephone 978-422-0204 Name of Licensed Plumber or Gasfitter
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 installations performed under Permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and
Chapter 142 of the General Laws.
I have informed the owner or his agent that I do not have liability insurance including completed operations coverage.
SigmtmeofOwncr/Agent
I have a current liability insurance policy to include completed operations coverage.
By
Title
City/Town
APPROVED (OFFICE USE ONLY)
G F 1,0'/8 7 L F
TYPE LICENSE:
Signature of Licensed
El Plumber Plumber or Gasfitter
LN Gasfitter
El Master
404 tORT11
0
0
0
cc%
L I
COCNIC —en,
PLANNING DEPARTMENT
Community Development Division
1600 Osgood Street
North Andover, Massachusetts, 01845
272 Bridges Lane & 5 Christian Way
North Andover, MA 0 1845
February 16, 2011
RE: ANR — "Plan of Land, Located in North Andover, record owners and applicants Hibbs
Nominee Trust, 272 Bridges Lane, North Andover, MA, and Michael A. Dunn &
Robin Pustizzi, 5 Christian Way, North Andover, MA, dated January 11, 2011 ",
prepared by Christiansen & Sergi, Inc, 160 Summer St., Haverhill, MA, 01830.
Plan of Land Being a Subdivision of Lots 57 & 60, as shown on Plans 36903 N & P,
located in North Andover, MA, prepared for Hibbs Nominee Trust and Michael A.
Dunn & Robin Pustizzi, dated January 11, 2011 ", prepared by Christiansen & Sergi,
Inc, 160 Summer St., Haverhill, MA, 01830.
Dear Mr. Hibbs & Mr. Dunn:
As you are aware, the Planning Department received a Form A Plan and a Registered Plan of
Land on January 27, 2011, proposing the revision of lot lines as shown on the plans described
above. The plan has been reviewed and endorsed, based on the following facts:
1 . Both lots on both plans have the required frontage (175 ft.) on a public way (Christian
Way Street) for the Residential I district. The square footage of each lot has not changed
(Lot 143 -1, 57,078 S.F. and Lot 122-1, 51,4 10 S.F.)
2. The endorsement of the plan is not a determination as to the conformance of the new lots
with the Town of North Andover's Zoning Bylaw and Regulations.
If you have any questions, please feel free to contact me.
Sincerel
udyy lymon., AICP
Town Planner
cc: Building Inspector Conservation Administrator
Assessor's Office Town Clerk
Date ..... k'F—eq
................ V ......
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ......... 8 ......
has permission to perform .....
wiring in the building of ............ ...............................................
at ........ 2.-74-121N)5� .... ............ North Andover, Mass.
........ .............. . .......
Fee..��. Lic. No./-� .... 5. 71V ....... ..
Check ELEMICAL IwEcf&
8 8 b Q"
(flmmonwea& ol MaMac"tb Official Use Only
Permit No. e -70 6
�7L
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS I FRev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NE9, 52WMR 12.00
(PLEASE PRJNT IN INK OR TYPE ALL INFORA14 TION) Date:
City or Town of. &i ok.)-eA To the' Inspector of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street & Number)—,,? 9 2 -C.5 e -
Owner or Tenant M x Z6 h Telephone No.
Owner's Address
F_711_�
Is this Dermit in conjunction with a building permit? Yes LIA No (Check Appropriate Box)
Purpose of Building L) &/ e ///'-1.9 Utility Authorization No.
Existing Service a 00 Amps Ila / o;o� Volts Overhead [�J� UndgrdF�
No. of Meters
New Service — Amps Volts Overhead Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: A er
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Above ED In- o
Swimming Pool grnd. grnd.
No. ot Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
Eo. 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 Pu p
Totamis:
J.N!�!p4er].TRns
J.KW
No. of Se If -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local Ei Municipal EJ Other
Connection
No. of Dryers
Heating Appliances KW
Security Svstems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
f No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
lNo. of Motors Total HP
Telecommunications Wir!'ng:
No. of Devices or Equivalent
OTHER: rl) e --e,'1,;1_9
Attach additional detail ifdesired. or as required by the Inspector of Wires.
Estimated V a.lue of Yec%kal Work: &.70, (When required by municipal policy.)
Work to Start: inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE CbVgRA�GE: Unless waived by the owner, no perivit 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 coverage . s in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ;�= 0 OTHER 0 (Specify:)
I certify, under lite p ins an penalties o jury, that lite information on this application is true and complete -
I _ 1pej ,
FIRM NAME: ve Z7it_ _XX LIC. NO.: ,�I/
Licensee: 2�1 1 �141 Signature LIC. NO.:
(If applicable, enter "exempt" in th F -Ticense lumber line, ') — Bus.117el. No.:���-6
6,2 )r -;e Alt. Tel. No. ff_oKf:-,:5J,9f
Address:
*Per M.G.L. c. 147, s. 57-61, secufity work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) [] owner 11 owner's ��t
Owner/Agent
Signature Telephone No. T FEE: $
4
INortheast John W. Mroszczyk, PhD, PE, CSP
Consulting
Engineers, Inc.
Consulting *Engineering *Design
June 11, 2009
Mr. Brian Murphy
Brown's Kitchen & Bath
72 Holten Street
Danvers, MA 01923
RE: 272 Bridges Lane, North Andover
Mr. Murphy:
At your request I have evaluated the I 3/4x 9 1/2 -2 ply LVL header over the triple mull window at
272 Bridge Lane in North Andover. The dwelling is a two story colonial. I used the Seventh Edition,
Massachusetts Building Code for One and Two -Family Dwellings (780 CMR).
Design Loads
Snow Load: 55 psf (780 CMR Table 5301.01.2(5))
Dead Loads: 2d Floor 14 psf
2nd Floor Ext. Wall 12 psf
Attic 10 psf
Roof 15 psf
Live Loads: 2d Floor 40 psf (780 CMR Table 5301.5)
Attic 20 psf (780 CMR Table 5301.5)
Design Values
Deflection: L/240 =.37" for 7'-5" span (780 CMR Table 5301.7)
Allowable Shear: 6318 lbs. (Versa -Lam Design Data)
Allowable Moment: 13958 ft -lb (Versa -Lam Design Data)
Calculated Loads On Header
Dead
91 lbs/ft
96 lbs/ft
65 lbs/ft
270 lbs/ft
522 lbs/ft
Engineering Solutions to Complex Problems
74 Holten Street * Danvers, MA 01923 * Phone 978/777-8339 9 978/750-8839 e Fax 978/777-6380 e email: nce3@verizon.net
Live/Snow
2nd Floor
260 lbs/ft
fd Floor Ext. Wall
-
Attic
130 lbs/ft
Roof
715 lbs/ft
Total
1105 lbs/ft
Total Live/Snow/Dead 1627 lbs/ft
End Shear 6019 pounds OK
Moment: 11,134 ft -lbs. OK
Deflection Under Combined Live/Snow/Dead Loads: .219" OK
Defection Under Live Loads: .148" OK
Dead
91 lbs/ft
96 lbs/ft
65 lbs/ft
270 lbs/ft
522 lbs/ft
Engineering Solutions to Complex Problems
74 Holten Street * Danvers, MA 01923 * Phone 978/777-8339 9 978/750-8839 e Fax 978/777-6380 e email: nce3@verizon.net
The I % x 9 1/2 -2 ply LVL header is adequate for the proposed application. The 1/2" carriage bolts,
staggered every 12 inches are appropriate connections. The same beam used over the 6'-3" opening
would likewise be adequate since the span is less.
