HomeMy WebLinkAboutMiscellaneous - 391 STEVENS STREET 4/30/2018This certifies that ......
has permission to perform IVEUJ S.
wiring in the building of A
......................
at 3q 4� ....... T�()rth Andover, Mass.
IT
Fee J. Lic. No .. ...... .........
ELECTRICAL INSPECTO
Check 4 Z-/
11400
<L.\ Commonwealth of Massachusetts Official Use Only
Permit No. l LID O
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/07] (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 27 CMR12.00
(PLEASE PRINT ININK OR TYPE ALL )NFORMATION) Date:
City or Town of. NORTH ANDOVER To the Inspectol of Miresk
By this application the undersigned given ce of his or her intention to perform the electrical work described below.
Location (Street & Number) S .SV,
Owner or Tenant / G-121
fJA
Telephone No. C ! % ��
No. of Luminaire Outlets
Owner's Address U
Generators KVA
1-1--
Swimming Pool Above ❑In- El
rnd. grnd.
Is this permit in conjunction/with a buildin ermit?
' V
Purpose of Building t %�/ .�i/Z�-
Yes No ❑ (Check Appropriate Box)
Utility Authorization No. , V4 E) 3
y
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
�
- Existing Service Amps / Volts
Overhead ❑
Undgrd ❑ No. of Meters
No. of Alerting Devices
New Service C� AmpsVolts
Overhead ❑
Undgrd_ No. of Meters_
C�
Number of Feeders and Ampacityp�`,
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers .
Location and Nature of Proposed Electrictal Work:
Completion ofthe following table may be waived by the Inspector of Wires.
No. of Recessed Luminaires
No. of Cell: Susp. (Paddle) Fans
TransTotal
Trsformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑In- El
rnd. grnd.
No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ran es
g
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Dis posers
p
Heat Pump
Totals;
Number
-
Tons
J.KW
..........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers .
S ace/Area Heating KW
p g
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
Heating Appliances KW
SecuritySystems:*
ces or Equivalent
No. of Water
Heaters KW
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
Hydromassage Bathtubs
No. of Motors Total HP
WirinNo.
Telecommunications No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: - (When required by municipal policy.)
Work to Start: 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 BOND ❑ OTHER ❑ (Specify:)
I certify, tinder the pai s and penalties of erjury, Ili at the info oration on this application is true and complete.
FIRM NAME:. �. r LIC. NO.:
Licensee: Signature LTC. NO.:��
(If applicable, enter "exem t" in the license numb r 1'ne.) Bus. Tel. No.:
Address: r/k-" " T Alt. Tel. No.: t 3�-
*Per Lc. 47, s. -57-6I, security work requires Departmen of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent PERMIT FEE. $
Signature Telephone No.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesfigations
600 Washington Street
Boston, MA 02111
UT www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name
Address:
City/State/Zip:
C:
Are yyoouan employer? Check the appropriate box: Type of pr ' t (required):
1. !°'I I am a employer 4. ❑ I am a general contractor and 1 6. Kew 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. # �• ❑Remodeling
ship and'have no employees These sub -contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
required.] officers have exercised their
3. ❑ I am a homeowner doing all work right of exemption per MGL I L ❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, § 1 (4), and we have no 12.❑Roof repairs
insurance required.] s 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 a -re doing all work and then hire outside contractors must submit anew 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 is providing workers' compensation insurance for my employees. Below is thepolicy and job site
information. I% j
Insurance Company Name: T Zg2fdj
Policy # or Self -ins. Lic. #:/,✓c- L77) �_�� Expiration Date:
Job Site Address: ��,�ii1(5 ,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 DTA for insurance coverage verification.
I do hereby cert jo upd'er the pains and penalties ofperjury that the information provided above is trge and correct.
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. lEIectrical Inspector 5. Plumbing Inspector
6. Other -- - -
Contact Person: Phone #:
0972.5 Date I, -Pld-112--
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
has permission to perform...'va—.�.. 4q ...............
plumbing in the buildings of. . .................
at. . .-,-J.1.1. .5/ ............ North Andover, Mass.
