HomeMy WebLinkAboutMiscellaneous - 273 BERRY STREET 4/30/2018 (2)N)
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
-Y\
This certifies that ........
..............................
VP . . ....
............ . .. .
has permission to perform ..... :N..QVJ ...... ............
wiring in the building of ....
-- -12
at ..... 4) ............. I ...... Aorth Andover, Mass.
.......... .............. I ............. : .............................
7 Fee.5.'4.Qt ...... Lic. No. ........... ............ E
i� - - .-- -R ... ..
0 K AL R�PE�
Check #
<L\\ Commonwealth of Massachusetts Official Use. Only
Emu =- I
Permit No.
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGUIATIONS I[Rev-1/071 (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 527 CMR 12.00
(PLEASE PRflVTVVNK OR TYPEALL MFOR&UTIOA9 Date: S�T-� 3
City or Town of. NORTH ANDOVER To the Inspe(tor"of Wires:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street &
Owner or Tenant
Owner's Address
Is this permit in'conjunction with a building permit? Yes No (Check Appropriate 13ox)
Purpose of Building I Utility Authorization No. YJ,2Q,2��Z
- Existing Service Amps Volts
New Servic 02W Amps cP40 / )2,12 Volts
Number of Feeders and Ampacity
Overhead Undgrd No. of Meters
Overhead Undgrd No. of Meters
Location and Nature of Proposed Electrical Work: �-,, W ep�
Completion of the following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Cefl.-Susp. (Paddle) Fans
No. o Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above Ei In-
grnd. grnd. El
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
JN'o. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
I.Nypj�.erlj�A�
I ...
JKW
.......................
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
LocalEl Mun"'W F1 Other
Connection
No. of Dryers
Heating Appliances KW
Security Systerns:*
No. of Devices or Equivalent
No. of Water KW
No. of No. of
Data Wiring:
Heaters
Signs Ballasts
No. of Devices or Equivalent
No. Hydromassage)3athtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
707
,4ttach additional detail ifdesired, or as required by the Inspector of 97res.
jEstimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with NIEC 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 operatioif' 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.
CBECK ONE: INSURANCE El BOND [j OTHEREI (Specify:)
Icerfify, underthepains andpenalfies ofperjury, thattheinforniation on this application is trueandcom
plete.
FIRM NAME: LIC. NO.:
Licensee: Signature LTC. NO.%�,2,/,(,`
(If applicab le,"en ter "eximpt " in tre 11 c P n g e n, im b er lin e) Bus. Tel. No. ---58;W
Address: Alt. Tel. No.: -
*Per M.G.L c. 147, s. 57-61, security 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) 0 owner F1 owner's agent.
Owner/Agent "10 00 1
Signature Telephone No. PVRMIT FEE:$
UV q -7 9 -� L / 6,6 7,0
2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G1 c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act ftirthers this
purpose by establishing an automatic four-year extension to certain permits and licenses conceming the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012.
• Rule 8 — Permit/Date Closed: Note: Reapply for new permit El
• Permit Extension Act — Permit/Date Closed: I
Trench Inspection
Pass M
Failed
Re- Inspection Required 0
Inspectors Comments:
,TEE& CQ �Z
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass V
Failed
Re- Inspection Required 0
Inspectors Comme-nts:
A
b A
r
oe
41
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass M K,
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPflCTION:
Pass
Failed
Re- Inspection Required 0
Inspectors Comme\,nts;n
4
U
Inspectors Signature:
Date:
FINAL INSPECTION:
Pass M
Failed
Re- Inspection Required 0
Inspectors Comments:
2- 0
P4-1-�'
Inspectors Signature:
Date:
IV — 7 - 7"C
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5wc — A�� - 5ZP7,
DEB WER41-101-1) ... TdWN OF MERRIMAC, MA. .......dweinhold@townofmerrimae.cfn
The Commonwealth ofMassachusetts
Department of IndustrialAccidi�ts
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information— Please Print Legibly
Name (Business/Organization/Individual)* :2;� �e,,), 122,
Address: 4�wbo Lfl P—D
City/State/Zip: , PaQge Phone #: 2 76 - 7 7 2 &Z,4�,
Are you an employer? Check the appropriate box:
LEJ I am a employer with
4. El I am a general contractor and I
employees (fall and/or part-time).*
have hired the sub -contractors
2.K I am a sole proprietor or partner-
listed on the attached sheet T
ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. F1 We are a corporation and its
required.]
officers have exercised their
3.E1 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. F1 New con * struction
7. E] Remodeling
8. E] Demolition
9. E] Building addition
10. n Electrical repairs or additions
ILE] Plumbing repairs or additions
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 aire doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site
information.
Insurance Company
Policy # or Self -ins. Lie.
Expiration Date:
Job Site Address: City/State/Zip:
r � -
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
4me 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.
Ido hereby certify underfi; Pll�a* andpenaltipe Jury that the information provided above is true and correct.
nt,.
