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HomeMy WebLinkAboutMiscellaneous - 42 EMPIRE DRIVE 4/30/2018 �, �. f Date. 0OR°T:,� TOWN OF NORTH ANDOVER . a PERMIT FOR PLUMBING ,sSACHUSE� nn This certifies that .6y.G. .S y. . . .l'.,. t'?�`�.— . . . . . . . . . . . . . . has permission to perform . . .Y\.0 . . . . . . . . . . . . . . . . . . . plumbing in the buildings of _ . . . . . . . .?W- at . . .z . �-�i . .�-'. N h.,Andover, Mass. Fee.t'1.j2•t'O .Lic. No. u 3�f T . � . . . . . . PLUMBING IN PECTOR Check # -7 S a' y 8417 1 Y C�x MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ����1V+�^ MA. DATE 6 " Z PERMIT# JOBSITE ADDRESS y Z. CO--,F�t1r L� t� OWNER'S NAME 0 P44t 6 '0<1� POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PS PRINT NEW.( RENOVATION:❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO ❑ CLEARLY FIXTURES Z FLOOR BSMT 1 2 3 4 5 6 7 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 1 FOOD DISPOSER FLOOR/AREA DRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN ' SHOWER STALL SERVICE/MOP SINK TOILET I Z URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER i INSURANCE COVERAGE: I have a current liabilitV insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142. Yes Q,No❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [f OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:1 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 ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 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 of th General Laws. PLUMBER NAME STEPt+150 c GAL-IPSKY SIGNATURE LIC# 103'91# MP 2r' JP❑ CORPORATION X# 319 b PARTNERSHIP ❑# LLC ❑# COMPANYNAME 6ALII3SKY PLUMBIA1b ADDRESS: P•0- GcX 1"701 CITY HAVERkILL STATE rA-A- ZIP 01%31 EMAIL www, mrP1VMbe%3!RQ1 . covet TEL 'Q 7V-37y- 043 CELL 50B-50q Sq 0H FAX a7$' oZI-'fi 3i f ROUGH PLUMBING INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No 114 1�7 THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ 27 �� FEE: $ PERMIT# PLAN REVIEW NOTES Date. . 6. rlZ.. .. HORTM °fti0 3= �` TOWN OF NORTH ANDOVER O P • . PERMIT FOR GAS INSTALLATION . h SACMUSEtA R This certifies that ",.b�"'�. . .��.`^^�q-y.. . . . . . . . . . rvi w ' has permission for gas installation . . . . .VN a-,,-c . . . . . . . . . . in the buildings of . . . . c 1��w�O. . .�l��1.�.��,�,� . . . . . . . . . . at orth/ verA�Mass. Fee Jot? no. . Lic. NoJ o3`0 GAS INSPECTOR/ Check# TS a G 8217 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: Y`1,10M& �1.���� MA. DATE: 6 - 2• PERMIT# JOBSITE ADDRESS:_ Z (CNV OhUL OWNER'S NAMEDA41I>36ND t I06i' GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIALIFKI PRINT' CLEARLY NEW:(ig RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES? 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 r POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER E, I I WATER HEATER M M_ INSURANCE COVERAGE I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL.Ch. 142 YES g NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY g OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT 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 wil be in compliance w'th 11 Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GAS FITTER NAME:STEPHEN C. GALI1`45KY LICENSE# 103w16 SIGNATURE COMPANYNAME: QALI►S3Kq PLUMINIOG t ADDRESS: P.D. NOX 1701 CITY: 0AVFr_HiLL STATE: M-A ZIP: 01831 FAX: 978- 621-4131 TEL: 979-37y- 17y3 CELL: 5-O4- 6bq- 690y EMAIL: W'W 1N. m u m beff Lo1 m MASTER[?( JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 1&31 iib PARTNERSHIP❑# LLC❑# Y _ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ AV FEE; $ PERMIT# PLAN REVIEW NOTES Date . . . . . . . . . . . . . • �Y�T'TI:HUj�'.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . ,'d.-. . . . ,fe'�'7.Q. . / . . . . . . . . . . . . . . has permission to perform . . W.' .! . .AIAII-. . . //� v- . .<. . . . . . . wiring in the building of . . . ,5. . . . .. .. 4s rl .a+. . . . . . . . . North Andover, Mass. Fee . .ir�Lic. No/ �� ,.Z. . . . . . . . . ELECTRICAL INSPECTOR Check# O Z' 10 922 Commonwealth of Massachusetts official Use only Department of Fire Services L07:7and No. /� y� � BOARD OF FIRE PREVENTION REGULATIONS anc Fee Checked eve blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK �p� �! All work to beperfonned in accordance with the Massachusetts Electrical Code (PLEASE PRINT IIdINK OR TYPEALL R&ORAM T10) Dates NEC), .327 CMR 12.00 .City or Town of. NORTH ANDO'V�Ig To.the Ins By this application the undersigned `vee notice of bis or her intention to " PeC,tor of fires: Location(Street&Number) o electrical work described below. 2 .•: Owner or Tenant v Owner's Address Tele hone No. 7_ �� L tltfs permit in conjunction with s building permit? . Yes ` Purpose cif BuildYag -n r No (Check Appropriate Box) Utility Authorization No. Eatstiag Service / Volts Overhead New ce _ Undgrd❑ NO.of Meters $ -- � Amps �w�eJ:Volts Overhead Uad 9-- N.. Nwtuber of Feeders and.Ampacity of Meters _L Location and Nature of Proposed Electrical Work: Co teflon o the ollowin 'table be waived b the No.of Recessed Luminaires ctor a Aires No.of Cell-Soap.(paddle}Fans Tr0.ansformers o No.of 1Lu uiivalre Orrtieta r f Hot 7Y VA 1.'.:. �i:u.tAt+ii8.►iu'did 'Swimnling1,001al�allOVe .'0.0:.."ra•', "':Jt':. d � en No.of Receptacle Outlets NO.of Oil Burners FIRE ALARMS No:of Zones No,of Switches No.of Gas B Qi?lerg 0..0 et OII an No.of Ranges Inch ' Devices . No.of Air Cond. o No,of Waste Disposers p Tans Na-of Aurting Devfices Totsrls. ane No.of Dishwashers Deteestioxy on Space/Area Hea.tfng KW Devices No.of Dryers Heating Appliances • ❑ Conneebton ❑ Other ec yyss 0.o ager ICW 0•o o KW N��o.of o. eS'ior utvalentDCeB neaten Bf s � No.Hydromassa a Bathtubs Ballasts. NoW Devices or E nivaient g No.of Motors T,�HP ecomm a one OTHER: No.of Devices or t Estimated Value of Electrical Work: Attack addttlonal detail if desired or as requireaby the Inspector a l;a' 'Work to Start; —2� Z Tirspections to be requested required by�i�pay,pouaY) f fres INSURANCE CO 4 st,n in accordance with MBC Rule 10,and upon comglotiou VERAGE: Unless waived by the owner,no permit for the performance of electrical work may the licensee proof of liability � drt3'insurance including"completes e y issue unless certifies that such coM��Ige,atui op ration"coverage or its substantial equivalent, The C138CK DIVE• Ii�iSURANCfi exhibited proof of same to the permit issuing office. jC 'r under thepains andpenaltieso OTIC ❑ �SP >f3'') .�IRMNAME: �a 0driul"Y,d tithe 1nf0rm41kx on t4&,g"V`catlan ss true and cornpl'e Licensee: LIC.NO.; ��' ', , f Signature ` (tf'appllcabl, m r--a nrpt •in th Address: e�license Mnaber line.) r LIC.NO.