Fee Lie. No.
................... ...
PLUMBING INSPECTOR
Check # /0)
•" "`
MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK
-
CITY � ."tel/ �il/Q,a(f�-� . MA DATE /y,� PERMIT #
`
JOBSITE ADDRESS OWNER'S NAME p,y/ P y�y j����i�
OWNERADDRESS , .. __...._ _. _ ... _..._ ...._.. _ _........ �.._ _..... TELI. JFAXC�
TYPE OR
OCCUPANCYTYPE COMMERCIAL E-1 EDUCATIONAL RESIDENTIAL
PRINT
CLEARLY
NEW: RENOVATION: REPLACEMENT: [ PLANS SUBMITTED: YES 1-71 NO
FIXTURES 7. FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14
BATHTUB
CROSS CONNECTION DEVICE _
-^i:.:..
DEDICATED SPECIAL WASTE SYSTEM
DEDICATED GASIOIUSAND SYSTEM
DEDICATED GREASE SYSTEM I._::....:..i(-.I—^I:.......
GRAY WATER SYSTEM
DEDICATED
DEDICATED WATER RECYCLE SYSTEM
DISHWASHER
DRINKING FOUNTAIN'
FOOD DISPOSER_L—.-__L-_-I�
FLOOR lAREA DRAIN
INTERCEPTOR (INTERIOR)
KITCHEN SINK
LAVATORY C%,_.; _;
ROOF DRAIN=__I
SHOWER STALL L .—'EZD i—l[-�.'s.[—__..i
SERVICE MOP SINKI_._._.._-II—._-_iI__:_L._-ISL
TOILET
URINAL-'�{--.I.
WASHING MACHINE CONNECTION,;
WATER HEATER ALL TYPES ,.:___....'LI�,--�L--I'
WATER PIPING
OTHER
s cc_c ,I
v sI
_,
__.,.. - _....: __........_.........._:
_ .. --.__.._.........._..- ......__, _
-
_......_..__.._..._._.. .._.._._ _77,
r_---.
INSURANCE COVERAGE:
I i lave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES
iF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY Q BOND El
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
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 pliance with all Pertinent prov' 'on of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
d�//
PLUMBER'S NAME ..... _ LICENSE # I1,2 8 SIGNATURE
MP[ JP CORPORATION(# PARTNERSHIP[ # LLCEI#
COMPANY NAME ,r/ j�j�Lc rye, ADDRESS
CITY •�/�(/ /�.L.. STATEZIP TEL 92 —7
FAX CELL j� EMAIL'.c)
12� Vi/III Utv& 114 LLCV' � V. 91.E
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/Organization/Individual):
Address: l'.�{ D�,J/.�il/� ��• .
City/State/Zip:,,7—Mone 7k aZ o2 9
Are you an employer? Check the appropriate box:
loyer with
1. ❑�ama
4. ❑ I am a general contractor and I
(full and/or part-time).*
have hired the sub -contractors
2.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. ❑ We are a corporation and its
required.]
3. ❑ 1 am a homeowner doing all work
officers have exercised their
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6.ew construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11. El Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
fain an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
%reformation.
Insurance Company Name:
'olicy # or Self -ins. Lic. #:
Expiration Date:
`ob_Site Address: 17/ —117c6l,,X- _, - ST, ti yr v City/State/Zi
kttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine 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
f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
nvestigations of the DIA for insurance coverage verification.
do hereby certifyInder the p anel penal i of perjury that the information provided above is trye and correct.
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
t.l -
Lic:E 0
NN
.�
EJ1tS3R MSCR
ISSUES THE ABOVE LICENSE
1 KIEL C ELSEMILL.ER
t 0L A°ANKEE RD
iLA I RHIL;. MA 01.832 10.67.