Official use only. Do not write in this area, to be completed by c4 or town official
City or Town:
Permit/License 9
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:
4 1
Information and Instructions -
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "....every person in the service of another under any contract ofhire.-
express or implied, oral or written."
An employerIs 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, -§�5C(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 requ , !red."
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 (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is ' required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Pleas ' e 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 offloially 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
Tol, # 617-727-4900 ext 406 or 1-877rMASSAFF,
Revised 5-26-05 Fax # 617-727-7749
LO
Pq
This certifies that.M I &kl e 1911 �e rJ 'b--2'1 Pye MriJ �qA4—
.............. . 7. -Y ............... ...
cl - . .
has permission for gas installation L� r- .
in the buildings of. (�U.d. r'�ve ............................
'7 -
at ............. .4 ........ North Andover, Mass.
'0 cil�� ... i� b .................... ...
,pFee ��O . . Lic. No....
-Check# ��4 GASINSPECTOR
8687
-C\-
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
CITY: NORTH ANDOVER MA. DATE: 05/01/2013 PERMIT #
JOBSITE ADDRESS: 273 BERRY ST OWNER'S NAME: ERIC CLIDIVIORE & JERRY GERRIOR
GOWNER
ADDRESS:
TEL: 978-423-6771 FAX:
TYPE OR
OCCUPANCY TYPE: COMMERCIAL El EDUCATIONAL El RESIDENTIAI-4�<
PRINT
CLEARLY INEW-Rn-
RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES El 1\104!�'
APPLIANCES FLOOR Bsmt 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
GRILLE
INFRARED HEATER
LABORATORY COCK
MAKEUP AIR UNIT
OVEN
HEATER
.IPOOL
ROOM/SPACE HEATER
�i�OOF TOP UNIT
TEST
UNIT HEATER
LINVENTED ROOM HEATER
WATER HEATER
INSURANCE COVERAGE
Wave a current-td�iiit insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES El NOD
If you have checked YES, please indicate the type of coverage by checking the appropriate box below.
LIABILITY INSURANCE POLICY El OTHER TYPE INDEMNITY El BOND
OWNERS 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.
CHECKONEONLY: OWNER OAGENT El
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted (or entered) regarding this permit application is true and accurate to the best of
my Knowledge. I certify that all plumbing work and installations performed under the permit issued, will be in compliance with all Pertinent provisions
of the Massachusetts Uniform State Plumbing Code, and Chapter 142 of the General Laws.
PLUM BER/GASF ITTER NAME?!�� LICENSE # " 3 SIGNATURE
COMPANY NAME: OSTERMAN PROPANE ILLC ADDRESS: 321A Merrimack St
CITY: Methuen STATE: MA ZIP: 01844 FAX: 978-738-0118
TEL: 800-368-9956 CELL: EMAIL: INFOaOSTERMANGAS.COM
MASTER El JOURNEYMAN OLPINSTALLER [0 �®RPORATION Elk—PARTNERSHIP E:]# --LLC Elk45-326-3311
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TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that ... ).6 J.
has permission to perform . ..................
plumbing in the buildings of . . r� I cL .............
at .... 2 North Andover, Mass.
Fee 51+15�- Lie. No;�99.2-...
. . ............... ..... ...
PLUMBING INSPECTOR
Check 4 a C-1 ;-'-
pegm A L5,51-12)
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TYPE OR
PRINT
CLEARLY
MASSAPHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
CITY MA DATE PERMIT#
JOBSITE ADDRESS OWNER'S NAME
OWNER ADDRESS TEL[ FAX
OCCUPANCY TYPE COMMERCIAL Ell EDUCATIONAL
NEW: & RENOVATION: 0 REPLACEMENT: 0
RESIDENTI�v
PLANSSUBMITTED: YESO NOD
I FIXTURES -1 FLOOR- I BSM 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8 1 9 1 10 1 11 1 12 1 13 1 14 1
BATHTUB
CROSS CONNECTION DEVICE
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOIL/SAND SYSTEM
DEDICATED GREASE SYSTEM
DEDICATED GRAY WATER SYSTEM
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER I
DRINKING FOUNTAIN
FOOD DISPOSER
FLOOR /AREA DRAIN
INTERCEPTOR (INTERI
KITCHEN SINK
LAVATORY
ROOF DRAIN
,5JOWER STALL
SERVICE / MOP SINK
TOILET
WASHING MACHINE CONNECTION
WATER HEATER ALL TYPES
WATER PIPING
dT H -ER f
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES W NO [J-1
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICYN, OTHER TYPE OF INDEMNITY 01 BOND DI
PWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER 0 AGENT 0
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 ccupte to the best of my kn edw
a, ow'
and that all plumbing work and installations performed under the permit issued for this application will be in compliance W. all rti nt provision the
h4assachusetts State Plumbing Code and Chapter 142 of the General Laws.
