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HomeMy WebLinkAboutMiscellaneous - 32 EMPIRE DRIVE 4/30/2018 BUILDING FILE. f` Date. . . .`.. .z.. .Z.... . .. . pf,HORTFi '1ti 3? �` TOWN OF NORTH ANDOVER p � A • . PERMIT FOR GAS INSTALLATION �9SSACHUSEt This certifies that . . . . . . . . . . . . . . . . . has permission for gas installat' n IV oAgV. . 4 t in the buildings of . . . . . dre // LQy�'. . . at North Andover, Mass Fee./ Lic. No.. . . . . . . . . . + . GAS INSPECTOR 4. Check# 124 { r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: R 1tlk hy� X� MA. DATE:-II"'I�- PERMIT# JOBSITE ADDRESS: ; Z L�wt/�f-u1 �I�..�c OWNER'S NAME: CAcW0,4\0 ui& - LLC-. OWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:J9 RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCESZ FLOOR, Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER i ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM NEATER WATER HEATER INSURANCE COVERAGE I have a current liabilqy insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY [jj' 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 [I AGENT ❑ SIGNATURE OF OWNER OR AGENT 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. PLUM BER/GAS FITTER NAME:__.STEPHEN C. GALINSKY LICENSE# 103LI16 — �( SIGNATURE COMPANYNAME: GALgS3KY PL006106 t Nrplll.➢E, ADDRESS: P.O- WX 1701 ,r CITY: 0AVERHILL, STATE: Pi-A. ZIP: 01831FAX: Sal-i4ISI TEL: 97K'3?H- 1743 CELL: wog - 5bW- 5904 EMAIL: W W'W• mC'Qw�be�( 0� tem MASTER[.( JOURNEYMAN❑ LP INSTALLER❑ CORPORATION/ 31 qh PARTNERSHIP❑# LLC❑# ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No Aw THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ _ FEE: $ PERMIT PLAN REVIEW NOTES 9381 Date. .`?'!!.z. . . . . . 3 NORTH •',;..�haoL TOWN OF NORTH ANDOVER 0- PERMIT FOR PLUMBING �SSCHUS This certifies that . . TC-?� . . . . .. . . . . . . . f has permission to perform . .Aw. plumbing in the buildings of at. . .3Z. . . ,f?' . . /-�?.!`. . . . . . . . . . . North pNorth Ando ei, Mass. Fee.yg3!0v Lic. No.. .A�P5'� .�e444./,44 . . . . . . . J/ PLUMBING INSPECTOR Check # � �7 -C-� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY M,op AA43JLA r- MA. DATE �'�� - 12 PERMIT# I , JOBSITE ADDRESS C-44P" Q&t, OWNER'S NAME Quu&VIII tu- P T OWNER ADDRESS TEL FAX ,- TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT NEW �' RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO ElCLEARLY FIXTURES Z; FLOOR BSMT 1 2 3 4 5 6 1 8 9 10 11 12 13 14 BATHTUB" " CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED'GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 7, URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142. Yes[?'No❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d OTHER TYPE OF 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 BOX ONLY: OWNER ❑ AGENT El Signature of Owner or Owner's 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 of the Massachusetts State Plumbing Code and Cha ter 142 o the General Laws. PLUMBER NAME STIEM+150 C_ GALIPSKY SIGNATURE LIC# IO34 S MP Rr' JP❑ CORPORATION F96 319 b PARTNERSHIP ❑# LLC ❑# COMPANYNAME 6AL40SKY PLUMOWL-, *- OVATILAU ADDRESS: P.D. GQx I?0i CITY HAy6iz"iLL STATE M.A- ZIP 0I131 EMAIL wvvw. t'r+f plorAbefWI . covet TEL g7$-37y- 174 3 CELL •550'8-,6Oo1-5g0,1 FAX C176-57,21-L413( I I ROUGH PLUMBING INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ r ��,/� FEE: $ PERMIT# PLAN REVIEW NO'T'ES Date........ ..`.`: ......."..Z-- r HORTI� °�<<``°;••'"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 1 CMuSE� This certifies that � � �'� .............................................. ............. ............................. has permission to perform .... ...............?5 -" �A wiringin the building of............................ ..................................................... atJ..;7 / <.�� ........ North Andover,Mass. m c� j :. Fee..��,.r� Lic.No..... <f..3�f 1.............. ............. ....., ..... / r ELECTRICALINSPECTO t Check # 10812 ' Commonwealth of : Ma . sea Chis o efts =ch=eckecd Department of Fire Services Permit N°'BOARD OF FIRE PREVENTION REGULATIONS �ecupancy and. 1/t)7j r APPLICATION FOR-PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code CAL WORK (PLEAMPRINT WDWX OR TYPE,4Z, R&O M 2yo (MEc).527 CMR 12.00 City or Town oh NORT11 Date:_ e _ 2 7_ �Z_ ANDO � BY To the Inspector of}fires: Location this the undersigned gives notice of bis or her,intention to perform the electrical work described below. (Street&Nnatber) lei L o /r j Owner or Tenant � , V, Owner's Address Telephone No. Is fibs permit In conjunction with a buil t Purpose ofBui3 ag s` . � yes ❑ No ❑ `(Check Appreprisfe Boa) Utility Authorization No.;/Z ?,Sfgi Existjing Service- / Volts Overhead❑ Un ' ew �v� Amps Jia l2 Volts �'d❑ No.of Meters ------ Z Overhead❑ Undgrd No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Worts: ' Co letton o the ollowin"table be waived b thector o Wirer. No.of Recessed Luminaires No.of Cell.-Suep.(Paddle)Fans °• o No.ofLumi� sire Outiets Transformer's 1 1... Jw",n.l`--lJ=T°' y�•►i .i«..Aia-..w 'eef� ....'�L; SwimmingPaol ' 9 [� - •❑ ° n d. 1Wg�� No.of Receptacle Outlets No.of On Burners units It=ALARMS No:of Zones No.of Switches No.of Gas Burners U-NA Juawguen an 1 No.of Ranges Initia Devices . ` No.of Air Cond., ° " Tons No.of Alerting Devices No.of Waste Disposers t Tatxls: Deteetfoa/Al . No,of Dishwashers Devices• Space/Area Heating XW I No.of d Conne: on Other Dryers Heating.Appliances �, scarify ystens: 0.0 ager Kw a.o o.o No.of Devices or E uivaleat 1 Heats Sf s Baiiasu. 0 8: No.H dronassa a Bathtubs of Devices or E aivalent Y $ No.of Motors Total HP ecomm sons OTHER: No.of Devices or uiV t Estimated Value of Electrical Work: Attach addWonal detail if desired oras,required by the Inspector of Wires j Work to Start n (When required by municipal policy) Inspections to be requested in accordance with MEC Rule 10 and INSURANCE COVERAGE: Unless waived by the owner,no permit for the mon completion. the licensce.provides proof of liability insurance mel perfoimamce of electrical work may issue unless T8"completed operation. coverage or its subsatial equivalent. The undersigned certifies that such coverage is' and has exhibited.proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ OTR ❑ (Spec I certify,under thepains and penalties efperfwy,drat the ' o ) mf rniatfox on dela alicarloac is frac and complete Licensee: /", r}. ,�_;� �r+r LIC.NO: ,9,9 Pf apPlicabl ",en` r"exempt••to the license number Ane) Signature, LTC.NO Address: Bit:.Tel.No.. *Per M.G.L c. 147,s.57-61,security work requires D Alt:Tel.No.: OWNER'S INSURANCE W aparttnerrt Public Safety"S" cense. Lic.No. RIVER. I am aware that the Licensee does not have Sze liab • required by law. By my signature below,I l e eby waive this u' '�'muce coverage normall Owner/Agent ! meat I am the(chec9ze!t Signature Telephone No. ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL L ROUGH INSPECTION: Passed- ' Failed- Reins tion aired 550.00)-[ Iuspecto menta: - (Ins rs' re -no itjlitiaks) Date 2.FINAL INT PECTION: Passed-FZ Failed- Re-ins ection required(580.00 -I Inspectors'co ents: ns tors'S - nature-no initials) 3.UNDER GROUND INSPECTION: Passed-I l Failed-I ] Reins tion required($50.00)-I Inspectors'comments: (Ins tors'Signature-no initials) Date J- 4.INSPECTION-SERVICE: DATE CAIJXED NATIONAL GRID: NAME: Passed Failed-[ Re-baspectionaired($50.00)_j j Inspectors'commen Inspectors'Si ature-no initials Date S.INSPECTION-OTHER: Passed-I I Failed fi-------n!equlred($50.00 - Inspectors'comments: (Insl I ors'Signature-no initials Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF %00 IS To i I LAWRENCE H.OGDEN, P.E. 198 EAST MAIN STREET 978-352-8318 fax 978 352-2858 cell: 978-502-5921 April 25, 2012 Mr. Robert Messina Orchard Village LLC. 277 Washington Street Groveland,Ma 01834 RE: THE WILLOW GBS#6213 Lot 5 Empire Drive,North Andover,Ma. 01845 Dear Mr. Messina Asou requested I visited y q s ted the site 4/25/12 to review the installation of the Engineered Materials consisting of LVLs and Engineered Joist utilized in the framing of the above project. These are shown on plans prepared by G.J. Bruno and Associates A- 1 to A-5 Dated 7/30/09 with the framing sheets certified by me 6/15/10, and sketch SK-I dated 2/15/11. Based on the above site visit and based on what I could visibly see I can certify that to the best of my knowledge the LVLs members and Engineered Joist utilized in the framing as shown on the drawings are installed properly and meet the loading conditions of the7th Edition of the Massachusetts State Building Code for 1&2 Family Residences. All other framing requirements of the drawings and code, including but not limited to materials,nailing schedules,blocking,connections and other details are the responsibility of the licensed construction supervisor responsible for the project. Should you have any questions please do not hesitate to call. Y7ence'l y, li OF La . OgdenP.E. Structural 27765 0� � '1AWR9Vcar- ti q LD Cc:Mr. Geny Bruno Mr. Jeff Horne 4f zs t Z Copy mailed to Mr. Robert Messina �o�F sT E �c w� ss�©NAL t aw: 135 Date.�/—� .' .`P.17 .. .. .. HpRTM pf TOWN OF NORTH ANDOVER t 1ti e p 0 `p PERMIT FOR MECHANICAL INSTALLATION 4 � . y �9SSACHUSESt This certifies that . .`!?.: . . �!!�` . . . . . . . . . . . . . . . has permission for mechanical installation in the buildings of ?. . . . . . . . . . . . . . .. . . . . . .. at ./ 77 . ? . . . . . // , North Andover, Mass. Fee. . .'. Lic. No. t1 . . . . . . . . . . . . . . . . -GA llgSPE OR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date q123111 Estimated Job Cost: 75'00 Permit Fee: $ q_0.00^� Plans Submitted: YES NO Plans Reviewed, 'VE,,; VO Business License# Applicant License M I Business(Information: Property Owner i Job L.ecatior. Tnforrnation: Name: A.,4. G /, �lltil�'�a l Name: o� ��GSS��A� Street:_16 G21 gr- f V14 $ki f z Street: citylTow"..: Cib"JTown: /iJoticr Telephone:_1I1K N3 3 fI671 Telephone: 97k. X 37 Cl5'S 3 Photo I.D, required/Cony of Photo I.D.attazhed: YES v NCi .� Stefi;n{tial J-1 i(9-1-unrestricted license i J-Z i M. -2-restricted to dwellings 3-stories or Icss and commercial up to 10,000 sq. /2-storie3 or less Re3idential: 1-2 family Multi-family _— Cando!Townhouses Other Commercial: Office Retail Industrial Educational Instirational Cther Square Footage: under 10,000 sc,. ft. !over 10.000 sq. tt Number of Stories: Sheet metal work to be completed: New W'vrk: � Renovation: HVAC L//"' Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: Commonwealth of-Massachusetts Sheet Metal Permit Date: 23 Permit + Estinattd Job Cost $ 7500 Permit Fee: $ gD,OO Plans Submitted: YES_,NO PlansReviewed: YES NO Business License f �pp ltcant License P Business Information: Property- Owner/Job Leeatior. Informatiio-n: Name: /4• �GGcc l — Name Street:=_� `piyl �a �< SK ��-I' Street: `L 6 j ✓� 1 h Ciry,r,otvr.