'.1288 05/0.1/14 147729
t
�COIUTROL#.H35O�4IMPORTANT
Ir
t ;ihis licenseis. lost or<,¢esGroyed, notify your Board at the: '•
Division of Professional Licensure, 1000 Washington St.,
Suite 710, Boston, NIA 02118-6100.
if your name or address shown is changed, notify your board
of correct name or address to insure proper mailing of next
Renewal Application. Always refer to your license number.
This license is subject to the provisions of the General Laws .
as amended. It is a personal privilege, and must not be loaned
or assigned to any other person. Keep this license on your
person or posted as required by law.
z
1
l
i
J
This certifies that.
�40"-.4 ...........
has permission for gas installation. . AJ.- -
in the buildings of. ., . . I
A - I //,-, e;, '/ .......................
at ...... Q/0 . U North Andover, Mass.
J ..........
Fee /4Y&.A) Lic. No.
GASINSPECTOR
Check # 6 6 � -
8509
12— l i [ LAA fY ej 11" 4 v2A,c.L_ Vfin "�
MASSACHL4SETTSLINIFORM APPLICATION FOR A PERMIT' TO PERFORM GAS FITTING VVORK
ww"
CITY - MA DATE�PERMIT# G Ot! SS 69k
�:/�
�
JOBSITE AD DRESS .sem moi, % OWNER'S NAMEi
�-
OWNERADDRESS TE1� FAX
.I _
TYPE OR
PRINT
OCCUPANCYTYPE COMMERCIAL EDUCATIONAL RESIDENTIAL
CLEARLY
NEW:RENOVATION; ED REPLACEMENT: C] PLANS SUBMITTED: YES[ ,� NOa
APPLIANCES 1 FLOORS- BSM 1 1 2 1 3 4 5 6 7 8 9 10 11 12 13 14
BOILER E
BOOSTER
CONVERSION BURNERCOOK
STOVEI---.( (— r.... L_ ....,... :.•I :...'-'. -^!I:.... (-
DIRECT VENT HEATER �.. L. _...'I �:_.. ,.?I.!(_.
--- ---
DRYER 1.. .:..: I<...- I- i (...
- ---
(_--1-__===F.
_.�
FIREPLACE
FRYOLATOR (.:"-V F7.71
FURNACE
GENERATOR__....:
GRILLE --' — — E
i ,
INFRARED HEATER - -- — — - —
LABORATORY COCKS
- -- -- ---
MAKEUP AIR UNIT - ---.h ... _!:..._._ F— �.—:r __r __�:_ �_� [7-
__ -�_
OVEN
POOL HEATER :�-� L- Y (-----
_
ROOM /SPACE HEATER [, I .. --- [__-- _(- �_ _._ .. -- -'r _. _ .... _ r _ E- .. _2 I. ..:. 1_._ ._ _EI_. i
N
�__._
ROOF TOP UNIT �_:....:_. (`_.!(u(li^._-L-^(--..._...`L-T.`t.__:_..:_
TEST --:L---- __:.;:'I:. ;.... �...�._ l:.. I:.:....._...._
_.__ .__........_
UNIT HEATER (.�- L.�.:..`L i_ (..,..._......:..
_ .._._
DR OM HEATER L::......(.._::_ I............_r.:...r
WATER HEATER `--- '— !-- -
r_)OTHERt.............
if f --
--IF
-
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES i
IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY c-- OTHER TYPE INDEMNITY E.J. BOND
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
CHECK ONE ONLY: OWNER [ AGENT C
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge
and that all plumbing -work and installations performed under the permit issued for this application will be in com nce with all rtinent pr v' 'on of the -
Massachusetts State Plumbing Code and Chapter 142 of the General Laws. t
PLUMBER GASFITTER NAME ��,q,.Y/ LICENSE # j/ SIGNATURE
MP ... GF (Q JP0 JGF r_j LPGID CORPORATION [#�-- PARTNERSHIP [ # LLC P,#=
COMPANY NAME:( j ,.� S� �, ADDRESS
CITY STATE ZIP 3� TEL �` 7.8 7z /��..