PLUMBER'S NAME Ov,,f L LICENSE SIGNATURE
Mpn
j JD CORPORATION M! # PARTNERSHIP D.I LLC
COMPANY NAME L-7'�;�D
ADDRESS
CITY STATE ZIP TEL -lo-2c
2
FAX ' � � � '� � I CELL I " _ __ _ _ _ � _ __. J1 EMAIL L___ _ __ _ � _ -.-- P
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The Commonwealth ofMassachusetts
Department ofIndustrialAccidints
Office of Investigations
600 Washington Street
Boston, MA 02111
Ut www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
city/state/zip: lli,,e
,�dtlr 4- 0( �Yhhone it: 2- 2 6 �-S
Are you an employer? Check the appropriate box:
Type of project (required):
LEI I am a employer with
4. El I am a general contractor and I
6��ew construction
,-employees (fall and/or part-time).*
2 IWI am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet
have
7. F1 Remodeling
8. E] Demolition
ship and'have no employees
These sub -contractors
working for me in any capacity.
workers' comp. insurance.
9. E] Building addition
[No workers' comp. insurance
5. El We are a corporation and its
10.El Electrical repairs or additions
required.]
3. El I am a homeowner doing all work
officers have exercised their
right of exemption per MGL
I L[J Plumbing repairs or additions
myself. [No workers' comp.
c. 152, § 1(4), and we have no
12.E] Roof repairs
insurance required.] t
employees. [No workers'
1311' other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policyinforniation.
t
I Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
Iam an employer that isproviding workers' compensation insuranceformy employees. Below is thepolicy andjob site
information.
Insurance Company Name:
Policy # or Self -ins. Lic.
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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
lertlfv
I do hereby certiq erpZ epains andpenalties ofperju ie information provided above tru anacorrect
Rio-nnflin-.-75, . ��= Date -
Phone M 7 7J-- Z 16 - Z 6, 2 -57
Official use only. Do not write in this area, to he completed by city or town offilcial
City or Town:
PermitUcense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact
Phone 9:
t�
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "....every person in the service of another under any contract of hire,
express or implied, oral or written."
An employeiis 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 requ.ired."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivi , sions 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 (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is. required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Addre&' 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 fille�d 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 p ermit 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
6 00 Washington Street
Boston, MA 02111
Tel, # 617-727-4900 ext 406 or 1-877,7MASSAFE
Revised 5-26-05 Fax# 617-727-7749
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This certifies that
has permission for gas installation .............
in the buildings of ... . ....................
at .2 ........ North Andover, Mass.
)
..Fee. I �-( .77.Lic.No.2GcxQ-4-. ..Mb ................... ...
GASINSPECTOR
Check # C2 q )-'�
8640
W
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WC
CITY MA DATEE- PERMIT # TS
JOBSITE ADDRESS ----7-]OWNER'S NAME
G
OWNER ADDRESS TELF__ _____jjFAX[
JIFAX.�
TYPE OR
OCCUPANCY TYPE COMMERCIAL EDUCATIONAL D RESIDENTIALPO
PR1NT
CLEARLY
NEW: 01 RENOVATION: El REPLACEMENT: Fj PLANS SUBMITTED: YE�,a NO F -J
APPLIANCES -1 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 L T-... -I
GENERATOR
GRILLE
i
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT
OVEN
OL HEATER
DOM / SPACE HEATER
OOF TOP UNIT
L -EST
IUNIT HEATER
UNVENTED ROOM HEATER X—
VVATER HEATER
-dT—HER
F
. ..... ..... . . . ...... . . . ... . ......
E-7 J L-- —7- A
I -_7
INSURANCE COVERAGE
Ch. YE&,�ffNO Ej
�11 have a current liabilily insurance policy or its substantial equivalent which meets the requirements of MOL. 1142
�I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY,� 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 E] 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 t the best of my PeyMedge
�ithe
and that all plumbing work and installations performed under the permit issued for this application Will be in compliance wi I A i vi�
Wnt
:o
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. ,
PLUMBER-GASFITTER NAME SIGNATURE�
LICENSE #ff
LLC
rMP El MGF -01 JP GF LPGI CORPORATION 0# [=PARTNERSHIP 0#[ 1#
COMPANY NAME: DRESS
11AD Ivi
STATE [ba [_61
CITY jj,�1,4 Ir ZIP r tl TELF -2)(),- 2- 6
J_ j
fl
FAX CELL ]JEMAIL
PI
W
COO
U.) rl
LLI
IL
LLI
rf) CO)
< LU
CO
LU
LU
Cl)
z
0
C.)
i
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Vi
The Commonwealth of Massachusetts
Ln Department of lndustria!Accidi�ts
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers
Applicant Information Please Print Legib
Narne (Business/Organization/Individual): T-6 Ji ao Y -e te e
Address: 3 Y /V")
citY/State/ZiP: 6 'A& J014- '0 (q 0 Phone #: 2 7d�-- 2-10 -- 2- 6 Ic;S
Are you an employer? Check the appropriate box:
Type of project (required):
1. 0 1 am a employer with
(full and/or part-time).*
4. El I am a general contractor and 1
have hired the sub -contractors
6. -L*ew construction
,_,mmployees
t
7. Remodeling
2. 911 am a sole proprietor or partner-
listed on the attached sheet
ship and'have no employees
These sub -contractors have
8. E] Demolition
working for me in any capacity.
workers' comp. insurance.
