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Miscellaneous - 46 MAYFLOWER DRIVE 4/30/2018
/�F �C( ��C�,a/L, �I✓.t.. / � I BUNILDIN, G FILE . I rr t !i r� r J i 1 337 Date. 1i .. It ��.. .. .. pf NORTH TOWN OF NORTH ANDOVER 0 a+ a pp PERMIT FOR MECHANICAL INSTALLATION y,SSACHUSEt This certifies that . .4o�4. + . A-z . . . . . . . . . . . . . . has permission for mechanical installation . .I.N.0 �, S . ... . . . .... . . . . in the buildings of . . /e. .�l.`. . � at . .TY7 . . . . . .. North,Andover, Mass. rrr �1 Fee. . . . . . . Lic. No.. .� !. . . . . . . . . . . . . . .. . . ..�. GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of'Massachusetts ` Sheet Metal Permit Date: Permit# Estimated Job Cost: $ V0 0 0 , o a Permit Fee: $-4-4r-- Plans —Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 196 Applicant License# Business Information: Property Owner/Job Location Information: Name: J&J Heating. & Air Conditioning Name: �e L Street. 17 Arlington St, Street:Li; 5- /�6 0 City/Town: Dracut, MA 01826 City/Town: North Andover, MA 01845 / Telephone- 978-454-8197 Telephone: o 9--3 , 31 3 °°d Photo I.D. required/ Copy of Photo I.D. attached: YES NO Staff Initial J-1 /M-1-unrestricted license J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residentiah-1--Tfatnily Y MWti-family Condo/Townhouses- Other Commercial: ' Office Retail Industrial _ Educational , Institutional Other Square Footage: under 10,000 sq. ft. ✓ over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Y Renovation: HVAC ✓ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: S o I v i ns to ll �67a 1 ale e t-cv o r k -(-If INSURANCE COVERAGE: I have a current liabilityinsurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes[INo❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ 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 Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],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. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master-Restricted Cityfrown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: S Fee$ ❑ Check at www.mass.govldpi Inspector Signature of Permit Approval t The Commonwealth ofMassachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Roston, MA 02111 w",mmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print JLeZibly; Name(Business/Organization/lndividual): J&J Heating & Air Conditioning, INc. Address: 17 Arlington St. City/State/Zip: Dracut, MA 01826 phone it: '978-454-8197 Are you an employer?Check the appropriate box: Type of project(regi'dred): 1.® I am a employer with 40 4• n I am a general contractor and I have hired the sub-contractors employees(full and/or part-time).* G. E]Now construction listed on the attached sheet. 7. E]Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition working for the in any capacity. employees and have workers' 9 []Building addition [No workers' comp.insurance comp.irnsurance.# required.] 5. We arc;a corporation and.its 10.[]Electrical repairs,or additions 3.❑ I am a homeowner doing all work officers have exercised their I LF1 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 seclion below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractbrs must submit anew 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'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: A.I.M. Mutual Insurance Policy#or Self-ins.Lic.#: WMZ-800-8006553-2013A Expiration Date: 06/01/15 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$25 ay against the violator. e advised that a copy of this statement may be forwarded to the Office of Invcsti tons of tln DIA for'ns arrc ove ge verifrcatioir. I do here 7erti render t{ ai and ralties�e3Cperjrrry that the information provided about is true and correct. Si natur . Date: 3 13 l Phone _54-8197 Official use only. Do not write in this area, to be completed by city or town olcial. City or Town: Permit/License# Issuing Authority(circle one): 1.hoard of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: I ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/10/2014 PRODUCER 978.887.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC# INSURED 7&J Heating & Air Conditioning, Inc. INSURER A: Great American Alliance Ins—Co- 17 nsCo17 Arlington Street INSURERB: Safety Insurance Company _ 39454 Dracut, MA 01826 INsuRERc: A.I.