Please call if any questions.
2
Da
4" TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... ...........
has permission to perform .....................
plumbing in the buildings of
...........................
a t .................... North Andover, Mass.
Fee.'.�.... Lic. No .... .....
P WING INSPECTOR
Check #
41N
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: OtrNcUeA***' MA. Date: 51-1-11bq Permit# '0A
Building Location: Owners Name: 4��.bs
Type of Occupancy: Commercial E] Educational E] Industrial Institutional Residential
New: r-1 Alteration: F] Renovation: Replacement: Plans Submitted: Yes F] No
IZIYTI IRFA
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes g No E]
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 14 Other type of indemnity E] Bond []
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Siqnature of Owner or Owner's Aaent Owner F1 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 mv
Knowledge and tnat all Plumbing work and installations performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
T&aturelof Cicenseef-PI me
Title Plumber u
City/Town Master
[]journeyman License Number: 9325
APPROVED (OFFICE USE ONLY) I I L r-� 6 647
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BASEMENT
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2 NuFLOOR
3 R" FLOOR
4'm FLOOR
5TR-F—LOOR
-Y'r—FLOOR
7"' FLOOR
8' FLOOR
Installing Company Name:
B.F. Murphy Plumbi ng & Heating
Inc.
Check One Only Certificate #
Z Corporation 2903C
AdIdress: 72 Holten Street
City/Town:
Danvers
state:
MA
0 Partnership
Business Tel:
978-774-3174
Fax:
978-774-8709
t
[I Firm/Company
Name of Licensed Plumber:
Brian F. Murphy
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes g No E]
If you have checked Yes, please indicate the type of coverage by checking the appropriate box below.
A liability insurance policy 14 Other type of indemnity E] Bond []
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Siqnature of Owner or Owner's Aaent Owner F1 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 mv
Knowledge and tnat all Plumbing work and installations performed under the permit issued for this application will be in compliance with all
Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
By Type of License:
T&aturelof Cicenseef-PI me
Title Plumber u
City/Town Master
[]journeyman License Number: 9325
APPROVED (OFFICE USE ONLY) I I L r-� 6 647
Date . . ......... )
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... 1'. jx�. 4,11 ....................
has permission to perform ... )I.(.- A,.O.V' ...............
plumbing in the buildings of 4j*.�.i— ........................
at. . .......... , North Andover, Mass.
Fee ... Y;?. —Lic. No..6.�! J.'. . ...........
PLUMBI N G14SPECTOR
Check#
7513
B. F. Murphy Plbg. & Htg. Inc
11
V
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Print or Type)
Q Mmm. Dot*9/,;g -'e� Permlt'6_7
Building Location c::I� 7e� 6/!Ak�, owners Name 4),
U
Map: Lot- - Zone: Type of Occupancy
Now LI Renovation Replacement 13 Plans Submitted: Y., Ur No LI
FIXTURES
Installing Company Name B.F. Murphy Plumbing & Heating Inc. Check one: Certificate
Address 72 Holten St Danvers, MA. 01923 U Corporation
Estimate Value of Work: L3 Partnership
Business Telephone 978-774-3174 Ll Firm / Co.
Name of Licensed Plumber or Gas F1 nor Brian F. Murphy
INSURANCE COVERAGE:
I have a cur llity Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142.
YOSVO NO 0
If you have chocked m, please Indicate the type coverage by checking the appropriate box.
A liability Insurance policy Ul/ �Othsr "a of Indemnity, U Bond 0
OWNER'S INSURANCE WAIVER: I am aware that the.licensee does not havq the Insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirerrient.
Check one:
Owner Q AgentU
of Owner or Owners Agent
I hereby cer* that all of the details and information I have submitted (or entered) In above application are true and accurate to the bestof
my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with
all perfinentprovWons of the Massachusetts State Plumbin Code and Chapter 142ol the General Laws.
By M"'
Tille SI rnatuieof Ljoienged Plumber
TypeofUcense: Master Journeyman Q
City / Town
]APPROVED (OFFICE USE ONLY) _j License Number 9325
RWsod 5/27192
. 6 1 1 el -I
0RT#j o
6 noil
Date ....
TOWN OF NORTH ANDOVER
VOW
PERMIT FOR GAS INSTALLATION
This certifies that ... P4-10?�elr: A5 ............
has permission for gas installati n . . I 6w-',*1Pj
in the buildings of .. ..... .....
at ..... ZZ? . North Andover, Mass.
Fee. Sg��9�� Lic. No.. 82-71
GASINSPECTOR
Check #
8252
Date. k ......
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
SACHU
This certifies that ......... .....................
.... ..... .
has permission for gas installation
in the buildings of ... ...............................
at .... 00 North Andover, Mass.
Fee.30:7... Lic. No.11'i... HA ....................
Check GAS INSPECTOR
8250 See
MASSACHUSETrS UNIFORM APPLICATON FOR PERMFr TO DO GAS FTrnNG
(Type or print) Date
NORTH ANDOVER, MASSACHUSETTS
11 - i - vy
Building Locations
Permit #
"ount o
Owner's Name 9)44n ri rl
New Renovation Replacement El Plans Submitted
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes E] No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy M Other type of indemnity Bond
L2J 0 1:1
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. Ge La s, an �tht
,rignatur on this permit application waives this requirement.
=9-4011 2 Check one:
i34 — 0
Signature of Owner or 6Kner's Agervr 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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
(OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
O�ember �d )� 9
Gas, Fitter License Number
ri Master
M Journeyman
& i 2,5-L
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SU B -BA SE MEN T
B A S E M E N T
IST. F L 0 0 R
2ND. F L 0 0 R
3RD. F L 0 0 R
4 T H F L 0 0 R
5 T H F L 0 0 R
6 T H F L 0 0 R
7TH. FLOOR
8 T H . F L 0 0 R
Name of Licensed Plumber or Gas Fitter
Check one: Certificate Installing Company
Corp.
Partner.
Firm/Co
INSURANCE COVERAGE Check one:
I have a current liability Insurance policy or it's substantial equivalent. Yes E] No
If you have checked yes, please indicate the type coverage by checking the appropriate box.
Liability insurance policy M Other type of indemnity Bond
L2J 0 1:1
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. Ge La s, an �tht
,rignatur on this permit application waives this requirement.
=9-4011 2 Check one:
i34 — 0
Signature of Owner or 6Kner's Agervr 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 installations performed under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws.