9. 0 Building addition
[No workers' comp. insurance
5. 0 We are a corporation and its
10.El Electrical repairs or additions
required.]
officers have exercised their
3. 1 am a homeowner doing all work
E]
right of exemption per MGL
I LEJ Plumbing repairs or additions
myself. [No workers' comp.
c. 152, § 1(4), and we have no
12.E] Roof repairs
insurance required.] t
employees. [No workers'
1311other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they 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 their workers' comp. policy information.
lam an employer that isproviding workers'compensation insuranceformy employees. Below isthepolicy andjob site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. h!: Expiration Date:
Job Site Address: , City/State/Zip:
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one"year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify 1*er #z e pgins andpenaltipf ofpfrjury A at th e information provided ah ovit is trpe an d correct.
Phone#:
Official use only. Do not write in this area, to he completed by city or town official.
City or Town:
Permit(License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone
Information and Instructions -
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer! is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in 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 requ.1red."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivi , sions 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 (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is. required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate Be.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Pleas ' e 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 fille ' d 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 CommoRwealth, of M-assachusetts
Department of Industrial Accidents
Office of Investigations
6 00 Washington Stu�et
Boston, MA 02111
Tel, # 617-727-4900 at 406 or 1-877,7MASSAFE
Revised 5-26-05 FaY, # 617-727-7749
__www.mass,gov1dia
i
V
194 Date.41-7--:5 I. ti� ..... I -
TOWN OF NORTH ANDOVER
PERMIT FOR MECHANICAL INSTALLATION
This certifies that
has permission for mechanical installation .............
in the buildings of n M i�� A (--,-A ................
at ....... North Andover, Mass.
Fee. Lic. ... ........ t5llu
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Commonwealth of Massachusetts
Date Sheet Metal Permit Permit #
OLN
Estimated Job Cost- UU Permit Fee:
Plans Submitted: YES -.01, NO
Business License 4 2-1 (,o
Business Information:
Name: /S 4Lo% c -
Street:
City/Town:
Telephone: 57
Plans Reviewed: YES `- NO
Applicant License # 7 -7.5-Li
Property Owner Job Location Information:
04K rTA
Name: -7d /W
Street:
s
City/Town:
Telephone:
Photo I.D. required / Copy of Photo I.D. attached: YES NO
Building Type:
Residential: 1-2 family V'*" Multi -family Condo / Townhouses
Commercial: Office Retail - Industrial Educational Institutional
Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. -
Sheet metal work to be completed: New Work: %,-� Renovation:
HVAC Metal Roofing _ Kitchen -Exhaust System Chimney / Vents
Provide brief description of work to be done:
0 e /4- c e,
F
co, to 4,f,4 w -c
gtA" V" -a- AV's r- L,1- "Y
e 4- 0-� -- � kvvg
1k
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 YesO'NoEl
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy ffl' Other type of indemnity El Bond El
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One OnI y
Owner Agent Ej
Signature of Owner or Owner's Agent
By checking this boxEl, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Date
Date
Proaress Inspections
Comments
Final Inspection
Conunents
Inspector Signature of Permit Approval
License Number: -:73-ilY
Check at www.mass.gov/dpi
k / /
Type of License:
By
El Master
Title
El Master -Restricted
CityfTown
21burneyperson
Permit #
ElJourneyperson-Restricted
Fee $
Inspector Signature of Permit Approval
License Number: -:73-ilY
Check at www.mass.gov/dpi
k / /
Sheet Metal Commercial Guidelines I Life Safety / 0ifical Systems
Inspection Checklist
Yes No N/A�
Set of stamped engineering documents and detailed description of
mechanical system to be installed has been provided
All workers performing sheet metal work onsite has valid Massachusetts sheet metal
license
All sheet metal work being performed with proper joumeyperson-to-apprentice ratios
Fire dampers with access door properly installed and checked for operation
Smoke and combination fire / smoke dampen with access doors properly installed -
actuator checked for proper operation (May also be verified by fire department during
fire alarm testing)
Duct smoke detectors with access doors properly located
(May also be verified by fire department during fire alarm testing)
Smoke / atrium exhaust systems installed and operation verified
(May also be verified by fire department during fire alarm testing)
Stair pressurization systems installed (where required) and operation verified (May also
be verified by fire department during fire alarm testing)
Grease / kitchen hood exhaust system installed with all scams and connections welded
airtight with properly located cleanouts. Proper cldi'ances, fire rated enclosures and
pressure testing required, j.