�.1. L Z
_ _ _
5`
FAX ... ... _.. _.__.._..__ CELL 54..._`x./ %/: EMAIL ...___r'S:M?
12— l i [ LAA fY ej 11" 4 v2A,c.L_ Vfin "�
c..
w The Commonwealth of Massachusetts
Qlfr
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
'i www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: 7 C
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
emees (full and/or part-time).*
have hired the sub -contractors
2. am a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
working for mein any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.].t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6.ew construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
am an employer that is providing workers' compensation insurance for my employees. Below is thepolicy and job site
formation.
tsurance Company Name:
alicy # or Self -ins. Lic. #:
Expiration Date:
)b Site Address:_ 37,1 sTE(/ .:/S ST y a__Ui2v� City/State/Zip:
ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ie 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
up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
vestigations of the DIA for insurance coverage verification.
to hereby certif'nder the p anel penal i of perjury that the information provided above is trye and correct.
Official use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/Licence #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk
6. Other
Contact Person:
.�"
•
4. Electrical Inspector 5. Plumbing Inspector
Phone #:
s,I
41_
l
r!
1
184 Date.
t�ORTH TOWN OF NORTH ANDOVER
PERMIT FOR MECHANICAL INSTALLATION
This certifies that Y�"'J. ................. Al
has permission for mechanical installation
1A.0 ..............
in the buildings of . k-'(,A)� J." --.'d pv� ...............
c '
at .... ) . . -� .0 Q (e ...... North Andover, Mass.
Fee�.U%!T.-. Lic. No.A�An(,P:�. . Nk .....................
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. I PINK: Treasurer
Commonwealth of Massachusetts
Sheet Metal Permit
Date: 4Ajl�o__
Estimated Job Cost: $
Plans Submitted: YES A___ NO
Business License # //i&4_3
Business Information:
Named
Street:.-�
City/Town: ,Vi 44-j,—-
Telephone:'? 7 ,?- *4/4 J 6 k 2"4�
Permit #
Permit Fee: $
Plans Reviewed: YES NO
Applicant License # f 1 j 4-Z
Property Owner / Job Location Information:
Name:PQ�,� , h"Al
Street
`o 7-
City/Town:
City/Town: d Y- T�/ 711 'gni !n�
Telephone: s/S %,G 9 2e
Photo I.D. required / Copy of Photo I.D. attached: YES NO
J-1 / M -1 -unrestricted license v-'
Staff Initial
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 ✓ Multi -family Condo / Townhouses Other
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. over J 0,000 sq. ft. Number of Stories:
Sheet metal work to be completed: New Work: ✓ Renovation:
HVAC V Metal Watershed Roofing Kitchen Exhaust System
Metal Chimney / Vents Air Balancing
Provide detailed de(c\\\rii�ption of work to be (done:
�i I 1 _ All. , i\7ML11 /1/V sig VA1
11/ UI/ LUlL 1U..L0
1 _
RODUCER
Cowan Insurance Agency, Inc.
359 Main Street
i7IOZ)ZJ_w007 UUWAN INbUKHIVVt F'Alat bl/Ell
CERTIFICATE OF LIABILITY INSURANCEF__
DATE(MMlDDNYYY)7112
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Haverhill MA 01830
INSURED Desired Tem erature I
P , nc,
1855 Bridge Street
Dracut MA 01826
INSURERS AFFORDING COVERAGE I NAIC #
THE POLICIESOF INSURANCE LISTED 13ELOW HAVE BEEN ISSUEDTOTHE INSUREDNAMEDABOVE FORTHEPOLICY PERIOD INDICATED.
NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE_ ISSUED OR
MAY PERTAIN, THE INSURANCEAFFORDEDBYTHEPOLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
/NSR
W00'
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
GENERAL
LIABILITY
LIMITS
EACH OCCURRENCE
11000000
A
X
COMMERCIAL GENERAL LIABILITY
I CLAIMS MADE X❑ OCCUR
3D27294
08103/12
08103113
DAMAGE TO RENTED
..2BEt>1i19�,S•.(Fe occurence) ^
� 100r000
x
Blanket additional insured
MED EXP An one eraon
5,000
_
PERSONAL & ADV INJURY
$ 1,000,000
$ 2 OOO,OOO
I GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
5-2,000,000'•- `
)(
F I' PRO.