• Taw 'elt City/Town; ndoller Teiephone:_�_�H�Z Telephone: '17X37 q j16 j Photo I.D,required/Cony of Photo I.D.atta;.hed: YES Z - J-1 ! _ _ �'� Slafi initis! I-�.:nreSiriCted I'tcenbe - - - --- •- _- -- •. � ___ ._ J-7 f M-2-restricted to dweilirngs 3-1 35 Date.!�. �`�...� .'.... .. Residential: E-? fantiiy Iv( Commercial: Office 0, µO o'" 14- TOWN OF NORTH ANDOVER IrtStiF= �' •'• oD PERMIT FOR MECHANICAL INSTALLATION Square Footage: under 10,000 se. + Sheet metal work to be complete ��,s�'.••o•'`,s�� I S^CLAUSE HVAC. i Ietal WateI Metal Chi:nnel This certifies that . Gly . . . . . . . . Provide detailed description of wo has permission for mechanical installation a in the buildings of AC),�h�? at ., . . L '-' • , . • . . . ., North Andover, Mass. '-4 Fee. . .`. Lic. No.!•��. . \-6 . _ -GAS-INSPCCTOR WHITE:Applicant CANARY:BuildingDept. PI P NK:Treasurer r, INSURANCE COVERAGE: --~ --- I I have a current liabil[U Insurance pciicy or Ito equiva!a:nt nrhtch meet3 the,requirement$ of M.G.L.Ch. 112 Yes rc,No L If you have checked Yes,Indicate the type of coverage by checking the appropriate box helm: i A liability ir:surance policy Other type of indemnity El gond ❑ O'NNER'S INSURANCE WAIVER:I am aware that tha Ncansee does not hate the Insurance coverage required by Chapter 112 of the PAassachu$etts Ceneral Laws,and that my signature on this permit application waives th!s reeuirement. ChRck One Cnly Owner ❑ Agent Sigrai,ire cf Gwrer or Ov:ner's Agent i 13,1 checking this boxty-,I hereby certify that all of the deta'Is and Information I neve submitted for entered)regarding this application aro true and accurate t0 the best of my knowledge and that all shoot msial work and Instailationa performed ander the permit Issued for this app'ttatton will to In compllance with all pertinent provision of tits 540ssachusot:9Uitding Code and Chapter 112 of tho General Laws. / Duct Inspecticn required prior to Insulation installation: YES Nal (/ Proaress Inspections Date ccmments I final Inspection Date C ofrrren�s r— --- ype of Licanse: �f ----- — t3y -- N mosier I �i TUe �fJ193ter-Restrictea ❑Jo,,rneyperscn t Signature of Licensee Permit —` � ,�Jo.trnayperen-Ree-rb;tec $ License NUfricef. j F9a _ C�7eck a:WWW-M9ss.gc y,driI Inspector 31gnaturs of permit approval T i ' ..;. Ref kr l) 1, r t79f Ft S�Pp�y --�-�-�- � ff 1nd I� Sheet 1 T �/cfm � v tiv 1 st flocr Sn �fm I a y �r6 i ffl�fm 382 cfm 6ft, o I 71' family /7 tli 2�Id ff S h SC�rm I Job #: RA MECHANICAL INC Scale: 1 : 74 Performed for: Page 1 16 LOMAR PARK Right-Suite®Universal 7/',L PEPPERED- MA 01463 7.1.17 RSU11207 Phone:9784338671 Fax,.9784334900 2010-Oct-1411:21:08 e St ramechanical@aol.com C macuments and SetiingslALAM.. GhcrS� to eA ccs v�' y 2nd floor 7 'r 5" 103 cmf h ! *7n5 f. GX12 I 6B6 l' r �l 1 cfm 7 7 rr 7 2nd floor i �X'Z xtc� 205 cf , I� 205 cfm 1 4 w -7 �l 1" cfm 1 cfm Job#: TP rf nnect f r: RA MECHANICAL INC Scale: 1 : 74 / 17,10 cv 16 LOMAR PARK Right-Suites Universal PEPPERE LL, MA 01463 7.1.17 RSU11207 Phone:9784338671 Fax: 978433490() 2010-0d-1411:21:08 ramechanical@aol.com C:10ocuments and SettingslALAM... The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` Please Print Legibly Name (Business/Organization4ndividual).' Address: "I%,(/< -� p/N6 Phone#: �� - )12 _ 9� City/State/Zi / Are you an employer? C e k the appropriate box: Type of project(required): 4. I am a general contractor and I 1.El I am a employer with 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ 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 comp. insurance.: required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LF❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they 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 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 insurance for my employees Below is the policy and job site information. Insurance Company Name: 7fA G Policy#or Self-ins. Lic.