-M. Mutual Insurance Co. INSURER D: --- --------_---- I 'INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DDT POLICY EFFECTIVE POLICY EXPIRATIONLTR NSRC TYPE OF INSURANCE POLICY NUMBER DATE MM(MM/DD/YY Y) DATE(MM/DofYYYYLIMITS GENERAL LIABILITY PAC6418906-08 06/01/2014 06/01/2015 EACH OCCURRENCE .$ 1,000,000 X COMMERCIAL_GENERAL_LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $_ 300,000 CLAIMS MADE n OCCUR MED EXP(Any one person) $ 10,()00 A PERSONAL 8 ADV INJURY $ ].,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- -- — JECT LOC AUTOMOBILE LIABILITY 2434550 06/01/2014 06/01/2015 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ _ 1,000,00_ ALL OWNED AUTOS BODILY INJURY B IX- SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) -- — --- PROPERTY DAMAGE ;$ • (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY UMB6418958-06 06/01/2014 06/01/2015 EACH OCCURRENCE $ 2,000,000 A X I OCCUR CLAIMS MADE AGGREGATE $ 2,000,000 — DEDUCTIBLE $ RE"IENTION $ $ OR KERS COMPENSATION WMZ-800-8006553-2014A 06/02/2014 06/02/2015 X TORY LIMITS _ I AND EMPLOYERS'LIABILII"Y _ ANY PROPRIETOR/PACLUDED XECUTIVE� E.L.EACH ACCIDENT — $ 1,000,OO C OFFICER/MEMBER EXCLUDED'? (Mandatory in NH)and E.L.DISEASE-EA EMPLOYEE $ 1,000,OO If yes,describe under _ SPECIAL_PROVISIONS below E.L.DISEASE_-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 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 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence of Insurance AUTHORIZED REPRESENTATIVE Peter Sennott/LAR �- ACORD 25(2009(01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0 4 I ;,4 COMMONWEALTH OF MASSACHUSETTS o Ins - o R TP is] BOARD OF SHEE"I METAL WORKERS ,: i ISSUES THE FOLLOWING LICENSE;.:,:, AS A MASTER-UNRESTRICTE �¢ iZ J J. HEATING & AC ERIC"R KL.;INE J & J HEATING AC ,Z 17 ARL:I NGTON ST DIRACl1T MA o 1826 3936 1568.': 0'5/28/:.l 214 X39 S1S'ACHUS I TN' DRIVER'$ LICENSE °,h •7i1 { - 4a ISS' -9a END 4d NUMBER P Ft05.03 2011 NONE' 'S9965,587� Ab.EXPX . 3:'DOB op5� 2T�o16 -.:05 221980 L -i SS _12 REST 15'SEX M 1pd I.'DM NONE r ,KEINE 2 ERIC RJ 9s tpe4 I, . 83 LONG DR DRACUT,MA 01826-2048,, . �7(. 5 DD 05-042011 Rev 07-15-2009 S - OMMONWFA TH 01= MASS CHOSE.TTS; ROAf3l; .1: SIIf:E'a >MI 1`'l1L'WO.IZ;:I<f:.R,c'?;r?;::: I SSUFS T41 F 0LL.OWING `>l I CCNSC /iSA BLISLN[.SS 7. I DWRO r AYOTTE. J` J I If A l l NG I I� COND I I I ON I NG I h J�.r 1 7 ARL'LNGT ON S I-Rf:.l l ` ORA:CU r MA 0'1826 �I i,:;.Gx O.J./l.. .:lei 1J.ELiJ�85 i.1C:LJiC'J?.C:.lt�x�l-17:A46S16IiS�::f:.CaJ:ii.���:7 2A�_1i(�,'f6fiA4�1�:.fC:Ltl;1'_[i'il_L1�1 i I I wri htsoftro Load Short Form Job: lot 5 mayflower g Date: March 13,2015 Entire House By: J&J Heating & Air Conditioning 17 Arlington St, Dracut,MA 01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com • a a For: Key Lime Inc Mayflower Dr, N Andover, MA 01845 Htg Clg Infiltration Outside db (°F) 14 82 Method Simplified Inside db (°F) 70 75 Construction quality Semi-tight Design TD (°F) 56 7 Fireplaces 0 Daily range - L Inside humidity (%) 50 50 Moisture difference (gr/Ib) 46 38 HEATING EQUIPMENT COOLING EQUIPMENT Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 80AFUE Efficiency 0 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 1029 cfm Actual air flow 1029 cfm Air flow factor 0.023 cfm/Btuh Air flow factor 0.046 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.85 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) First Floor 780 20400 13680 460 625 Second Floor 800 13896 4601 313 210 Third Floor 560 11382 4259 257 194 Entire House 2140 45678 22540 1029 1029 Other equip loads 3936 492 Equip. @ 0.87 RSM 20037 Latent cooling 4140 TOTALS 2140 49614 24177 1029 1029 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wrightsoftm Right-Suite®Universal 2015 15.0.12 RSU05790 2015-Mar-13 15:58:56Page 1 ACCK C:\Users\eric\Desktop\W rights oft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N Wrl htsoft® Building Analysis Job: lot 5 mayflower g Date: March 13,2015 Entire House By: J&J Heating & Air Conditioning 17 Arlington St,Dracut, MA01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com e - • o For: Key Lime Inc Mayflower Dr, N Andover, MA 01845 Location: Indoor: Heating Cooling East Falmouth, Otis Angb, MA, US Indoor temperature (°F) 70 75 Elevation: 131 ft Design TD (°F) 56 7 Latitude: 420N Relative hums lty (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.0 37.6 Dry bulb (°F) 14 82 Infiltration: Dally range °F) - 15 ( L ) Method Simplified Wet bulb (°F� - 72 Construction quality Semi-tight Wind speed (mph) 15.0 7.5 Fireplaces 0 r Component Btuh/ft2 Btuh % of load Walls 3.8 11253 22.7 Glazing 31.9 4405 8.9 Doors 20.2 423 0.9 " Ceilings 5.4 11643 23.5 Floors 4.8 10337 20.8 Infiltration 2.4 7618 15.4 Ducts 0 0 Piping 0 0 Humidification 0 0 Ventilation 3936 7.9 Adjustments 0 Total 49614 100.0 e f • -Component Btuh/ft2 Btuh % of load Walls 0.8 2391 10.4 Glazing 64.7 8929 38.8 Doors 7.6 159 0.7 Ceilings 4.3 9252 40.2 Floors 0.5 1055 4.6 , Infiltration 0.2 754 3.3 Ducts 0 0 Ventilation 492 2.1 Internal gains 0 0 � Blower 0 0 Adjustments 0 ,. Total 23032 100.0 Latent Cooling Load = 4140 Btuh Overall U-value = 0.126 Btuh/ft2-°F Data entries checked. ` - wrightsoft° 2015-Mar-1315:58:56 .