By:
Title
City/Town
(OFFICE USE ONLY)
Signature of Licensed Plumber Or Gas Fitter
O�ember �d )� 9
Gas, Fitter License Number
ri Master
M Journeyman
& i 2,5-L
�4-
Ct-6 re fr^A
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
wwwmass.govIdia
koo�v� -
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ninfirant Information Please Print Leaibl:
Name (Business/Orgaiiizatioti/individual)
Address:
city/s
I /�qvi 0 03PI
Phone #: k3 -9?S- M&
Are you an employer? Check the appropriate box:
00
4. [] I am a general contractor and I
1. 1 am a employer with
employees (full and/or part-time).*
have hired the sub -contractors
2. 1 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.14
5. E] We are a corporation and its
required.]
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. E] New construction
7. g] Remodeling
8. E] Demolition
9. Building addition
10. Electrical repairs or additions
11.0 Plumbing repairs or additions
12.[:] Roof repairs
13.0 Other -----
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the su b -con tractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurancefor my employees. Below is lite policy andjob site
information.
insurance Company Name:
r/uv,
V -
Policy H or Self -ins. Lic. #: V( 0 L) 3 Expiration Date:__0//0/VP
Job Site Address: vq 61idw5 City/State/Zip:_ gw baU5'
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 under the pains andpenallies ofperjury that the information provided above is true and correct.
�, /J-, / /)
4zianntiire- Pal aw� Date:
&03) W-Ziwl
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 N:
5 6 Date
'40RT" TOWN OF NORTH ANDOVER
PERMIT FOR MECHANICAL INSTALLATION
This certifies that � ( -T� 0
..................
has permission for mechanical installation . J:�V
.. .............
in the buildings of ... A f�Z .....................
at .... North Andover, Mass.
Fee Lic. No.. . . . . . . . . . . . . . . . . . . . . . . .
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. . PINK: Treasurer
-t
I
Commonwealth of Massachusetts
Date:
Estimated Job �Ost:
Plans Submitted: YES NO
Business License # /,/ J� I"
Business Information:
Name:
Street:
City/Town
Telephone:
Sheet Metal Permit
Permit #
Permit Fee: $
Plans Reviewed: YES NO
Applicant License #
Property Owner / Job Location Information:
Name:
Street:
City/Townfif,
A�L
Telephone:
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Staff Initial
restricted license
J-2 / M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. / 2 -stories or less
Residential: 1-2 family _q_ Multi -family
Commercial: Office
Retail
- Condo / Townhouses Other
Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. J over 10,000 sq. ft. Number of Stories:
Sheet metal to be completed: New Work: ve) Renovation:
HVACW2 Metal Watershed Roofing _ Kitchen Exhaust System
Metal Chimney / Vents jz Air Balancing _
I
Jon Rickards
From: 11paul valente" <pfval186@hotmail.com>
Date: Wednesday, July 11, 2012 7:36 PM
To: 'John desired temp" <jon@desiredtemperature.com>
Attach: desired temp n andover bill penny.pdf
Subject: manual j finn n andover
60,000 btu furnace with 3 ton a/c
Best Regards Paul Valente Outside Sales / Geothermal Representative
API of NH 603-231-1383
Paul F. Valente
Page I of I
7/12/2012
Load Short Form Job:
API of NH Date:
AM By:
Duct Design Desired Temp
Dracut, Ma
0
For: ce, Desired Temp
272 Bridge Lane, North Andover, Ma
Rig Cig Infiltration
Outside db (OF) -1 94 Method Simplified
Inside clb (cF) 70 75 Construction quality Tight
Design TD (cF) 71 19 Fireplaces 2 (Tight)
Daily range - M
Inside humidity 30 50
Moisture difference (gr/lb) 29 47
HEATING EQUIPMENT
Make Rheem
Trade RHEEM, RUUD, WEATHERKING
Model RGRS-06EMAES
AHRI ref no.4356231
Efficiency
Heating input
Heating output
Temperature rise
Actual air flow
Air flow factor
Static pressure
Space thermostat
92.5AFUE
11.0 EER, 13 SEER
60000
Btuh
56000
Btuh
41
OF
1247
cfm
0.031
cfm/Btuh
0
in H20
COOLING EQUIPMENT
Make Rheem
Trade AIRSTAR, TFC, MERIDIAN
Cond RANL-037JEZ
Coil ASL*3618A28G++D+V
AHRI ref no.4350706
Efficiency
11.0 EER, 13 SEER
Htg load
Sensible cooling
26180
Btuh
Latent cooling
11220
Btuh
Total cooling
37400
Btuh
Actual air flow
1247
cfm
Air flow factor
0.047
cfm/Btuh
Static pressure
0
in H20
Load sensible heat ratio 0.94
475
ROOM NAME
Area
Htg load
CIg load
Htg AVF
Cig AVF
(ft2)
(Btuh)
(Btuh)
(cfm)
(cfm)
zone 1
1342
24546
18003
771
852
zone 2
1107
15124
9591
475
454
AH1
2449
39670
26353
1247
1247
Other equip loads
0
0
Equip. @ 0.99 RSM
26089
Latent cooling
1628
TOTAI.q
IWAO
137710
10A
-d 11A -7
-1 V �1 I lu I C --f I IC -+j
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2012 -Jul -11 19:33:03
+ wrightsoW Right-SufteO Universal 8.0.24 RSU11815 Page I
... RDocuments\DESI RED TEMP\desired ternp n andover bill penny. rup Calc=MJ8 faces: N
zone 1
1342
24546
18003
771
852
Other equip loads
0
0
Equip. @ 0.99 RSM
17823
Latent cooling
356
T()TA I _Q
iWf)
13ArAr-
1010A
774
COCO
I U. %ju III V.Jr-
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
+ wrightSofto Right-SuReS Universal 8.0.24 RSU11815
... I\Documents\DESIRED TEMP\desired temp n andover bill penny.rup Calc = MJS faces: N
2012-Jui-11 19:33:03
Page 3
Load Short Form Job:
API of NH Date:
zone 2 By:
Duct Design- Desired Temp
Dracut, Ma
For: Finn Residernce, Desired Temp
272 Bridge Lane, North Andover, Ma
HEATING EQUIPMENT
Make n/a
Trade n/a
Model n/a
AHRI ref no.n/a
Efficiency
n/a
Htg load
Heating input
0
Btuh
Heating output
0
Btuh
Temperature rise
0
cF
Actual air flow
0
cfm
Air flow factor
0
cfm/Btuh
Static pressure
0
in H20
Space thermostat
n/a
84
COOLING EQUIPMENT
Make n/a
Trade n/a
Cond n/a
Coil n/a
AHRI ref no.n/a
Efficiency
n/a
Htg load
Sensible cooling
0
Btuh
Latent cooling
0
Btuh
Total cooling
0
Btuh
Actual air flow
0
cfm
Air flow factor
0
cfm/Btuh
Static pressure
0
in H20
Load sensible heat ratio
0
84
ROOM NAME
Area
Htg load
Clg load
Htg AVF
Cig AVF
(ft2)
(Btuh)
(Btuh)
(Cfm)
(cfm)
bonus rm
366
4651
2464
146
117
mstr bath
133
2691
1775
85
84
mstr bdrm
318
4287
3513
135
166
stair 2
128
289
219
9
10
study 2
96
2449
1362
77
64
wic
66
756
259
24
12
zone 2
1107
15124
9591
475
454
Other equip loads
0
0
Equip. @ 0.99 RSM
9495
Latent cooling
1272
Tr)TA I 4Z
11n7
I r,1 13A
I n -M-7
A -7r-
ACA
Calculations approved by ACCA to meet ail requirements of Manual J 8th Ed.