,nstalIe.d--Oi6.-'d'Y6quired. h
'eciiiibment and
Duct penetrations seal6d'
Metal roofing systems installed watertight using proper materials and fasteners
Flexible duct runs installed 6'-0" maximum length
Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle
iron
Ductwork. / plenum connections scaled substantially airtight
Ductwork insulated by means of external covering or internal lining
Volume dampers installed for each supply air branch duct
New/clean - properly sized filters installed (final inspection)
Testing and Balancing report complete (final sign -off)
Yes
'loll
Sheet Metal Residential Guidelines / Inspection Checklist
No N/A
Detailed description and sketch of sheet metal system to be installed has
been provided
All workers performing sheet metal work onsite has valid Massachusetts
sheet metal license
All sheet metal work being performed with proper joumeyperson-to-
apprentice ratios
Equipment sized per heating / cooling load calculations
Duct work sized per manual "D" calculations
Bath / shower rooms contain mechanical exhaust fan vented outdoors
Electric dryer exhaust properly installed maximum total run 35'-0",
maximum flexible run 8'-0"
Flexible duct runs installed 14'-0" maximum length
Volume dampers installed for each supply air branch duct
Ductwork installed using proper gauges and hangers
Ductwork / plenum connections scaled substantially airtight
Ductwork insulated by means of external covering or internal lining
New/clean - properly sized filter installed (final inspection)
Testing and Balancing report complete (final sign-ofo
HEATING / COOLING Load Short Form
MANUAL J FuRNAcE 1
EAST COAST METALS LLC
For: House Plan 12-84, EAST COAST METALS LLC
273 Berry Street, North Andover, Ma
Job:
Date: Mar 01, 2012
By:
HEATING EQUIPMENT
Make Rheern
Trade RHEEM,RUUD,WEATHERKING
Model RGRS-04EMAES
AHRI ref 4356230
Efficiency
Heating input
Heating output
Temperature rise
Actual air flow
Air flow factor
Static pressure
Space thermostat
93.5AFLIE
Htg
Cig Infiltration
Outside db (IF)
3
88 Method Simplified
Inside db (OF)
68
75 Construction quality Tight
Design TD (OF)
65
13 Fireplaces 1 (Tight)
Daily range
-
M
Inside humidity
50
50
Moisture difference (gr/lb)
46
31
HEATING EQUIPMENT
Make Rheern
Trade RHEEM,RUUD,WEATHERKING
Model RGRS-04EMAES
AHRI ref 4356230
Efficiency
Heating input
Heating output
Temperature rise
Actual air flow
Air flow factor
Static pressure
Space thermostat
93.5AFLIE
Area
45000
MBtuh
42000
Btuh
62
OF
623
cfm
0.034
cfm/Btuh
0
in H20
COOLING EQUIPMENT
Area
Make Rheern
Cig load
Trade RHEEM 14AJM SERIES
CIg AVF
Cond 14AJM19
(ft2)
Coil RCFL-H*2417+RGRM-04?MAE?
AHRI ref 5550161
(cfm)
Eff iciency 13.0 EER, 16 SEER
BASEMENT
Sensible cooling 13090
Btuh
Latent cooling 5610
Btuh
Total cooling 18700
Btuh
Actual air flow 623
cfm
Air flow factor 0.087
cfm/Btuh
Static pressure 0
in H20
Load sensible heat ratio 0.94
820
ROOM NAME
Area
Htg load
Cig load
Htg AVF
CIg AVF
(ft2)
(Btuh)
(Btuh)
(cfm)
(cfm)
BASEMENT
1102
8512
1296
289
113
LIVING RM
182
2540
1601
86
139
FOYER
120
820
191
28
17
DINING RM
174
1559
1397
53
121
LAV
40
591
359
20
31
PAN
40
251
41
9
4
KITCHEN/BREAKFAST
547
4118
2294
140
199
FURNACE1
2204
18391
7177