+- Right-SuiteO Universal 2015 15.0.12 RSU05790 �� C:\Users\eric\Desktop\wrightsoft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N Page 1 wri htsoft Component Constructions Job: lot 5 mayflower g Date: March 13,2015 Entire House By: J&J Heating & Air Conditioning 17 Arlington St, Dracut, MA01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com For: Key Lime Inc Mayflower Dr, N Andover, MA 01845 I I Location: Indoor: Heating Cooling East Falmouth, Otis Angb, MA, US Indoor temperature (°F) 70 75 Elevation: 131 ft Design TD (°F) 56 7 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.0 37.6 Dry bulb (°F) 14 82 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Semi-tight Wind speed (mph) 15.0 7.5 Fireplaces 0 ffll Construction descriptions Or Area 1.1-value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ftl-°F ft2-°F/Btuh Btuh/ft2 Btu Btuh/ft2 Btu Walls 12E-Osw: Frm wall,vnl ext,1/2"wood shth,r-19 cav ins,1/2" n 474 0.068 19.0 3.81 1805 0.81 384 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud e 1014 0.068 19.0 3.81 3861 0.81 821 s 486 0.068 19.0 3.81 1851 0.81 393 w 981 0.068 19.0 3.81 3736 0.81 794 all 2955 0.068 19.0 3.81 11253 0.81 2391 Partitions (none) Windows 1 D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, in 12 0.570 0 31.9 383 14.7 177 1/4"thk;6.67 ft head ht w 12 0.570 0 31.9 383 56.6 679 all 24 0.570 0 31.9 766 35.7 856 1 D-c2ov:2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap, a 36 0.570 0 31.9 1149 56.6 2038 1/4"thk;6.67 ft head ht w 36 0.570 0 31.9 1149 56.6 2038 w 42 0.570 0 31.9 1341 56.6 2378 all 114 0.570 0 31.9 3639 56.6 6455 Doors 1110:Door,wd pnl type,mtl strm a 21 0.360 1.0 20.2 423 7.56 159 Ceilings 1613-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 1360 0.026 38.0 1.46 1980 1.16 1574 gypsum board int fnsh C part ceiling,:C part ceiling,carpet fir fnsh,frm fir,12"thkns,1/2" 780 0.221 1.0 12.4 9662 9.84 7678 gypsum board int fnsh Floors 19A-Obscp: Part floor,carpet fir fnsh,frm fir, 12"thkns,1/2"gypsum 1360 0.295 0 6.21 8440 0.78 1055 board int fnsh 22D-5tpl:Bg floor,light dry soil,prm int ins cov,on grade depth,r-5 118 0.287 5.0 16.1 1896 0 0 edge ins,r-5 ins „ 2015-Mar-1315:56:57 wri htsoft" Right-Suite®Universal 2015 15.0.12 RSU05790 Page 1 A:C�% C:\Users\eric\Desktop\wrightsoft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N wrl htsoft Component Constructions Job: lot 5 mayflower 9 Date: March 13,2015 First Floor By: J&J Heating & Air Conditioning 17 Arlington St, Dracut,MA01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jiheating-aircond.com For: Key Lime Inc Mayflower Dr, N Andover, MA 01845 EMEMEMM @ - • a • • Location: Indoor: Heating Cooling East Falmouth, Otis Angb, MA, US Indoor temperature (°F) 70 75 Elevation: 131 ft Design TD (°F) 56 7 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.0 37.6 Dry bulb (OF) 14 82 Infiltration: Daily range (OF) - 15 ( L. Method Simplified Wet bulb (°F) - 72 Construction quality Semi-tight Wind speed (mph) 15.0 7.5 Fireplaces 0 Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ft2-°F ftz-°F/Btuh Btuh/ft2 Btuh Btuh/ft2 Btu Walls 12E-Osw:Frm wall,vnl ext,1/2"wood shth,r-19 cav ins,1/2" n 180 0.068 19.0 3.81 685 0.81 146 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud a 318 0.068 19.0 3.81 1211 0.81 257 s 180 0.068 19.0 3.81 685 0.81 146 w 297 0.068 19.0 3.81 1131 0.81 240 all 975 0.068 19.0 3.81 3713 0.81 789 Partitions (none) Windows 1 D-c2ov:2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap, a 12 0.570 0 31.9 383 56.6 679 1/4"thk;6.67 ft head ht w 12 0.570 0 31.9 383 56.6 679 w 42 0.570 0 31.9 1341 56.6 2378 all 66 0.570 0 31.9 2107 56.6 3737 Doors 1110:Door,wd pnl type,mtl strm a 21 0.360 1.0 20.2 423 7.56 159 Ceilings C part ceiling,:C part ceiling,carpet flr fnsh,frm flr,12"thkns,1/2" 780 0.221 1.0 12.4 9662 9.84 7678 gypsum board int fnsh Floors 22D-5tpl:Bg floor,light dry soil,prm int