+ wrightsoft, Right-SuiteD Universal 8.0.24 RSU11815 2012 -Jul -11 19:33:03
Page 4
... RDocuments\DESIRED TEMP\desired ternp n andover bill penny.rup Cale = MJ8 faces: N
Building Analysis Job:
API of NH Date:
AM By:
Duct Design Desired Ternp
Dracut, Ma
For: Finn Residerrice, Desired Temp
272 Bridge Lane, North Andover, Ma
Component
W
Btuh
% of load
Walls
Location:
11006
Indoor:
Heating
Cooling
Lawrence Muni, MA, US
18.2
Indoor temperature (T)
70
75
Elevation: 151 ft
Ceilings
Design TD (IF
71
19
Latitude: 43 cN
2.7
Relative humily
30
50
Outdoor: Heating
Cooling
Moisture difference (gr/lb)
28.6
46.7
Dry bulb (OF) -1
94
Infiltration:
0
Daily range cF) -
18 (M
Method
Simplified
0
-
77
Construction quality
Ti ht
Adjustments
Wind speed (mph) 15.0
7.5
Fireplaces
2'?Tight)
Component
Btuh/ft2
Btuh
% of load
Walls
4.6
11006
27.7
Glazing
33.2
7223
18.2
Doors
18.4
385
1.0
Ceilings
8.4
15546
39.2
Floors
2.7
1434
3.6
Infiltration
1.5
4076
10.3
Ducts
0
0
Piping
0
0
Humidification
0
0
Ventilation
0
0
Adjustments
0
Total
39670
100.0
Component
Btuh/ft2
Btuh
% of load
Walls
1.3
3141
11.9
Glazing
36.3
7911
30.0
Doors
8.2
171
0.6
Ceilings
6.5
12078
45.8
Floors
0.7
386
1.5
Infiltration
0.2
546
2.1
Ducts
0
0
Ventilation
0
0
Internal gains
2120
8.0
Blower
0
0
Adjustments
0
Total
26353
100.0
Latent Cooling Load = 1628 Btuh
Overall U -value = 0.101 Btuh/ft2-cF
Data entries checked.
We, Internal Gains
/Infiftr.
Ceilings
Other
+ wrightsoft, 2012 -Jul -11 19:33:03
Right -Suite@ Universal 8.0.24 RSU11815 Page I
... I\Documents\DESIRED TEMP\desired ternp n andover bill penny.rup Calc = MA faces: N
1 BUilding Analysis Job:
API of NH Date:
zone By:
Duct Design . Desired Ternp
Dracut, Ma
For: Finn Residerrice, Desired Temp
272 Bridge Lane, North Andover, Ma
NOWL 1-7 1 ;t 1,1111, _0 Jili"'
Component
Btuh1ft2
Btuh
E"
R,
Walls
F
Location:
19.0
Glazing
Indoor:
Heating
Cooling
Lawrence Muni, MA, US
18.4
385
Indoor temperature (99
70
75
Elevation: 151 ft
53.1
Floors
Desiqn TD (cF
71
19
Latitude: 43 cN
1.5
1753
Relative humily
30
50
Outdoor:
Heating
Cooling
Moisture difference (gr/lb)
28.6
46.7
Dry bulb (cF)
-1
94
Infiltration:
Ventilation
Daily range �OF)
-
18 (M
Method
Simplified
Wet bulb (cF
Wind speed (mph)
115.0
77
7.5
Construction quality
Fireplaces
Ti ht
2 ?Tight)
NOWL 1-7 1 ;t 1,1111, _0 Jili"'
Component
Btuh1ft2
Btuh
% of load
Walls
4.6
4655
19.0
Glazing
33.2
3274
13.3
Doors
18.4
385
1.6
Ceilings
17.4
13045
53.1
Floors
2.7
1434
5.8
Infiltration
1.5
1753
7.1
Ducts
6.7
0
0
Piping
Adjustments
0
0
Humidification
18003
0
0
Ventilation
0
0
Adjustments
0
Total
24546.
100.0
Component Btuh/ft2
Btuh
% of load
Walls 1.3
1329
7.4
Glazing 46.1
4548
25.3
Doors 8.2
171
1.0
Ceilings 13.5
10135
56.3
Floors 0.7
386
2.1
Infiltration 0.2
235
1.3
Ducts
0
0
Ventilation
0
0
Internal gains
1200
6.7
Blower
0
0
Adjustments
0
Total
18003
100.0
Latent Cooling Load = 356 Btuh
Overall U -value = 0. 136 Btuh/ft2- 'F
Data entries checked.
0"W
Z.
20
+ wrightsoft, Right-SufteG) Universal 8.0.24 RSU11815 2012 -Jul -11 19:33:03
"'ftK ... kDocumentsTESIRED TEMP\desired temp n andover bill penny.rup Calc = MJ8 faces: N Page 2
Building Analysis Job:
API of NH Date:
Duct Design zone 2 By:
Desired Ternp
Dracut, Ma
For: Finn Residernce, Desired Temp
272 Bridge Lane, North Andover, Ma
�"ftoOfttk V
too'
Component
Btuh/ft2
Btuh
% of load
Location:
4.6
6351
Indoor:
Heating
Cooling
Lawrence Muni, MA, US
26.1
Doors
Indoor temperature (cF)
70
75
Elevation: 151 ft
Latitude: 43N
2.3
2501
Design TD (OF
71
19
0
0
Infiltration
Relative humi2ity
30
50
Outdoor:
Heating
Cooling
Moisture difference (gr/lb)
28.6
46.7
Dry bulb (cF)
-1
94
Infiltration:
0
0
Daily range (OF)
-
18 (M
Method
Simplified
Wet bulb (T)
Wind
-
77
Construction quality
Ti ht
100.0
speed (mph)
15.0
7.5
Fireplaces
2'?Tight)
�"ftoOfttk V
too'
Component
Btuh/ft2
Btuh
% of load
Walls
4.6
6351
42.0
Glazing
33.2
3949
26.1
Doors
0
0
0
Ceilings
2.3
2501
16.5
Floors
0
0
0
Infiltration
1.5
2323
15.4
Ducts
0
0
P1
0
0
H upmInAif icati on
0
0
Ventilation
0
0
Adjustments
0
Total
15124.
100.0
MCA!