••` �x No.: ' *Per M.G-Z c. 147,s.57-61,security work reqs Department ,� „ Air:TeL No-: OWNER'S INSURANCE W Public Safety S License: Lic.Na. MAired AIVER: I am aware that the Licensee does not have the liab' . Abgent By my signature below,I Hereby waive this requirement I am the(check one��a,coverage normally Signature owners ent. Telephone No. PERAUTFEMI ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-DOUG SMALL I.ROUGHINSPECTION: Passed— Failed— ) Re-fins tion aired S5t1.00).[ Inspectors'comments: 011 {Ins. rs'S# tore- itials) Date 2.FINAL INSPECTION: Passed— Failed,— Re-ins eetion aired($50.00)-[ ) Inspectorsm ns tors'Si natur - o initials} Date 3.UNDER GROUND INSPECTION: Passed.—[ ) Failed—[ ) Re-ins tion required Inspectors'comments: (Inspectors'Signaiture-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAS: Passed— Failed—[ Reins tion 2quired($50.00) Inspectors'comments: 12 aLiiii,1111 11! -(Inspectors'Signati o initials) Date i S. INSPECTION---OTHER: Passed-C ) Failed—[ Reins tion required($50.00).j Inspectors' comments: (Inspectors'Signature-no initials) Date DOOR TAGS ARE TO BE FILLED�l T AND LEFT ON SM IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF Moo ISTO�,,,BE eR�Fn, LAWRENCE H. OGDEN,P.E. 198 EAST MAIN STREET 978-352-8318 fax 978 352-2858 cell: 978-502-5921 June 25,2012 Mr. Robert Messina Orchard Village LLC. 277 Washington Street Groveland,Ma 01834 RE: THE WILLOW GB#6213 4a G�m I )A-X- Lot 9 Empire Drive,North Andover,Ma. 01845 I Dear Mr. Messina As you requested I visited the site 6/25/12 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- ] 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 With plans modified for Lot 9 dated 5/17/12 and certified by me 5/18/12. 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. Yours truly, �� I]n wrence H. Ogden P.E. Structural 27765 Cc: Mr. Geary Bruno Mr. Jeff HorneKAROLD � �cyN Copy mailed to Mr. Robert Messina cs � 1 4.9 Date.`!'. 1.. .� ''. ... . . NORTH TOWN OF NORTH ANDOVER a2 '� p` PERMIT FOR MECHANICAL INSTALLATION � i a 9SSACNUSEt t i2A NlpQ � This certifies that . . . . . . . . . . . . . J .� :` . . . . . . . . . . . . . . . . . has permission for mechanical installation in the buildings of .rC-%�?_� ' : . . .. . . . . . . . . . . . . . . . . . � akr at .�_. lY�n:�?. -. ., : . .° . . . , North Andover, Mass. Fee ol.Q—N). Lic. No.!.,,SS.� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer p. l Commonwealth of Massachusetts Sheet ?Metal Permit Date: 64 Z ?ermiz Estimated job Cost. S 7SW Permit Fee: II' Plans Submitted: YES NO Plans Reviewed: YES NO Business License # Applicant License 0 Business Info r mation: / Property Owner,'Job L.ecatior. Information: Name; / CGf�Gn/71/'(a l _ Name: O/J /�t j�s�/JGf Street:_� 4 L�i�A/ AIC _ Street:, - - 9 Cit„�-� Telephone: q 7 5(, 7I Telepi•ore: �7� &q,?7 Photo',.D. required/Copy of Pho-c I.D. attached: YES ti0 J-1 Siefi Initial r 1-,nrestricted license J-Z J M-2-restricted to dweilings 3-stories or.= and commercial u to 10 0�'-) s les; ✓J A q. ::,: �-stcr�es or P Residential- l-? fan:iiy Multi-family __ Condo!Townhouses Other Commercial: Oftice Rc:ail Educational Cristivitiocal tither Y y / 1 Square Footage: un.dcr 10,000 s<<. f1. I0;000 sq ft. Number of Stories: Sreet metal werk to be completed: ` Now Wcrk: Rercvat:oa: _ HVAC V Metal Watershed Roofing K:tchtri Exhaust System Irletal Chimney/ Vents Air Balancing ?rovide detailed description o_'wor!is to be done: ��ZGIi-riy Q'L' p. 2 INSURANCE COVERAGE: -- i I have a current l:a ulr,Insurance policy ori°.a 3qulva!w-1 Nhich meets the requlrernents of M.31. Ch.112 yes LX No L f 11 you have checked Yes,:ndiCate the