ins cov,on grade depth,r-5 118 0.287 5.0 16.1 1896 0 0 edge ins,r-5 ins 1_%Z. wri htsaft Right-Suite®Universal 2015 15.0.12 RSU05790 2015-Mar-1315:58:57 ACCK C:\Users\eric\Desktop\W rights oft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N Page 2 II wri htsoft Component Constructions Job: lot 5 mayflower 9 Date: March 13,2015 • Second Floor By: J&J Heating & Air Conditioning 17 Arlington St, Dracut, MA01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com For: Key Lime Inc Mayflower Dr, N Andover, MA 01845 Location: Indoor: Heating Cooling East Falmouth, Otis Angb, MA, US Indoor temperature (°F) 70 75 Elevation: 131 ft Design TD (°F) 56 7 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.0 37.6 Dry bulb (°F) 14 82 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Semi-tight Wind speed (mph) 15.0 7.5 Fireplaces 0 Construction descriptions Or Area 1.1-value Insul R Htg HTM Loss Clg HTM Gain ft� Btuh/ftz°F 112-TBtuh Btuh/ft2 Btu Btuh/ftz Btuh Walls i 12E-Osw: Frm wall,vnl ext,1/2"wood shth,r-19 cav ins,1/2" n 180 0.068 19.0 3.81 685 0.81 146 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud a 336 0.068 19.0 3.81 1279 0.81 272 S 180 0.068 19.0 3.81 685 0.81 146 w 348 0.068 19.0 3.81 1325 0.81 282 all 1044 0.068 19.0 3.81 3976 0.81 845 Partitions (none) Windows 1D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, w 12 0.570 0 31.9 383 56.6 679 1/4"thk;6.67 ft head ht 1 D-c2ov:2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap, a 24 0.570 0 31.9 766 56.6 1359 1/4"thk;6.67 ft head ht Doors (none) Ceilings 16B-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 800 0.026 38.0 1.46 1165 1.16 926 gypsum board int fnsh Floors 19A-Obscp:Part floor,carpet fir fnsh,frm fir,12"thkns,1/2"gypsum 800 0.295 0 6.21 4965 0.78 621 board int fnsh L ti•. W11 htsoft% Right-SuiteO Universal 2015 15.0.12 RSU05790 2015-Mar-1315:58:57 ACCA C:\Users\eric\Desktop\Wrightsoft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N Page 3 wri htsoft Component Constructions Job: lot 5 mayflower 9 Date: March 13,2015 Third Floor By: J&J Heating & Air Conditioning 17 Arlington St, Dracut,MA 01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com For: Key Lime Inc Mayflower Dr, N Andover, MA 01845 � - • s • a Location: Indoor: Heating Cooling East Falmouth, Otis Angb, MA, US Indoor temperature (°F) 70 75 Elevation: 131 ft Design TD (°F) 56 7 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.0 37.6 Dry bulb (°F) 14 82 Infiltration: Dally range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Semi-tight Wind speed (mph) 15.0 7.5 Fireplaces 0 Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ftz-°F ft2-°F/Btuh Btuh/ftz Btu Btuh/112 Btu Walls 12E-Osw: Frm wall,vnl ext,1/2"wood shth,r-19 cav ins,1/2" n 114 0.068 19.0 3.81 434 0.81 92 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud a 360 0.068 19.0 3.81 1371 0.81 291 s 126 0.068 19.0 3.81 480 0.81 102 w 336 0.068 19.0 3.81 1279 0.81 272 all 936 0.068 19.0 3.81 3564 0.81 757 Partitions (none) Windows 1 D-c2ow:2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap, n 12 0.570 0 31.9 383 14.7 177 1/4"thk;6.67 ft head ht. 1 D-c2ov:2 glazing,cir outr,air gas,vnl frm mat,clr innr,1/4"gap, w 24 0.570 0 31.9 766 56.6 1359 1/4"thk;6.67 ft head ht Doors (none) Ceilings 166-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 560 0.026 38.0 1.46 815 1.16 648 gypsum board int fnsh Floors 19A-Obscp:Part floor,carpet flr fnsh,frm fir,12"thkns,1/2"gypsum 560 0.295 0 6.21 3475 0.78 434 board int fnsh C1. 2015-Mar-1315:58:57 WPI htsoft Right-Suite®Universal 2015 15.0.12 RSU05790 Page 4 ACCP. C:\Users\eric\Desktop\W rights oft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N Project Summar Job: lot 5 mayflower wrightsoftm y Date: March 13,2015 Entire House By: J&J Heating & Air Conditioning 17 Arlington St,Dracut, MA 01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com • • 0 For: Key Lime Inc Mayflower Dr, N Andover, MA 01845 Notes: ® - • o 0 Weather: East Falmouth, Otis Angb, MA, US Winter Design Conditions Summer Design Conditions Outside db 14 OF Outside db 82 OF Inside db 70 OF Inside db 75 OF Design TD 56 OF Design TD 7 OF Daily range L Relative humidity 50 % Moisture difference 38 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 45678 Btuh Structure 22540 Btuh Ducts 0 Btuh Ducts 0 Btuh Central vent (64 cfm) 3936 Btuh Central vent (64 cfm) 492 Btuh Humidification 0 Btuh Blower 0 Btuh Pi in Btuh Equipment load 49614 Btuh Use manufacturer's data n Rate/swing