PRODUCTS -COMF/OPAGG
POLICY LOC
AUTOMOBILE
LIABILITY
A
ANY AUTO3-727294
08/03/12
08/03/13
(E M=IidpDtSINGLELIMIT i
B
ALL OWNED AUTOS
X
SCHEOULED AUTOS
BODILY INJURY
(For person)
$ 100,000
X
HIRED AUTOS
••
-
X,
NON-OVVNED AUTOS
BODILY INJURY
300,000
GARAGE LIABILITY
ANY AUTO
EXCESS / UMBRELLA LIABILITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
B I ANY PROPRIETOR/PAR7NERlEXECUTIV Y/ N
...,.....____ T.: 1 TWC3294503
OTHER
( Orocu ant(
PROPERTY DAMAGE $ 100 000
(Per accident) I
AUTOONLY-EA ACCIDENT_ •$ _
OTHER THAN GAACC $
AUTO ONLY: ,
S
4 `
pTH-
E_ inn nnn
x I WC STAT
MIT$ — FL
08/03112 08103113 a. F4/ W nrrinc. _
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES I EXCLUSIONS ADDED BY ENDORS2MENT I SPECIAL PROVISIONS
978 688 9542
EA EMPLOYEE 5 100,000
-
POLICYI IMIT i Q 50A nnn
HVAC Contractor. All parties as required b contract are listed as additional insureds on the general liabilityinsurance policy,
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANYOF THE ABOVE DE SCRIBED POLICIES BE CAN CELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O
Building Department GAYS WRITTEN
1600 Osgood St NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFT, OUT FAILURE TO DO SO SHALL
North Andover, MA 01845 IMP ^` .LN ILI Y KIND UPON THE INSURER ITS AGENTS OR
Town of North Andover
The ACORD name and logo are rstered ks o'�UKYVRATION. All
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Component Constructions Date. 5.87.10.8.1.12
ah i By:
DESIRED TEMP
e-roject initormation
For. TOM PATENAUDE HOMES INC, DESIRED TEMP
LOTI STEVENS ST., NORTH ANDOVER, Ma
]Psion Conditicc
Location:
Or
Indoor:
Heating
Cooling
Lawrence Muni, MA, US
Loss
Indoor temperature (°F)
70
75
Elevation: 151 ft
1F
Design TD (°F)
67
9
Latitude: 430N
aw",
Relative humidity (%)
30
50
Outdoor: Heating
Cooling
Moisture difference (gr/Ib)
27.7
30.3
Dry bulb (°F) 3
84
Infiltration:
n
264
Daily range (°F) -
18 ( M)
Method
Simplified
0.65
Wet bulb (°F) -
71
Construction quality
Tight
0.065
Wind speed (mph) 15.0
7.5
Fireplaces
1 (Tight)
248
Construction descriptions
Or
Area
U -value
Insul R
Htg HTM
Loss
Clg HTM
Gain
-
a
1F
Bht ft' --"F
tt2-°F/Bhfi
BU ft
Bhfi
aw",
Btuh
Walls
e
42
0.470
0
31.6
1327
33.2
1394
12F-0sw: Frm wall, wd ext, 3/8" wood shth, r-21 cav ins, 1/2" gypsum
n
264
0.065
21.0
4.37
1153
0.65
171
board int fnsh, 2" x6" wood frm
a
384
0.065
21.0
4.37
1676
0.65
248
s
264
0.065
21.0
4.37
1153
0.65
171
sw
14
0.065
21.0
4.37
62
0.65
9
w
353
0.065
21.0