623
623
Other equip loads
0
0
Equip. @ 0.93 RSM
6660
Latent cooling
479
TnTA I Q
10,301
-7-f qn
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2013 -Apr -14 22:47:23
wrightsoft, Right -Suite@ Universal 2012 12.1.05 RSU11815 Page 1
... Documents\rnel parris geo\EAST COST METALS 273 BERRY STREET.rup Calc = MJ8 Front Door faces:
HEATING / COOLING Load Short Form
MANUAL J FURNACE2
EAST COAST METALS LLC
For: House Plan 12-84, EAST COAST METALS LLC
273 Berry Street, North Andover, Ma
Method
Construction quality
Fireplaces
Job:
Date: Mar0l,2012
By:
Infiltration
Simplified
Tight
1 (Tight)
HEATING EQUIPMENT
Htg
Cig
Outside db (OF)
3
88
Inside db (OF)
68
75
Design TD (OF)
65
13
Daily range
-
M
Inside humidity
50
50
Moisture difference (gr/lb)
46
31
Method
Construction quality
Fireplaces
Job:
Date: Mar0l,2012
By:
Infiltration
Simplified
Tight
1 (Tight)
HEATING EQUIPMENT
Area
(ft2)
COOLING EQUIPMENT
CIg load
(Btuh)
Make Rheem
CIg AVF
(Cfm)
Make Rheem
514
Trade RHEEM,RUUD,WEATHERKING
Trade RHEEM 14AJM SERIES
192
Model RGPN-05(E,N)AUER
M BATH
Cond 14AJM19
975
AHRI ref 4356178
34
Coil RCFL-H*2414C
LAU
60
673
AHRI ref
23
Efficiency 80AFUE
BATH
Efficiency 11.5 EER, 13.5 SEER
875
Heating input 50000
MBtuh
Sensible cooling 12110
Btuh
Heating output 40000
Btuh
Latent cooling 5190
Btuh
Temperature rise 63
cF
Total cooling 17300
Btuh
Actual air flow 577
cfm
Actual air flow 577
cfm
Air flow factor 0.034
cfm/Btuh
Air flow factor 0.063
cfm/Btuh
Static pressure 0
in H20
Static pressure 0
in H20
Space thermostat
7A
Load sensible heat ratio 0.96
ROOM NAME
Area
(ft2)
Htg load
(Btuh)
CIg load
(Btuh)
Htg AVF
(Cfm)
CIg AVF
(Cfm)
MSTR BDRM
514
5572
2227
192
140
M BATH
90
975
534
34
34
LAU
60
673
460
23
29
BATH
90
875
518
30
33
BDRM4
217
2681
1053
92
66
BDRM3
233
2658
1783
92
112
UPPER FOYER
196
1162
930
40
58
Pr)PItAO
1 W,
131 A 11
1 r-nfl
7A
.4 Ar_
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2013 -Apr -14 22:47:23
wrightsoft* Right -Suite@ Universal 2012 12.1.05 RSU11815 Page 2
... DocurnentsXrnel parris geo\EAST COST METALS 273 BERRY STREET.rup Calc=MJ8 FrontDoortaces:
FURNACE2
1596
16738
9173
577
577
Other equip loads
0
0
Equip. @ 0.93 RSM
8513
Latent cooling
363
-rn-rA 1 0
1 rzniz
A r-7120
007r
r-
%-� I r,% L -j I �Jvu I UI 'JU Vul V it I 'JI A
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2013 -Apr -14 22:47:23
wright"ft* Righl-S,ite9 Universal 2012 12.1.05 RSU11815 Page 3
... Docurnents\rnel Parris geo\EAST COST METALS 273 BERRY STREET.rup Cale = MJ8 Front Door taces:
HEATING / COOLING Load Short Form Job:
Date: Mar 01, 2012
MANUAL J FURNACE 1 By:
EAST COAST METALS LLC
For: House Plan 12-84, EAST COAST METALS LLC
273 Berry Street, North Andover, Ma
ROOM NAME
Htg
Clg
Infiltration
Htg AVF
Outside db (F)
3
88
Method Simplified
Inside db (OF)
68
75
Construction quality
Tight
Design TD (T)
65
13
Fireplaces 1 (Tight)
Daily range
-
M
1601
86
Inside humidity
50
50
820
191
Moisture difference (gr/lb)
46
31
174
1559
HEATING EQUIPMENT
53
COOLING EQUIPMENT
LAV
Make Rheem
591
359
Make Rheem
31
Trade RHEEM,RUUD,WEATHERKING
Trade RHEEM 14AJM SERIES
251
Model RGRS-04EMAES
9
4
Cond 14AJM19
547
AHRI ref 4356230
2294
140
Coil RCFL-H*2417+RGRM-04?MAE?