multiplier 0.87 Infiltration Equipment sensible load 20037 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Semi-tight Fireplaces 0 Structure 2505 Btuh Ducts 0 Btuh Heating Cooling Central vent (64 cfm) 1635 Btuh Area (ft2) 2140 2140 Equipment latent load 4140 Btuh Volume (ft3) 19260 19260 Air changes/hour 0.28 0.15 Equipment total load 24177 Btuh Equiv.AVF (cfm) 124 98 Req. total capacity at 0.70 SHR 2.4 ton Heating Equipment Summary Cooling Equipment Summary Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 80AFUE Efficiency 0 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 1029 cfm Actual air flow 1029 cfm Air flow factor 0.023 cfm/Btuh Air flow factor 0.046 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.85 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. htsofta 9 2015-Mar-1315:58:57 Wrl 9 Ri ht-Suite®Universal 2015 15.0.12 RSU05790 Page 1 �� C:\Users\eric\Desktop\Wrightsoft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N i AED Assessment Job: lot 5 mayflower - - wrightsoft� Date: March 13,2015 Entire House By: J&J Heating & Air Conditioning 17 Arlington St,Dracut, MA01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com For: Key Lime Inc Mayflower Dr, N Andover, MA 01845 Suwon Location: Indoor: Heating Cooling East Falmouth, Otis Angb, MA, US Indoor temperature (°F) 70 75 Elevation: 131 ft Design TD (°F) 56 7 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.0 37.6 Dry bulb (°F) 14 82 Infiltration: Daily range °F) - 15 ( L ) Wet bulb (°F) - 72 Wind speed (mph) 15.0 7.5 Hourly Glazing Load 10,000-- 9.000-- 8,000-- 7,000-- 5 0,0009,0008,0007,000 m 6,000-- 5,000-- 0 ,0005,0000 4.000-- 3,000-- 2,000-- 1,000-- 0 ,0003,0002,0001,0000 8 9 10 11 12 13 14 15 16 17 18 19 20 Hour of Day /Hourly /Average /A Lint Maximum hourly glazing load exceeds average by 55.9%. House does not have adequate exposure diversity (AED), based on AED limit of 30%. AED excursion: 1618 Btuh (PFG - 1.3*AFG) Ad I A� wrightsoft° Right-Suite&universal 2015 15.0.12 RSU05790 2015-Mar-13 15:58 Page age 1 1 �� C:\Users\eric\Desktop\Wrightsoft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N Wri htsoft9 Right-J@ Job: lot 5 mayflower -�' 9 Right JO Worksheet Entire House Date: March 13,2015 J&J Heating &Air Conditioning By: 17 Arlington St, Dracut, MA 01826 Phone:978-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com 1 Room name Entire House First Floor 2 Exposed wall 346.0 ft 118.0 ft 3 Room height 9.0 ft 9.0 ft heat/cool 4 Room dimensions 20.0 x 39.0 ft 5 Room area 2140.0 ft2 780.0 ft2 Ty Construction Ll-value Or HTM Area (ft2) Load Area (ft2) Load number (Btuh/ft2-°F) (Btu 2) or perimeter (ft) (Btuh) or perimeter (ft) (Btuh) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6 � 12E-0sw 0.068 n 3.81 '0.81 486 474 1805 384 `` " 180 186 fi85 146 i D clow 0.570.,n_° 31.92 14.72 12 0 383 177 0 0 . '0 0 12E-Osw 0.068 a 3.81 0.81 1071 1014 3861 821 351 318 1211 257 1D-c2ov 0.570 e 31.92 56.62 36 0 1149 2038 12 0 383 679 11 D ,1110 0.360 dsw .e....,, 20.16 7.56 21 21 423 159__._._. 21 21. 423 159. W 1 D c2ovd � _0.068 S. = 3;$1 0 81 ' 1071 9813736 794 351 180 1685 246 61 486 486 1851 393.., 180 180 885 146 U���NNJ 12E Osw 0.068 w 3.81 0. 1D-c2ov 0.570 w 31.92 56.62 36 0 1149 2038 12 0 383 679 0.570 w 31.92 56.62 42 0 1341 2378 42 0 1341 2378 1 D-c2ow.. 0.570 w_ 31.92 56.,62 12 0 383 679 0 0 0 0 ,C, 16B38ad _0.026 i.46 1.1.6 1360 1360 1980 '.�' 1574 ...._ __0, __ o -'0 W..�. C._ W.Cpar;..ceihno_ ._ _ 0221 1239 ...9.84 .. 780 780 _,...... �. ,....._ ..._.._._ . .. .678 F 19A 06sc -.- p ,0.295 6.21 .:`0:78 1360 .;1360 8440 1055 780 _ 7 0 9�0 7, p F 22D75tpl 0.287 16.07 0.00 780 . ..,,118 ,. 1896. 0• _..780 118 1896 6 I 6 c)AED excursion 1618 1060 Envelope loss/gain 38060 21786 17802 13423 12 a) Infiltration 7618 754 2598 257 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 0 0 O 0 Appliances/other 0 0 Subtotal(lines 6 to 13) 45678 22540 20400 13680 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 45678 22540 20400 13680 15 Duct loads 0% 0% 0 0 -0% 0% 0 0 Total room load 745678 22540 20400 13680 Air required(cfm) 1029 1029 460 625 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed t -f-k Wrightsoft`° Right-Suite@ Universal 2015 15.0.12 RSU05790 2015-Mar-13 15:58:57 SICCA C:\Users\eric\Desktop\W rights oft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N Page 1 i, +wrightsoft' Right-J® Worksheet Job: lot 5 mayflower Entire House Date: March 13,2015 By: J&J Heating &Air Conditioning 17 Arlington St,Dracut, MA01826 Phone:976-454-8197 Fax:978-454-8615 Email:www.jjheating-aircond.com 1 Room name Second Floor Third Floor 2 Exposed wall 120.0 ft 108.0 ft 3 Room height 9.0 ft heat/cool 9.0 ft heat/cool 4 Room dimensions 20.0 x 40.0 ft 14.0 x 40.0 ft 5 Room area 800.0 ft2 560.0 ft2 Ty Construction U-value Or HTM Area (ft2) Load Area (ft2) Load number (Btuh/ftz°F) (Btuh/ft2) or perimeter (ft) (Btuh) or perimeter (ft) (Bt h) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6 12E 0sw. 0068 n 3.81 .0,81 �j80 '160 685 146 126 -" 114 434 92 12-Osw 0.060 a X33.81 50.82 360 336 1279 272 ��360 360 1371 : .. ;29 56.62 24 0 766 1359 0 0 0 0 11 1110 __. 