Component
Btuh/ft2
Btuh
% of load
Walls
1.3
1813
18.9
Glazing
38.7
4604
48.0
Doors
0
0
0
Ceilings
1.8
1943
20.3
Floors
0
0
0
Infiltration
0.2
311
3.2
Ducts
0
0
Ventilation
0
0
Internal gains
920
9.6
Blower
0
0
Adjustments
0
Total
9591
100.0
Latent Cooling Load = 1272 Btuh
Overall U -value = 0.069 Btuh/ft2- OF
Data entries checked.
wl-�
Gazing
.Ceilings
At= + wrightsoft, 2012 -Jul -11 19:33:03
,4CCK Right-Sufte@ Universal 8.0.24 RSU11815 Page 3
... RlDocurnentsMESIRED TEMP\desired ternp n andover bill penny.rup Calc = MJ8 faces: N
Component Constructions Job:
API of N -H Date:
AM By:
Duct Ded'
Desired Temp
Dracut, Ma
al fff
For: Finn Residernee, Desired Temp
272 Bridge Lane, North Andover, Ma
IR119=11a M",
Location:
Indoor:
Heating
Cooling
Lawrence Muni, MA, US
Indoor temperature (cF)
70
75
Elevation: 151 ft
Design TD (OF)
71
19
Latitude: 43 cN
Relative humidity
30
50
Outdoor: Heating Cooling
Moisture difference (gr/lb)
28.6
46.7
Dry bulb (OF) -1 94
Infiltration:
Daily range (OF) - 18 ( M
Method
Simplified
Wet bulb (F) - 77
Construction quality
Tight
Wind speed (mph) 15.0 7.5
Fireplaces
2 (Tight)
Construction descriptions
Or
Area
1.1 -value Insul R Htg HTM Loss
Cig HTM Gain
ft'
BtuhW- T ft- 'F/Btu h
Bhjh/ft2 Btuh
Btuh/1112
Stuh
Walls
12F-Osw: Frm wall, wd e)d, 3/8" wood shth, r-21 cav ins, 1/2" gypsum
ne
468
0.065 21.0
4.59 2149
1.31
613
board int fnsh, 2"x6" wood frm
se
596
0.065 21.0
4.59 2734
1.31
780
sw
645
0.065 21.0
4.59 2958
1.31
844
nw
690
0.065 21.0
4.59 3165
1.31
903
all
2398
0.065 21.0
4.59 11006
1.31
3141
Partitions
(none)
Windows
4A5-2ow: 2 glazing, clr low -e outr, argon gas, wd frm mat, cir innr, 1/2"
ne
24
0.470 0
33.2 785
27.8
659
gap, 1/4" thk
se
16
0.470 0
33.2 542
33.9
553
sw
93
0.470 0
33.2 3097
33.9
3162
nw
84
0.470 0
33.2 2798
27.8
2349
all
218
0.470 0
33.2 7223
30.9
6723
I)oors
11 EO: Door, wd sc type, wd strm
ne
21
0.260 0
18.4 385
8.15
171
Ceilings
16B-30ad: Attic ceiling, asphalt shingles roof mat, r-30 ceil ins, 1/2"
1137
0.032 30.0
2.26 2569
1.76
1996
gypsum board int fnsh
C part ceiling,: C part ceiling, hrd wd fir fnsh, frm fir, 8" thkns, 1/2"
720
0.255 1.0
18.0 12977
14.0
10082
gypsum board int fnsh
Floors
19A-19bswp: Part floor, hrd wd fir fnsh, r-19 ins, frm fir, 8" thkns
529
0.049 19.0
2.71 1434
0.73
386
2012 -Jul -11 19:33:04
ACC4�1 + wrigh'tSOft' Right -Suite@ Universal 8.0.24 RSU11815 Page 1
...I\Documents\DESI RED TEMP\desired temp n andover bill penny.rup Calc = MA faces: N
Component Constructions Job:
A!P1 Of Date:
DU zone By:
Desired Ternp
Dracut, Ma
For: Finn Residernce, Desired Temp
272 Bridge Lane, North Andover, Ma
I 11�11111 msmm���= 111 ,, - is'��.W-'��':-�g , ,, �" 1. i
Construction descriptions Or Area U -value Insul R Htg HTM Loss Cig HTM Gain
ft2 Btuh/ft2-IF f?-'F/Btuh Btuh/W etuh Btuh/ft2 Btu h
Walls
12F-Osw: Frm wall, wd ext, 3/8" wood shth, r-21 cav ins, 1/2" gypsum
board i nt f ns h, 2"x6" wood f rim
Partitions
(none)
Windows
4A5-2ow: 2 glazing, cir low -e outr, argon gas, wd frim mat, cir innr, 1/2"
gap, 1/4" thk
Doors
11 ED: Door, wd sc type, wd strm
Ceilings
16B-30ad: Attic ceiling, asphalt shingles roof mat, r-30 cell ins, 1/Z'
gypsum board int frish
C part ceiling,: C part ceiling, hrd wd flr fnsh, frim f1r, 8" thkns, 1/2"
gypsum board int fnsh
Floors
19A-19bswp: Part floor, hrd wd f1r frish, r-19 ins, frm f1r, 8" thkns
ne
231
0.065
21.0
4.59
Location:
1.31
Indoor:
Heating
Cooling
Lawrence Muni, MA, US
21.0
Indoor temperature (cF)
70
75
Elevation: 151 ft
sw
Design TD (cF)
71
19
Latitude: 43 cN
1926
Relative humidity
30
50
Outdoor: Heating
Cooling
Moisture difference (gr/lb)
28.6
46.7
Dry bulb (OF) -1
94
Infiltration:
1014
0.065
Daily range (OF) -
18 ( M
Method
Simplified
1329
Wet bulb (OF) -
77
Construction quality
Tight
2.26
Wind speed (mph) 15.0
7.5
Fireplaces
2 (Tight)
720
I 11�11111 msmm���= 111 ,, - is'��.W-'��':-�g , ,, �" 1. i
Construction descriptions Or Area U -value Insul R Htg HTM Loss Cig HTM Gain
ft2 Btuh/ft2-IF f?-'F/Btuh Btuh/W etuh Btuh/ft2 Btu h
Walls
12F-Osw: Frm wall, wd ext, 3/8" wood shth, r-21 cav ins, 1/2" gypsum
board i nt f ns h, 2"x6" wood f rim
Partitions
(none)
Windows
4A5-2ow: 2 glazing, cir low -e outr, argon gas, wd frim mat, cir innr, 1/2"
gap, 1/4" thk
Doors
11 ED: Door, wd sc type, wd strm
Ceilings
16B-30ad: Attic ceiling, asphalt shingles roof mat, r-30 cell ins, 1/Z'
gypsum board int frish
C part ceiling,: C part ceiling, hrd wd flr fnsh, frim f1r, 8" thkns, 1/2"
gypsum board int fnsh
Floors
19A-19bswp: Part floor, hrd wd f1r frish, r-19 ins, frm f1r, 8" thkns
ne
231
0.065
21.0
4.59
1060
1.31
303
s e
128
0.065
21.0
4.59
586
1.31
167
sw
420
0.065
21.0
4.59
1926
1.31
550
nw,
236
0.065
21.0
4.59
1083
1.31
309
all
1014
0.065
21.0
4.59
4655
1.31
1329
s e
16
0.470
0
33.2
542
33.9
553
sw
57
0.470
0
33.2
1902
33.9
1943
nw
25
0.470
0
33.2
830
27.8
696
all
99
0.470
0
33.2
3274
32.4
3192
ne
21
0.260
0
18.4
385
8.15
171
30
0.032
30.0
2.26
68
1.76
53
720
0.255
1.0
18.0
12977
14.0
10082
529
0.049
19.0
2.71
1434
0.73
386
-= + wrightSOft" Right-SuitO Universal 8.0.24RSU11815 2012 -Jul -11 19:33:04
14CAZ;k ... I\Documents\DESIRED TEMP\desired temp n andover bill penny.rup Cale = MJ8 faces: N Page 2
Dracut, Ma
Component Constructions Job:
Date:
zone 2 By:
Desired Temp
ag
tm -lj^�r
RA
For: Finn Residernce, Desired Temp
272 Bridge Lane, North Andover, Ma.
Partitions
(none)
Windows
4A5-2ow: 2 glazing, cir low -e outr, argon gas, wd frm mat, clr innr, 1/2"
gap, 1/4" thk
Doors
(none)
Ceilings
1613-30ad: Attic ceiling, asphalt shingles roof mat, r-30 ceil ins, 1/2"
gypsum board int fnsh
Floors
(none)
ne
24
0.470
0
33.2
785
Location:
659
Indoor:
Heating
Cooling
Lawrence Muni, MA, US
33.2
Indoor temperature (cF)
70
75
Elevation: 151 ft
59
Design TD (cF)
71
19
Latitude: 43 cN
27.8
Relative humidity
30
50
Outdoor: Heating
Cooling
Moisture difference (gr/lb)
28.6
46.7
Dry bulb (OF) -1
94
Infiltration:
Daily range (OF) -
18 ( M
Method
Simplified
Wet bulb (OF) -
77
Construction quality
Tight
Wind speed (mph) 15.0
7.5
Fireplaces
2 (Tight)
UawX guava x Wxl= I = am - - M Kan BKOWN 1040 a RE9
Construction descriptions
KUMAIMM
Or
Area U -value Insul R Htg HTM Loss
Cig HTM Gain
W Btu h/ft2- T ft2-F/Btuh Btuh/W Btuh
RON Btuh
Walls
12F-Osw: Frrn wall, wd ext, 3/8" wood shth, r-21 cav ins, 1/2" gypsum ne
237 0.065 21.0
4.59 1089
1.31 311
board i nt f ns h, 2"x6" wood f rm
s e
468 0.065 21.0
4.59 2148
1.31 613
sw
225 0.065 21.0
4.59 1033
1.31 295
nw
454 0.065 21.0
4.59 2082
1.31 594
all
1384 0.065 21.0
4.59 6351
1.31 1813
Partitions
(none)
Windows
4A5-2ow: 2 glazing, cir low -e outr, argon gas, wd frm mat, clr innr, 1/2"
gap, 1/4" thk
Doors
(none)
Ceilings
1613-30ad: Attic ceiling, asphalt shingles roof mat, r-30 ceil ins, 1/2"
gypsum board int fnsh
Floors
(none)
ne
24
0.470
0
33.2
785
27.8
659
sw
36
0.470
0
33.2
1195
33.9
1220
nw
59
0.470
0
33.2
1969
27.8
1652
all
119
0.470
0
33.2
3949
29.7
3531
1107 0.032 30.0 2.26 2501 1.76 1943
Arc + wrightSOft' Right-S,iteO Universal 8.0.24RSU11815 2012 -Jul -11 19:33:04
,OCCA ... I\Documents\DESIRED TEMP\desired ternp n andover bill penny.rup Cale = MJ8 faces: N Page 3
This certifies that
has permission to perform ... A? 0. 77— ..................
wiring in the building of �j ...........................
at .... North Andover, Mass.
Fee. Lic. No. ... ............ pz'/""�.
C
2/a ELECTRICAL INSPEC?OR
Check # S
11 / VO —""'
10948
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit NO.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code Q4ECh 527 CMR 12.00
PLEASE PRINT IN INK OR TYPE ALL INFORM TION) Date: OVI I
11
City or Town of. NORTH ANDOVER To the Inspector' of Wires:
By this application the undersign(�� gives notice of his or her.intention to perform the electrical work described below.
Location (Street & Number)
Owner or Tenant
Owner's Address
Is this permit in conjunction
in ,
Purpose of Building �,P__9A
M
Telephone No.
permit? Yes EY No F] (Check Appropriate Box)
9 (50 Amps 12Z 2-4C)Volts
Existing Service.. —
New Service Amps Volts
N*wber of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
I _.r., - 1-1 t r�l I -, —
Utility Authorization No.
Overhead 0 Undgrd 0
[I Undgrd
No. of Meters I
No. of Meters
Ilu
Completion qfthefollowing table may be waived by the Inspector of Wires.
No. of Recessed Luminaires 2g�)
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires 14
Swimming Pool Above Ei In-
grnd. grnd.
r Emergency Lighting
Bat'tery Units
No. of Receptacle Outlets SO
No. of Oil Burners
FIRE ALARMS �
No. of Zones
No. of Switches 9-0
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
41 CbZ
No. of Waste Disposers
Heat Pump
Totals:
I Number
I Tqp�
I ..
JKW
.......................
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local E] Municippi E] Other
Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of evices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
. No. of Devices or Equivalent I ki
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent �_Cj
OTHER:
M
Ic
OL
Attach additional detail ifdesired, or as required by the Inspector of 07res.
Estimated Value of Ejectical Work: �,S�00 (When required by municipal policy.)
Work to Start: 0 1 / '�l 11 In4snctions to be requested in accordance with NIEC Rule 10, and upon completion.
INSURANCE COVtRAGE: 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 cove9ge is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE �Z BOND [I OTHER El (Specify:)
I certify, under trl;g andIrpenalties vfper' rA that the information on this application is true and complete.
FIRM NAMC- LIC. NO.: .2,349
Licensee: 0��_ cpla%e_ro,� Signature LIC. NO.: 2- 1 1�9
(Ifapplicable, erte,,� " m 11 in the li ense imber line&W Bus. Tel. No.: S1 I q 70&
%, _\.. t
Address: "I oly�_ 02 W Pr Alt. Tel. No.:
*Per M.G.L c. 147, s. 51-61, security work requires Department of Public Safety "S" License: Lie. 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) [I owner El owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, AM 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
Address: k S
C,
Ist I
Q^
Gty/State/Zip:"e_Y\, WA Q�4t�k Phone#:... QT �:71 �7b�:
VU_
Are you an employer? Check the appropriate box:
I -El I am a employer with
4. El I am a general contractor and I
I
employees (full and/o r part-time)
have hired the sub -c ontractors
ctors
2. 1 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. 0 We are a corporation and its
reou
quired.]
officers have exercised their
3. 1 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.1
Type of project (required):
6. D New construction
7. El Remodeling
8. F1 Demolition
9. EJ Building addition
10 El Electrical repairs or additions
I 10 Plumbing repairs or additions
12.0 Roof repairs
13.0 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such.
�Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurancefor my employees. Below is thepolicy andjob site
information.