4.37
1542
0.65
228
Doors
nw
14
0.065
21.0
4.37
62
0.65
9
11 E0: Door, wd sc type, wd strm
all
1293
0.065
21.0
4.37
5648
0.65
836
Partitions
(none)
Windows
4A5-2ow: 2 glazing, dr low -e outr, argon gas, wd frm mat, dr innr, 1/2"
n
24
0.470
0
31.6
758
10.0
.241
gap, 114" thk
a
60
0.470
0
31.6
1905
33.2
2002
e
42
0.470
0
31.6
1327
33.2
1394
s
24
0.470
0
31.6
758
17.8
427
sw
11
0.470
0
31.6
358
29.1
330
w
76
0.470
0
31.6
2400
33.2
2523
nw
11
0.470
0
31.6
358
23.1
261
all
249
0.470
0
31.6
7863
28.8
7179
Doors
11 E0: Door, wd sc type, wd strm
w
21
0.260
0
17.5
367
5.50
115
Ceilings
--_ _
-
C part ceiling,: C part ceiling, hrd wd fir fnsh, frm fir, 8" thkns, 1/2"
14
0.255
1.0
17.2
240
11.4
160
gypsum board int fish
Floors
19A-19bswp: Part floor, hrd wd fir fnsh, r-19 ins, frm fir, 8" thkns
20
0.049
19.0
2.58
52
0.34
7
.tVVrI I1tS®ft°
,.�. � Right -Suite® Universal 201212.0.13 RSU11815
2012 -Oct -1006:34:02
14CCK ...sVaul\DocumentsV)ESIREDTEMPIDESIREDTEMPLOT5NANDOVER.rup
Calc=MJB
faces: N
Page 1
Job: 5.87.10.8.1.12
ATI of Building Analysis Date:
ah 1 By:
Duct Design DESIRED TEMP
DRACUT,Ma
For. TOM PATENAUDE HOMES INC DESIRED TEMP
LOT 5 STEVENS ST, NORTH ANDOVER, Ma
Component
D - • e
e e
% of load
Walls
Location:
5648
Indoor:
Heating
Cooling
Lawrence Muni, MA, US
48.5
indoor temperature (°F)
70
75
Elevation: 151 ft
Ceilings
Design TD (°F)
67
9
Latitude: '430N
2.6
Relative humidity (%)
30
50
Outdoor: Heating
Dry bulb
Cooling
Moisture difference (gr/Ib)
27.7
30.3
(°F) 3
84
Infiltration:
0
Daily range ff) -
18 (M)
Method
Simplified
0
Wet bulb(' ) -
71
Construction quality
Tiht-
Adjustments
Wind speed (mph) 15.0
7.5
Fireplaces
1 Might)
Component
Btuh/ft'
Btuh
% of load
Walls
4.4
5648
34.9
Glazing
31.6
7863
48.5
Doors
17.5
367
2.3
Ceilings
17.2
240
1.5
Floors
2.6
52
0.3
Infiltration
1.3
2034
12.6
Ducts
0
0
Piping
0
0
Humidification
0
0
Ventilation
-
0
0
Adjustments
0
Total
16204
1 100.0
Component
Btuh/ft2
Btuh
% of load
Walls
0.6
836
8.3
Glazing
28.8
7179
71.0
Doors
5.5
115
1.1
- Ceilings
11.4
160
1.6
Floors
0.3
7
0.1
Infiltration
0.1
143
1.4
Ducts
0
0
Ventilation
0
0
Internal gains
1670
16.5
Blower
-
0
0
Adjustments
0
Total
10110
100.0
Latent Cooling Load = 505 Btuh
Overall U -value = 0.132 Btuh/ft2 °F
Data entries checked.
�� Wrl htsoft® 2012 -Oct -1006:34:02
9 Right SuiteCal Universal 2012 12.0.13 RSU11815 Page 1
I&...sVauRDocumenfsUESIREDTEMPNDESIREDTEMPLOT5NANDOVER.rup Calc=MJ8 faces: N
Building Analysis
T ah 2
DESIRED TEMP
DRACUT,Ma
For.