0.360__e__ "" 20.16 7.56 0 0 0 0 0 0 0 0 W 12E-Osw 0.068 s,; 3.81 0.81 180 ' " 180, 685 146 + 126 .::126 480 102 V� 12E-0sw 0.068 w 3.81 0.81 360 348 1325 282 360 336 1279 272 1D-c2ov 0.570 w 31.92 56.62 0 0 0 0 24 0 766 1359 1D-c2ovd 0.570 w 31.92 56.62 0 0 0 0 0 0 0 0 1 D-c2ow 0.570 w 31.92 56.62 120 383 679 0 0 0 0 C 16B-38ad 0,026 1.46 1,16 800 800 1165 926 560 =, " 560 815 648 C Cpart ceilinq ___, 0.221 12.39 9.84 0 0 0 0 0" _ 0 ," 0 0 F- 19A;0bscp a 0.295 -- " 6.21 0.78" 806 800 _ 4965 _._ 621 560 560 3475 ,, 434 F 22D-5tpl._ 0.287 16.07 0.00 0 „"0 .. . 0 ." _. 0 0 0 _. 6 c)AED excursion -90 648 Envelope loss/gain 11254 4339 9004 4023 12 a) Infiltration 2642 262 2378 235 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 0 0 0 0 Appliances/other 0 0 Subtotal(lines 6 to 13) 13896 4601 11382 4259 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 13896 4601 11382 4259 15 Duct loads -0% 0% 0 0 -0% 0% 0 0 Total room load 13896 4601 11382 4259 Air required(cfm) 313 210 1 1 2571 194 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed Wrightsoft, Right-Suite®Universal 2015 15.0.12 RSU05790 2015-Mar-13 15:58:57 ��E' C:\Users\eric\Desktop\W rights oft HVAC\Osgood.rup Calc=MJ8 Front Door faces: N Page 2 c Date........ ..............1 ... �NonrH TOWN OF NORTH ANDOVER o PERMIT FOR WIRING �`rSgCHUeb This certifies that ............ ......................`� GL-; has permission to perform ....... J �fJ ........................................................... wiring in the building of.............. r E.. -�u G ..... ............................................................. 0 ` at .. 52... ./ Ol ......................................North Andover,Mass. Fee Lic. No. �61. .................... ...... ........ y� ELECTRICAL INSPECTOR Check# t Commonwealth of Massachusetts Official Use Only 99 Department of Fire Services Permit No. I Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: j Q-- ,q—k City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention toperformthe electrical work described below. Location(Street&Number) % K0114� c}%c� 44r. lV. &y,,L--g,- Owner or Tenant . t Telephone No. .!ri e,- li DO V30 Owner's Address t oflkd, At, IL Wcer Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building L)--*;,) ,;"i._ Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service '4. Amps i�U / �N,c Volts Overhead❑ Undgrd' . No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- o.o Emergency Lighting rnd. rnd. F-1BatteryUnits 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 t No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. 1 Estimated Value of Electrical Work: (q(?) (When required by municipal policy.) Work to Start: 'O--1S -m 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 t BOND ❑ OTHER ❑ (Specify:) I certify,under the pains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: f ti 1C LIC.NO.: Licensee: Brk v,,` �.tt;��c�( Signature �v.t, LIC.NO.: (If applicable,enter "exempt"in thet'ce,ns,e number-line.) Bus.Tel.No.' cf�i- I I Address: �` y aN ��cyf , .�w�,`I'�:�` �. C`9 Alt.Tel.No.: ci?Fr U-11t�] *Per M.G.L c. 147,s. 57- 1,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)❑owner ❑owner's tent Owner/Agent Signature Telephone No. PERMIT FEE. $ 0 6 t >.>'a'=MMONWEALTH OF MASSACHUSETCS:.>< '> DIVISION OF R• • cl THE :t LLOWI NG L- E-EN`SE 'A S.>::; � 0 RESTt=RED MASTER ELECTRICIAN ELECTR 1 C BR`I AN A.-MR:f:S c-M. 21 HYAT'F: AMIE }-z iL .: B. 'Ap>=aRD::::.. >:::::. >>:-#�A 01835-822.:x: 2ot8a' `>: f'<`07`%3> /<t:6 163131 1 t i � QDate.NQ..-.t. ....- 3..... G �;� of 00 TP, TOWN OF NORTH ANDOVER „ PERMIT FOR PLUMBING This certifies that... .................. has permission to perform....... .. ... ......... ................................ plumbing in the buildings of...9.� .......... ........ at.......`.J G........✓Vt >-Cc�w c�.vl z..........