type of coverage by checking the appropriate box below: i A Ilabllity insurance paticy ( Other typa of indemnity Bond OWNER'S INSURAMCE WAIVER:1 am aware that the Ilcensoe does not have the Insurance coverage required by Chaptor 112 of the Massachueettts General Lbws,and that my slgnaturs on this parmit application waives th's recuirement Check Cne Cnly — owneren� I G 9 t � Sigr,at•-ire cf Gwrer or Owners Agent 8,1 checking}thsr boxC,I noroby certify that all of the dwa'Is and Informatlo,t I neve submitted for entered)roganding this applicatlnn aro true and accurate to the best of my knowtodge and that all shoot malal work and Instailatlons penormsd under the parmit Issued forthis app'icatlon wilt t:e In oompllance with ail pertinent provistan of the htasaachusaM SLilding Coda and Chapter 112 of it,.*General Laws. / Duct Inspection required prior to Insulation installaticn: YES NO i/ Proeresn insaections Date �mmt nts a Final inspection Date Comrnen�3 ype o`Licdnso ----- I S y "Jlii5ler TUC ,?iut332Br-Re8ttlCtea _Jo.irneryperec-n Sign31U,e of Licensee Permit fi I '�Jo.tmayperson-Res'rlcter Li^e^se IVun-�aer j Pea$ � ❑ � Check a:_www.rnass.gQ+,ldnl I Inspector 31gnatnrs of Permit Approval _ I � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington on Street -- Boston, MA 02111 45� www.mass.gov/dia Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumb ers Applicant Information Please Print Legibly Name (Business/Organization/Individual):'--P, r �'1��`��(� r l L(�[ 1 r I C4 G Address:/; I_rrY1GU'Z City/State/ZiP: I ) �, Phone#: Are you an employer. Check the appropriate box: Type of project(required): 1.7 I am a with employer 4. ❑ I am a general contractor and I �— 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 g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. E] Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ 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' 13.0 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 1 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. 1 � Insurance Company Name: ��!(�( ,(C L f)� '{ A'�C`� C O Policy#or Self-ins. Lic.#: I h�(��" ?J �c- , 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 der the pains a penalties of perjury that the information provided above is true and correct Sig-nature: Date: � 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#: ACC)RD® CERTIFICATE OF LIABILITY INSURANCE (MMIDDNYYY) `.� 1 03/26/2012 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, sItothe the terns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer righcertificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: NORTH ANDOVER INSURANCE AGENCY, INC. ,,c.,, Es, (978) 686-2266 F"" (978) 686- (AIC, Not: E-MAIL cfernandez@nafins.com PROTOMER M.J. FOSTER INSURANCE SERVICES ADDRESS.163 MAIN STREET CUSTOMER ID_fD_."•A . Mechanical, Inc. NORTH ANDOVER MA 01845-2508 INSURER(S)AFFORDING COVERAGE NA(C x INSURED INSURER A :PEERLESS INSURANCE CO R.A . Mechanical, Inc. INSURER 8 :GUARD INSURANCE 16 Lomar Park INSURER C f Suite 1 INSURER 0 _ I INSURER E Pepperell MA 01463- 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. INSR 1 i O 1 WVR tMM,DDNYYY) i(MMIDONYYY)P LTR I TYPE OF INSURANCE I INSR !WVD POLICY NUMBER LIMITS A I GENERAL LIABILITY Y CBP5337500 01/01/2012 01/01/2013 EACH OCCURRENCE $ 1,000,000 X..COMMERCIAL GENERAL LIABILITY / / / / DAMAGE VENTED PREMISESEa occurrences I$ 100,000 CLAIMS-MADE I xj OCCUR / / / / MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE 1 $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: j / / / / 'PRODUCTS-COMP/OP AGG •$ 2,000,000 JECT X�POLICY 1 PRO- ---�LOC / / / / EBLIA 1 $ A AUTOMOBILE LIABILITY BA8832363 01/01/2012 01/01/2013 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) L ANY AUTO _ BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X I SCHEDULED AUTOS --- PROPERTY DAMAGE � X:HIRED AUTOS / / / / (Per accident) $ NON-OWNED AUTOS $ A X UMBRELLA One X OCCUR CU8825678 01/01/2012 01/01/2013 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE, / / / / AGGREGATE $ 1,000,000 �I DEDUCTIBLE / / - / / `$ )RETENTION $ $ B (WORKERS COMPENSATION IBAWC231923 01/01/2012 01/01/2013 WC STATU- 0TH- AND EMPLOYERS' UABILITY ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT_ $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) f E.L.EDISEASE-EA EMPLOYEE $ 500,000 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more 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(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(2oosos) The ACORD name and logo are registered marks of ACORD TMA.'SACHUSETT'S" DRIVER'S == LICENSE. ..._._..._ -- JUSA 1.Zn OF Ml NUMBER. - :..:...:.:....... ab' NONES x818 - ;; vatic M 11"—"'.' C E ..;, ::.::. �f ::: LTTE _ _._.. ... ; ! a 657 MAMMOTH RD DRACUT,MA 01826.4349 v � 5 DO 09.03.2010 R•,07.15.2009 COMMONWEALTH OF MASSACHUSETTS SHEET METAL WORKERS AS A MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO: ci - DONALD J OUELLETTE 657 MAMMOTH RD _ . DRACUT ' MA 01826-4349 4688 07/28/12 947069 • ..t 4 f- L Oux..."a- kef kr/) 1st F( s�rPP�y -- �.�d Sheet 1 � till I I /c`m y k N k tr N QV\ 1 s flccr SnC; au"boli 'I �'�.1rm x s 7�� rn 7 Job #: RA MECHANICAL INC Scaie: 1 : 74 Performed for. Page 1 / 16 LCMAR PARK Right-SuiteO Universal �!'j e �� ` �✓ PEPPERELL MA 09463 7.1.17 RSU11207 Phone:9784338671 Fax 9784324GCO 2010-CM-14 11:21:08 ramec!ianic31@ac1.com C.Tomments and SedingawLAtv1.. wr t ,i '.l.t' •yip..► ��.yhP t , 1 F y4<p•� ' MIT �5 � � - ` r•Jit yA�'t+I ♦ �i�ti�j,�k•� r � �� q i l taw •'- � .i+ sj f 4 „n1f � VIII ly 4,` � .I� J Ta �s Y}•a,t.E.� .d 777 1 v I r _ i I t • ; 1 I i •%C1C t: i i "r'c .7 a :�'!IC ' wale: ' L i .A Nc MA 0 Ile 44 �•}. umec^anlGl2�aci.r;m �C:Ccc,:r,�enm an' a �l ^1 Thf.. � .�_. l Xt�' �k�TN'fa •✓ � .7.1� �,y�iys MN� �1 i a ' .,� '.. j ..�.....rr...r�-...�... - .._-.n ^A9.'AE"3t`�''8en�r'S.��:.."S'�___!^L7_Awi'-.. ,�... '�17.`C.'^i.^FMlty-•TT•.w'. ... .." .. t Sheet Metal Residential Guidelines/Inspection Checklist Yes/ No N/A Detailed description and sketch of sheet metal system to be installed has been provided v All workers performing sheet metal work onsite has valid Massachusetts / sheet metal license All sheet metalwork beingperformed with proper J ourneYA ers on_t - / apprentice ratios (/ Equipment sized per heating/cooling load calculations ✓ Duct work sized per manual "D" calculations I/ Bath/shower rooms contain mechanical exhaust fan vented outdoors `- Electric dryer exhaust properly installed maximum total run 35'-0", / maximum flexible run 8'-0" V Flexible duct runs installed 14'-0" maximum length V g / Volume dampers installed for each supply air branch duct r V Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated b means of external covering or internal linin ZNew/clean y g g -properly sized filter installed (final inspection) (/ Testing and Balancing report complete (final sign-off)