Insurance Company Name:
Polic # or Self -ins. Lic.
y
Job Site Address:
Expiration Date:
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.
f do hereby ce�F�nder the pains andpenalties offierjury th at the information provided above is true and correct.
C � 7 S�v R
Q)W t k 1 (2 -
Official use only. Do not write in this area, to be completed by city or town offi-ciaL
City or Town: PermithLicense #
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 #:
,57 '41
Date
e -T
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that .... �� C. . . (,?e i ......
has permission to perform ....
wiring in the building of .....
at .... 1�yrth Andover, Mass.
Lic. No.. ........
ELECTRICAL INSPECTOR
1'7
'Check
11146
Official Use Only
f7i
Permit No. I I LA
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
A I] work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALI, INFORAM TION) Date: Qababer lo,ama
City or Townof- Q,,.,r1A" A4drjk)gc- To the Inspector of Wir�s:
By,this application the undersigned gives notici of hii or her intention to perforin the electrical work described below.
Location (Street& Number) a-7.1 'br
OwnerorTenant Sh2&m nywx Telephone No. (W)717 -1109q
Owner's Address lkyna 0-5 Qbmle
Is this permit in conjunction with a building permit? Yes 9 NoE] (Check Appropriate Box)
Purpose of Building Solov, Py Utility Authorization No.
Existing Service Amps Ic1l) JL4() Volts OverheadE] Undgrd M No. of Meters
New Service Amps Volts Overhead Undgrd F1 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: Aca ta;t Cry) sv.sL-e,,,,
oktcd 1.98 ym u. P 5T.C. CMC,.d-heA I
Co—lotionnfiliefnito-i- blenza-be—i-ec, #I. I.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
� r W
2EE raL ires.
No. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above -In - E]
girnd. 0 gr'nd.
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIREALARMS JNo.ofZones
No. of Switches
No. of Gas Burners
I
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:
I
V
Tons
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El Municl*pM El Other
Connection
No. of Dryers
No. of Water
Heaters KW
Heating Appliances KW
No. of No. of
Signs Ballasts
Security Systems:*
No. of Devices or Equivalent
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
iNo- of Motors Total HP
Telecommunications Wir!'ng:
No. of Devices or Equivalent
OTHER:
4017 6 Attach additional detail ff desired, or as requircdh,v the Inspector of Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: P- 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 coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE P5 BONDEJ OTHER E] (Specify:)
Icertifi,,140derthe 'ns and penalties ofperjuty, that the information on this application is true and complete -
FIRM NAME: 0 tall.- C J � / C.OrloneJ., dq LIC. NO.: 0 9 71 A
Licenscc:j �,e,52'.J /� "'Signature LIC. NO.: 2,5-19 (.. -
(1fapplicable, enter "exempt " in the license number line) Bus.TeI.No-q? _q4�45v"I
Address: Zq �4, Mari, 12,-, Bigldmc Z, On, 4- 1 1, Mo-lbre-.4-444 Qt?c�7 Alt. Tel. No.:
*Per M.G.L. c, 147, s. 57-61, security work requTires bepartment of Public Safdty"'S" License: Lie. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not hme the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) 0 owner 0 owner's a t
Owner/Agent
Signature Telephone No._ PERMIT FEE:
The Commonwealth of Massachusetts
Department of Industrial Accidents
64 Office of hwestigations
I Congress Street, Suite 100
Bovton, MA 02114-2017
www.mass.govIdia
Wdrkers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lezibly
Name ()3usiness/Organizatioii/individual): SolarCity Corporation
Address:3055 Clearview Way
-San Mateo, CA 94402 650 963-5100
Phone#:
Are you an em�ployer? Check the appropriate bo I x:
1. 1 am a employer with 1500
4. 1 am a general contractor and 1
employees (full and/or part-time).*
have hired the sub -contractors
2. 1 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. insuranec.1
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
eniployees. [No workers'
comp. insurance reciuired.1
Type of project (required):
6. El New construction
7. n Remodeling
8. E] Demolition
9. E] Building addition
10. F1 Electrical repairs or additions
I Q:1 Plumbing repairs or additions
12.E] Roof repairs
13.El OtherSolar Installation
*Any applicant that checks box 91 must also fill out the section below showing their workers' compensation policy information,
t Homeowners who submit (his 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-conlractors have employees, they must provide their workers' comp. policy number.
I am an ciriployerthatisprovidittg workel-s'compensation insuranceformy employees. Below is the policy andjob site
information.
�nsurance Company Name: Zurich American Insurance Company
Policy # or Self -ins. Lic. #:WC96734670 Expiration Date: 9/01/2013
Ll
Job Site Address: 01-19- b1zidote-s lonp_ City/State/Zip:�),'OLd4,jeriMA--�`/..Y'VS-
\J I
Attach a copy of the workers' compensation policy decla , ration pate (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.
Idoherekipcerti under thegains—aflApenalties goerjuty that the informationprovided above is true and correct.
Phone M 774-226-0769
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing AuthoriO, (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
I
Location ' / � L �,- 'I-
-2
r
No. Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee
A 17 -/
r 1.0
,Other-Pefrhit-Fee
SeWer Connection Fee
'Water Connection Fee
�N
rVrA1
0
Building Inspector
Div. Public Works
PER.111T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1
Of
MAP i4O.
LOT NO.
2 RECORD OF OWNERSHIP IDATE
BOOK '.PAGE
ZONE
SUB DIV. LOT NO.
LOCATION r7
PUQJIQGC'CW-MUILDING -21,
OWNER'S NAME
NO. OF STORIES ZE
OWNER'S ADDRESS
BASEMENT OR SLAB
AR 14
SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME /&-,?
SPAN
DISTANCE TO NEAREST BU G
DIMENSIONS OF SILLS
DISTANCE FROM STREET
POSTS
DISM&N-E ERG -92�ES - SIDES
GIRDERS
AREA OF LOT
FRONTAGE
HEIGHT OF FOUNDATION THICKNESS
IS BU'�5�MAS-Aa-t e4�ffk
951�4-)Vz-f
SIZE OF FOOTING x
IS BUILDING ADDITION
MATER:AL OF CHIMNEY
IS BUILDING ALTERATION
IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE YaT -5
IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY
IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS
SEE BOTH SIDES
PAGE I FILL OUT SECTIONS 1 3
PAGE 2 FILL OUT SECTIONS 1 12
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING
.ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
SIGNATURE OF OWNER OR AUTHORIZED AGENT
F E E 57 -
PERMIT GRANTED -7k c- 610,716- �4s-�2- t
L-3 /
3 PROPERTY INFORMATION
LAND COST
EST. BLDG. COST
EST. BLDG. COST PER SQ. IFT.
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
4 APPROVED BY
BOARD OF HEALTH
WHITE: Building Dept. CREAM: Assessors CANARY: Treasurer
PLANNING BOARD
BOARD OF SELECTMEN
Date. "07..'-).L
71
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..... e�'
........................... I ..............................
has permission to perform .........
wiring in the building of..
at .... r1.2 .....
* d ......................... . North Andover, Mass.