�...,/North Andover, Mass. Fee`:�.�!111�..Lic. No. kDaL4.....C,... /! �. 7 .................................................. t' PLUkIBING INSPECTOR Check# 1 5-,; 7 Date....�. ... .�..�'+..�.. `I........... OF NORT�y,h o� �, TOWN OF NORTH ANDOVER h � 9 PERMIT FOR GAS INSTALLATION �i This certifies that ................................... ................................................................ has permission for gas installation .... .. ..V-"... ' ..!`''. ................. in the buildings of.....ol-Q.-.......... G.�' .......... G....... -'............................ at...........q..(.......Vq....�`.....f tuv w.e-.....�' ., N h A idover, Mass. 4 lo3`-fb Fee..:D ... Lic. No. .......................... . . .................................................... GAS INSPECTOR Check# 115 ID X —I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: �40 AV i- "& /-- MA. DATE:�� �(.—�� PERMIT# aIOBSITE ADDRESS: V►"-q!l Uu.4f OWNER'S NAME: y/6'. GOWNER ADDRESS: TEL: FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL{� PRINT / CLEARLY NEW: RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ APPLIANCES-1 FLOOR- 8 1 2 3 4 5 6 7 8 9 10 11 12 13 94 BOILER BOOSTER CONVERSION BURNER COOKSTOVE I DIRECT VENT HEATER DRYER 1 FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability 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 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 will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER/GASFITTER NAME: STEPHEN C. C-ALINSKY LICENSE# 103,4t SIGNATURE COMPANY NAME: GSA L 1 i 3 Kq PI..V0 6114 + 1 EKt- & ADDRESS: P.D- SOX 1-701 CITY: 4AVi=RHtLL, STATE: m A ZIP: OIS31 FAX: q7I- 5,11-8131 TEL: 978—37q— 1783 CELL 5'Cd— 5OA— 59oq EMAIL: W'VV'W. mrI u+h�a� MASTER Ed JOURNEYMAN❑ LP INSTALLER❑ CORPORATION 5 # 31 at PARTNERSHIP❑# LLC❑# 1 OUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No Al THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ I FEE: $ PERMIT# -- PLAN REVIEW NOTES I 5� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY yn,4O 6Tt, A0-Q00VL5jf1, MA. DATE 03 --7 —N PERMIT# JOBSITE ADDRESS A M4 OWNER'S NAME 0 POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT NEW:J-�e RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO ❑ CLEARLY FIXTURES 1 FLOOR— BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 t-0 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) I KITCHEN SINK LAVATORY Z ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET I I I URINAL I j WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING I OTHER I I I INSURANCE COVERAGE: have a current liabifitV insurance policy or its substantial equivalent which,meets the requirements of MGL Ch. 142. Yes R No 0 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Z 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 ❑ Signature of;Owner or Owner's A ent 1 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-rny.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 Chapt of the General Laws. PLUMBER NAME S'"Ef'060 C- C AL4PGKY SIGNATURE LIC# 103114# MP[' JP❑ CORPORATION [ # 1 q PARTNERSHI ❑# LLC ❑# COMPANY NAME &t91-Ws KY PLUiv PIM{R �' RVATI O G ADDRESS: P.D. Go X 1-20, CITY HAVC(ZRjLL STATE M-A- ZIP 01131 EMAIL vvvvw. ml^ lombeCo TEL (178-3?q- 17+13 CELL -50B--54Ci—.rig0i1 FAX97$5AI-I13- 131 s ..4 O GH PLUNtBING INS ECTIO NOTES THIS PAGE 1+OR INSPECTOR USE ONLY FINAL INSPECT Z NOTES Yes No THIS APPLICATIOU§ERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES i Date.... U.. ./.....!..................... NORT#j TOWN OF NORTH ANDOVER • i - PERMIT FOR GAS INSTALLATION • 83ACMUg� This certifies that !.....:t.. � u,J� / t P fin ......................I ................................. has permission for gas installation . ... ...................................................... in the buildin s of....�-LA....L.!ey L....: at...................X.........:�:......('�.�2�..................................�, North Andover, Mass. Fee..�.Q....... Lic. No. ....... 