#: A r A 6`7 Expiration Date: Job Site Address: 4 t-d C tnz_ City/State/Zip: N j). 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 a' and penalties ofperjury that the information provided above is true and correct Si afore: Date: `-/ 64 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: _--assaillio DAT A� CERTIFICATE OF LIABILITY INSURANCE F03/E 3E26 2D 2 i i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. r IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to lthe terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: FAX NORTH ANDOVER INSURANCE AGENCY, INC. (AIC"No, Ext): (978) 686-2266 (A/C, No):(978) 686-6410 M.J. FOSTER INSURANCE SERVICES ADDRESS: cfernandez@nafins.com PRODUCER p A . Mechanical Inc. 163 MAIN STREET CUSTOMER ID R. r NORTH ANDOVER MA 01845-2508 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A :PEERLESS INSURANCE CO R.A. . Mechanical, Inc. INSURER B :GUARD INSURANCE 16 Lomar Park INSURER C Suite 1 INSURER D INSURER E Pepperell MA 01463— 1 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR INSR NSR I I WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DDlYYY1'i (MM/DDIYYYY) A GENERAL LIABILITY Y CBP5337500 1/01/2012 1/01/2013 EACH OCCURRENCE $_ 1,000,000 X COMMERCIAL GENERAL LIABILITY AMAGE RENTED 100 000 PREMISES(Ea occurrence) `$ , CLAIMS-MADE X OCCUR / / / / MED EXP(Any one person) I$ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY! PRO LOC / / / / EBLIA $ A AUTOMOBILE LIABILITY BA8832363 b1/01/2012 01/01/2013 COMBINEDSINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS / / / / (Per accident) $ X NON-OWNED AUTOS / / / / $ $ A ]{ UMBRELLA UAB X OCCUR CD8825678 1/01/201201/01/2013 EACH OCCURRENCE Is 1,000,000 j EXCESS UAB 1CLAIMS-MADE AGGREGATE Is 1,000,000 DEDUCTIBLE / / / / $ j RETIII ENTION $ / / / / I$ j B WORKERS COMPENSATION RAWC231923 1/01/2012 '01/01/2013 WC STATU- IOTH AND EMPLOYERS' LIABILITY Y/N TORY LI M ff$ R ANY PROPRIETOR/PARTNER/EXECUTIVE / / / / E.L.EACH ACCIDENT $ 500,000 h OFFICERIMEMSER EXCLUDED? ❑ N/A (Mandatory In NH) / / / / E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under I DESCRIPTION OF OPERATIONS below / / / / E.L.DISEASE-POLICY LIMIT I$ 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. R.A. MECHANCIAL, INC. 16 LOMAR PARK AUTHORIZED REPRESENTATIVE SUITE 1 PEPPERELL MA 01463- ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 poogog) The ACORD name and logo are registered marks of ACORD �MASSAGHL7SUITs' DRIVER'S =� LICENSE .... . OF Mqs@ - 9a END- 4d NUMBER-.: NONE 18 ;� 59357 a ;. : 10 .984 w s E ..75 t .._ TTE +, ..._.. a 657 MAMMOTH RD rt DRACUT,MA 01828.4349 � 5 OD 09.03•t010 Rev 07.7SI009 ' COMMONWEALTH OF MASSACHUSETTS" ' , SHEET METAL WORKERS AS A MASTER-UNRESTRICTED - ISSUES THE ABOVE LICENSE TO: DONALD J OUELLETTE 657 MAMMOTH RD - DRACUT MA 01826-4349 4688 07/28/12 947069 • LOLA I b A Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to- / apprentice ratios V Equipment sized per heating cooling/ liload 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 usingand Pro proper P gauges es g hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining . New/clean -properly sized filter installed (final inspection) Testing and Balancing report complete(final sign-off) g fl f