Fee.�� ............. Lic. No..../
L: ICAL IMS
Check # .29<r
7699
--C\, Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No.
Occupancy and Fee Checked -3.5
[Rev. 1/07]
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 52 MR 12.00
(PLEASE PRWININK OR YTTE ALL NFO"ATJON) X
Date: Afl,2 /;��
City or Town of. NORTH ANDOVER To the—I-nspector of Wires:
By this application the undersigned gives notickof his or her intention to perform the electrical work described beinw
Location (Street & Number)
40 -r
Owner or Tenant Z 1,t deq &,,kbe -s Telephone No.
Owner's Address
Is this permit in conjunction with a building permit? Yes 0 No F-1 (Check Appropriate Box)
Purpose of Building _,/� We /// �1'9 Utility Authorization No.
Existing Service Aa Amps llel oO�� Volts Overhead Undgrd [:] No. of Meters
New Service Amps Volts Overhead UndgrdD No. of I Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion of the olloudn abl- -! A 4*11, L IL
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
V eimpectorol wires.
IN 0. of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool in_
0
�0- of Emergency Ligh
grnd.
Batte!y Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
o. of Detection and -
Initiating Devices
No. of Ranges
No. of Air Cond. I
T s
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
I ��...J.'o.n
KW
No. of Sel ontained
..........
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
Local El Mumclp�l
Connection 0 Other
St, ity S stems:*
of evices or Equivalent
No. of Dryers
Heating Appliances KW
No. of Witer
KW
No. of No. of
Heaters
Signs Ballasts
Dat, Aring:
No. of Devices or Equivalent
;
No. Hydromassage Bathtubs No. of Motors Total HP lelecommunications- Wiring:
I
& No. of Devices or Equivalent
OTHER:
rl) I
Estimated Value of E)ectri al Work: ZIA01. 00 Attach additional detail if desired, or as required by the Inspector of Wires.
(When required by municipal policy.)
Work to Start: le Inspections to be requested in accordance with MEC Rule 10, and upon
INSURAN -4 completion.
CE CO �RAGE* 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 coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE El BOND [] OTHER E] (Specify:)
I certift, under thefain� a dpenalties ofperjury, that the information on this application is true and complete -
FIRM NAME:
Licensee: 141&g�0491
IIpl Signature000 LIC.NO.:
(Ifapplicablelemor exempt inth cense qxmber line) Bus. Tel. No.*�!?�-�'7�-,o��,o��7
11011 /;9:"!z, -s0 W 9a _
Address: "r __� '0� / Alt. Tel. No.: 9 -
*Per M.G.L c. 147, s. 57-61, secuInty work requires Department of Public Safety "S" License: Lic. No. �-s
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability misurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) El owner F1 owner's agent
Owner/Agent
Signature Telephone No.
r--; www.mass.gov1dia
Workers' Compensation Insiarance Affidavit: Buflders/Contractors/Electriciang/plumbers
A�Plicant Information
Please, Print Le—gibly
Narrie (Business/Organization/individual):
Address: �S'Z; *Y -e—
A
City/State/Zip ete^-5 Phone#:
Are youan employer? Check the appropriate box:
�Iam
1. 9� a employer with /.2—
4. 1 am a general contractor and I
The Commonwealik of Massachusetts
B-1
Department of Industrial Accidents
These su&contractors have
Office of Investigations
workers' comp. insurance.
600 Washington Street
Boston, MA 02111
r--; www.mass.gov1dia
Workers' Compensation Insiarance Affidavit: Buflders/Contractors/Electriciang/plumbers
A�Plicant Information
Please, Print Le—gibly
Narrie (Business/Organization/individual):
Address: �S'Z; *Y -e—
A
City/State/Zip ete^-5 Phone#:
Are youan employer? Check the appropriate box:
�Iam
1. 9� a employer with /.2—
4. 1 am a general contractor and I
employees (full and/or part-time),*
2.0 1 am asole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet
ship and have no employees
These su&contractors have
working for me.in' any capacity.
workers' comp. insurance.
[NO workers' comp. insurance
5. D We are a corporation and its
required.]
3.[1 1 am 8 homeowner doing all work
officers have exercised their
right of exemption per MOL
,myself, [No-workirs, comp.
c., 1.52, § 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. De mol iti.on
9. Building addition
10. Electrical repairs or additions
I I U Plumbing repairs or additions
12.[3 Roof repairs
1,3.[3 Other
t-.' -Fpl-�Ift LOULL UUWKS DDXP I MUStSJSD fill out the section below showing their workets' bornpensmion policy inforrna�fiotL
Homeowners who submit this Rfrl&vit indicating they are doing all work and then hire outside 6ontmctors Must submit a new affidavit indicating suclL
lCoUtractors that check this box Mustattached an additional sheet showing the nam of the sub -contractors and their workets, comp. policy intommtion.
I am an enWloyer thiv is prqvidingworkers I compensation insurance
information. for nV emPlOyeeL Below is the policy andjob site
Insurance Company Name: * & e
Policy 4 or Self -ins. Lie. #:
el
Expiration
IF—
Job Site Address: City/State/zip.
Attach a copy of the workers' . com . pensation policy declamtion 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
andp
–1� -
that the information provUed above ind con -cot.
--Date:
Officiat 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 #:
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Add Glass
another dimension t
handcrafted
enrh etchect o the flarr.,
. . . .......
WT7
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des and Nor Of the firebox are
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Of Safe, rel - Oxidation, insu
iable h heating ringYears
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sy'ste.w
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Chann e
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secOnda fresh air for
ry
s
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to t e bustion
the ire o e regions of
c ea t ich
t'eates
v I . b s e tacular,
isi le seco
It
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s "burned
gases. This allows
st"'.
stove to the
ac IeVe high
T out ut
greater e - and
ciency.
S-1- — _Wj"Y
0 id brass
blac cast r original
a cast - OOrs feature
r re I Iron I s
tamer for
tight lr_ ears of air-
1� Perto
fleavy ance,
Uty fibergja�'
gasket. S
d(o)or 10 'ng and a Positiv,
ck mechanism
ensure a Consistent -
t'ght door seal. ajr-
Power&1.8
I
04'e
(NO t Sh o, r
The W-7)
optional L0pI
thermost., Multi.,
e speed,
anting designs.g, es with Manuall,, ca/ly controlled blower can be
ass, available in three quietl Or I
Travis Industries reserves Y enhaaulomaticall
the system. ces the Y operated, and
right to alter or heat . -1 Perfect natural
Improve its circulation addition to Convection
Products in You ncrease
at any r home.]
I ft.�ftEft_' ft—S.—ft YOUR A OR'ZED LOpI )F time witho,,t
A �ALER IS.. cation.
Pl�to�"' retet'd
82 1IL12 7 arn00 lierse
k e , 'St. 07. U -L. 'tatldards
0. #'S 'VCR 219.
COP
Yrjght 199� Travis Inkitries In,
Printed in
USA
t4'n"acturld ay,
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IMS"VC-11W.
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10850 117th pl
Phone (206) 82* NE * hirkland,
7-9505 WA 98033
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