Location:
Lawrence Muni, MA, US
Elevation: 151 ft
Latitude:' 430N
Outdoor:
Dry bulb (°F)
Daily range F)
Wet bulb (° )
Wind speed (mph)
TOM PATENAUDE HOMES INC, DESIRED TEMP
LOT 5 STEVENS ST., NORTH ANDOVER, Ma
Job: 5.87.10.8.1.12
Date:
By:
Component
_
Indoor:
Heating
Cooling
Walls
Indoor temperature (°F)
Design TD (°F)
70
67
75
9
Heating Cooling
3 84
Relative humidity (%)
Moisture difference (gr/Ib)
Infiltration:
30
27.7
50
30.3
- 18 ( M)
15.0 7.5
Method
Construction quality
Fireplaces
Simplified
Tiht
1 Tight)
0
Component
_
Btuh/ft'
Btuh
% of load
Walls
4.4
10386
46.2
Glazing
31.6
5484
24.4
Doors
0
0
0
Ceilings
2.2
3273
14.6
Floors
0
0
0
Infiltration
1.3
3320
14.8
Ducts
0
0
Piping
0
0
Humidification
0
0
Ventilation
0
0
Adjustments
0
Total
22464
100.0
Component
Btuh/ft2
Btuh
% of load
Walls
0.6
_ 1538
12.8
Glazing
35.6
6186
51.5
Doors
0
0
0
Ceilings
1.4
2175
18.1
Floors
0
0
0
Infiltration
0.1
234
2.0
Ducts
0
0
Ventilation
0
0
Internal gains
1870
15.6
Blower
0
0
Adjustments
0
Total
12003
100.0
Latent Cooling Load = 1499 Btuh
Overall U -value = 0.070 Btuh/ftp °F
Data entries checked.
^.L Wri htso Ri2012-Oa-1008:34:02
g Right-Sufte® Universal 2012 12.0.13 RSU11815 Page 2
/CICA ...slpaul\DocumentslDESIREDTEMP\DESIREDTEMPLOT5NANDOVER.rup Calc=MJ8 faces: N
ah 2
Other equip loads
2083
22464
12003
793
793
0
0
Equip. @ 0.89 RSM
10658
Latent cooling
1499
TOTALS
9nRI
ARA
4n4 G7
/.7J
Calculations approved byACCA to meet all requirements of Manual J 8th Ed.
wrightsofte Right-Suitee Universal 201212.0.13 RSU11815 2012 -Oct -10 06:34:02
ACCK slpaul\Documents\DESIREDTEMPIDE8IREDTEMPLOT5NANDOVER.rup Calc=MJB faces: N Page
TLN CONSULTING, LLC
STRUCTURAL ENGINEERING SERVICES
505 Middlesex TPK
Unit 14
Billerica, MA 01821
Phone — (978) 362-1804
Mobile — (978) 406-5726
February 15, 201.3
Mr. Tom Patenaude
Owner
Tom Patenaude Homes, Inc.
P.O. Box 5
North Andover, MA 01845
Cell: (978) 815-7692
Fax: (978) 686-3635
Re: Framing Observations
Single Family Residence
391 Stevens St., N. Andover MA
TLHC Proj # 130212
Tom,
On January 1.2, 2012 TLH Consulting (TLHC) visited the site referenced above. The purpose of
the visit was to observe the as constructed condition of the new framing.
Both the conventional framing and the engineered lumber framing members and
connections were observed. Based on our observations the members and the connections
appear to meet the requirements shown on the construction documents and meet the
requirements of the Eight Edition of the Massachusetts State Building Code for One and
Two Family Dwellings.
Thanks for the opportunity to provide our services to you. Please accept our apologies
for the delay in getting this letter to you. If you have any questions please feel free to call
us at (978) 362-1804. _4 '—"e.-
Sincerel _ _� "V�
HEDLY
�-' No. 4f 433
Todd Hedly, P.E. o
Cc File 9a1sTE�
Page 1
Location
No. ��o
Date �z
Check# A�?/ -?
26003
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
E�uildin
g Inspector
$
$A04 41- ,7