FURNACE1
2204
18391
AHRI ref 5550161
623
Efficiency 93.5AFLIE
Other equip loads
Efficiency 13.0 EER, 16 SEER
0
Heating input
45000
MBtuh
Sensible cooling 13090
Btuh
Heating output
42000
Btuh
Latent cooling 5610
Btuh
Temperature rise
62
cF
Total cooling 18700
Btuh
Actual air flow
623
cfm
Actual air flow 623
cfm
Air flow factor
0.034
cfm/Btuh
Air flow factor 0.087
cfm/Btuh
Static pressure
0
in H20
Static pressure 0
in H20
Space thermostat
Load sensible heat ratio 0.94
ROOM NAME
Area
Htg load
CIg load
Htg AVF
CIg AVF
(ft2)
(Btuh)
(Btuh)
(cfm)
(Cfm)
BASEMENT
1102
8512
1296
289
113
LIVING RM
182
2540
1601
86
139
FOYER
120
820
191
28
17
DINING RM
174
1559
1397
53
121
LAV
40
591
359
20
31
PAN
40
251
41
9
4
KITCHEN/BREAKFAST
547
4118
2294
140
199
FURNACE1
2204
18391
7177
623
623
Other equip loads
0
0
Equip. @ 0.93 RSM
6660
Latent cooling
479
TnTA I Q
OOnA
40,201
71 in
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
wright:SOft* Right -Suite@ Universal 2012 12.1.05 RSU11815 2013 -Apr -14 22:47:23
Page 1
'40:;K ... Documents\rnel parris geo\EAST COST METALS 273 BERRY STREET.rup Calc = MJ8 Front Door faces:
HEATING / COOLING Load Short Form
MANUAL J FURNACE2
EAST COAST METALS LLC
For: House Plan 12-84, EAST COAST METALS LLC
273 Berry Street, North Andover, Ma
Job:
Date: Mar 01, 2012
By:
HEATING EQUIPMENT
Make Rheem
Trade RHEEM,RUUD,WEATHERKING
Model RGPN-05(E,N) AUER
AHRI ref 4356178
Efficiency
Heating input
Heating output
Temperature rise
Actual air flow
Air flow factor
Static pressure
Space thermostat
80AFUE
Htg
Cig Infiltration
Outside db
3
88 Method Simplified
Inside db (OF)
68
75 Construction quality Tight
Design TD (OF)
65
13 Fireplaces 1 (Tight)
Daily range
-
M
Inside humidity
50
50
Moisture difference (gr/lb)
46
31
HEATING EQUIPMENT
Make Rheem
Trade RHEEM,RUUD,WEATHERKING
Model RGPN-05(E,N) AUER
AHRI ref 4356178
Efficiency
Heating input
Heating output
Temperature rise
Actual air flow
Air flow factor
Static pressure
Space thermostat
80AFUE
11.5 EER, 13.5 SEER
50000
MBtuh
40000
Btuh
63
OF
5T7
cfm
0.034
cf m/Btuh
0
in H20
COOLING EQUIPMENT
Make Rheem
Trade RHEEM 14AJM SERIES
Cond 14AJM19
Coil RCFL-H*2414C
AHRI ref
Eff iciency
11.5 EER, 13.5 SEER
Htg load
(Btuh)
Sensible cooling
12110
Btuh
Latent cooling
5190
Btuh
Total cooling
17300
Btuh
Actual air flow
577
cfm
Air flow factor
0.063
cfm/Btuh
Static pressure
0
in H20
Load sensible heat
ratio 0.96
29
ROOM NAME
Area
(ft2)
Htg load
(Btuh)
CIg load
(Btuh)
Htg AVF
(cfm)
CIg AVF
(Cfm)
IVISTR BDRM
514
5572
2227
192
140
M BATH
90
975
534
34
34
LAU
60
673
460
23
29
BATH
90
875
518
30
33
BDRM4
217
2681
1053
92
66
BDRM3
233
2658
1783
92
112
UPPER FOYER
1%
1162
930
40
58
Dr*IDKA,3
Ina
131 A2
I r_r_n
7A
Ina
Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2013 -Apr -14 22:47:23
wrightsoft, Right -Suite@ Universal 2012 12.1.05 RSU11815 Page 2
... Docurnents\rnel parris geo\EAST COST METALS 273 BERRY STREET. rup Calc=MJ8 FrontDoorfaces:
FURNACE2
1596
16738
9173
577
577
Other equip loads
0
0
Equip. @ 0.93 RSIVI
8513
Latent cooling
363
TnTA I C
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I C-7130
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Calculations approved by ACCA to meet all requirements of Manual J 8th Ed.
2013 -Apr -14 22:47:23
wrightsoft' Right -Suite@ Universal 2012 12.1.05 RSU11815 Page 3
...Docurnents\rnel parris geo\EAST COST METALS 273 BERRY STREET.rup Cale = MJ8 Front Door faces:
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ACORD'
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYW)
04/16/2013
PRODUCER Phone: (781) 275-2114 Fax: (781) 275-3824
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MAGOVERN OFFICE I BALDWIN INSURANCE AGENCY, INC.
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
131 GREAT ROAD
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO BOX 559
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
BEDFORD MA 01730
INSURED
INSURERA: Central Mutual Insurance Company
EAST COAST METALS, INC.
INSURERB:
91 CHESTNUT STREET
INSURER C:
PEPPERELL MA 01463
INSURER 0:
VNSURER E:
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADEF-10CCUR
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSR
LTR
ADUO
INSR4
TYPE OF INSURANCE
POLICYNUMBER
POLICY EFFECTIVE
DATE (NIMIDWY)
POLICY EXPIRATION
DATE (MMIDDIM
LIMITS
GENERAL LIABILITY
CLIP 8454747
06/01/12
06101/13
EACH OCCURRENCE $ 1000000
DAMAGE TO RENTED
PREMISES (Ea o=rww) $ 300,000
1A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADEF-10CCUR
MED. EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
i
PRO -
7X POLICYF] -[FfT F-1 LOC
$
AUTOMOBILE LIABILrrY
ANY AUTO
BAP 8874211
07/29/12
07129/13
COMBINED SINGLE LIMIT $
(Ea accident)
BODILY INJURY
(P�r person) $ 1,000,000
ALL OWNED AUTOS
X SCHEDULED AUTOS
A
—
X HIRED AUTOS
X NON -OWNED AUTOS
BODILY INJURY $ 0
(Per accident)
PROPERTY DAMAGE
(Per accident) $ 5,000
I
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EAACC $
FANY AUTO
I
AUTO ONLY: AGG $
EXCESS I UMBRELLA LIABILITY
_X] OCCUR F ]CLAIMS MADE
CXS 8457788
06101/12
06101/13
EACH OCCURRENCE $ 1,000,000
AGGREGATE $ 1,000,000
$
A
$
DEDUCTIBLE
RETENTION $
$
WORKERS COMPENSATION AND
WC'STLATU
TO Y 'M'�. OTHER
EMPLOYERS'LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE F
E.L. EACH ACCIDENT $
E.L. DISEASE -EA EMPLOYEE $
OFFICFRIMEMBER EXCLUDED?
Ran atory In NH)
(M d
E.L. DISEASE -POLICY LIMIT $
if Y�' d.sMb� und.r
SPECIAL PROVISIONS belm
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
f'FRTIF11'ATF t4ni niFR CAN11111=1 I ATInN
John Fitzgerald
26 Upton Hills Lane
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
Middleton, MA 01949
DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, irs
AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE (--
Attention:
Judy Delzingo
ACORD 25 (2009/01) Certificate # 53043 @ 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
The Commonwealth ofmassachusetts
Department of Indusoial Accidents
Office of Investigations
600 Washington Street
Boston, AM 02111
www.massgovIdia
Workers' Compensation Insurance Affidavit: Builders/C-ontractors/Electricians/Plumbers
Applicant Information Please Print Legib
NaMC (Business/Organization/Individual): E&5 ktS 374NC-
Address:_%
City/State/Zip:
0 /14,(,,:? Phone#:
Are you an employer? CbU the appropriate box:
I am a emp loyer with 4. r] I am a general contractor and 1
Type of project (required):
employees (full and/or part-time).*
have hired the sub -contractors
6. E] New construction
2. 1 am a sole proprietor or partner-
listed on the attached sheet.
7. E] Remodeling
ship and have no employees
These sub -contractors have
8. Demolition
working for me in any capacity.
employees and have workers
9. Building addition
[No workers' comp. insurance
required.]
comp. insurance.T
5. FJ We are a corporation and its
I0.EJ Electrical repairs or additions
3. 1 am a homeowner doing all work
officers have exercised their
11. n Plumbing repairs or additions
myself. [No workers' comp.
right of exemption per MGL
12.n Roof repairs
insurance required.] t
c. 152, §1(4), and we have no
13.n Other
employees. [No workers'
co— insurance re uired 1
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' oomp. policy number.
I am an employer that is providing workers'compensation insurancefor my employees. Below is the polky andjob site
information.
Insurance Company Name:ll e Ap Finj
Policy # or Self -ins. Lic. I(- -q-,-rl 6 Expiration Date: 9.
Job Site Address: M3 b&�V_Li 5± - City/State/Zip: ('�(3
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 andpenalties ofperjury that the information provided above is true and correct.
Phone #:
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License#
,cAd/3.
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone
East Coast Metals Inc.
91 Chestnut Street
Pepperell, MA 01463
Name / Address
John Fitzgerald
26 Upton Hill Lane
Middleton, MA 0 1949
Estimate
Date
Estimate #
04/15/2013
IC10OA9991A
islo-er Sa na ure
Phone #
Project
273 Berry St No. An...
cell (508)509-9660 ...
Description
Qty
Cost
Total
East Coast Metals will furnish and install
15,500.00
15,500.00
I st floor
I - Rheern 95% gas furnace RGRC-04EMAES
I -Matching evaporator coil RCFL-HM2417CC
I -Rheern 13 SEER condensing unit 13AJN I 8AO I
2nd floor
I-Rheem 80% gas ftimace RGPN-05EAUER
I -Matching evaporator coil RCFL-HM2417CC
I -Rheem 13 SEER condensing unit 13AJN I 8AO I
2 -Trion Air Bear 2000 5" media air cleaner
2 -digital programmable thermostats
2 -propane conversion kits
permit
manual J load calculation
all duct will be sealed and insulated to Energy Star Standards
all bedrooms will have dedicated return registers
Duct is guaranteed to pass duct leak test (test not included in price)
will vent (3) bath fans (fans supplied by others)
will vent (1) dryer
will vent (1) kitchen exhaust
Exclusions:
electrician to run low voltage wires East Coast will make final
connections to equipment
Total $1 1;�500.00
islo-er Sa na ure
Phone #
Fax #
E-mail
cell (508)509-9660 ...
(978) 433-0657
mparris668 I @charter.net
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