1M.r................................................... GASINSPECMR Check# 0636 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY: NORTH ANDOVER MA. DATE: fQ j / PERMIT# JOBSITE ADDRESS: 46 MAYFLOWER DRIVE OWNER'S NAME: KEYLIME INC GOWNER ADDRESS: TEL: 508-328-4630 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: 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 3 INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER �— ROOM/SPACE HEATER ROOF TOP UNIT TESTC>< UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE ' I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ❑ NO [_] f If you have checked YES,please indicate the type of coverage by checking the appropriate box below. ,,(J LIABILITY INSURANCE POLICY ❑ OTHER TYPE INDEMNITY ❑ BOND ❑ -t= 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 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. PLUMBER/GASFITTER NAME/' XCENSE#,� SIGNATURE COMPANY NAME:OSTERMAN PROPANE LLC ADDRESS: 321A Merrimack St CITY: Methuen STATE:MA ZIP:01844 FAX:978-738-0118 TEL: 800-368-9956 CELL: EMAIL:INFO OSTERMANGAS.COM MASTER []JOURNEYMAN ❑LP INSTALLER ORPORATIONI )) ❑# PARTNERSHIP ❑# LLC #45-32a33 ❑ 1 I ,:' ��' -� I The Commonwealth of Massachusetts - Department of IndifstriglAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsfElectricians/Plumbers Applicant Information Please Print Lewibly Name (Business/Organization/Individual): Address:_:5�2/' oO City/StatPhone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and 1 6. F1 Now construction F employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and'have no employees These su tractors have 8. [J Demolition working for me in.any capacity. w ers'comp.insurance. 9. E]Building addition [No workers' comp.insurance 5. e are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 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 12.0 Roofrepairs insurance required.]T employees.[No workers' 1311 Other comp.insurance required.] 'Any applicant that checks box#I must also fill out the section bel6w showing their workers'compensation policy information. r-Homeowners who submit this affidavit indicating they nie doing allwork and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis 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 the policy and job life information. Insurance Company Name% Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: '�� L'�°� /�sA y �GavL�L,�'2 City/State/Ax G/o—,""I 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 ze pai s and penalfies of perjury that the information provided above is it a and correct. Sim0. 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.PIumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions Massachusetts Gene e 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 employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint 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 required" 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)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 maybe 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(ifnecessary)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 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 Go ,onwealt�ofM-assa.,ch-metts DepaxtxaoutofIndustrial.Accidents Office ofIavestigation,% 600 Wasbhtgtoa Stzeet Boston,MA,021.1.1 Tel,#61.7-7-27-4900 eyt 406 ox 1-8,77 MASSAFF, Revised 5-26-05 FaY,#617-727-7749 www.�x�ass,g4�fdia ,r1 I �I ;<s COMMONWEALTH OF MASSACHUSETTS k' • • - •19 • B PLUMBERSp. :- : �g:G�SF ITTERS �h ISSUES THE FOLLOWING; LiC.ENSE I CENSE;D AS AN LP GAS 'I NST.ALLER MICHAEL A BRYSON SR `- $ ARBOR CT IS , LYNN MA 01902-1110.. r 933 X5;/01/16 223720 i I Date...' .. O% ............... �NORrM� TOWN OF NORTH ANDOVER n PERMIT FOR WIRING S`SgCHU55 Thiscertifies that ......................................... ...................I.:.........................................� � r has permission to perform ........, A;." . ' fl< wiring in the building of........./.... . .... ............... ... ...:......................... at .. ..... ..!-2 „/ „ r �/ ............. PNh Andover,Mass. Fee...... ?..............Lic.No.—?6-4.v 11A.�. ....................... ....... .............. . ... SPECTOR Check# /� • Commonwealth of Massachusetts Official /Use Only Permit No.11/' Department of Fire Services Occupancy and Fee Checked r` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date:_,, G - City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) G-Nat1NJ ,U` Owner or Tenant Y-e", t,c Telephone No. 50Q-S;J- L/Io3G Owner's Address 0 l oe e-i,`c k be, Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building u Ev— Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service 7Amps }p Volts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity + Location and1 _Nature of Proposed Electrical Work: j)N,Qe��,roc,n� �c,����� ✓v. N u n� VAC,C c N 11 1� Completion of the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA 1 No.of Luminaires Swimming Above In- o.o Emergency Lighting Pool ❑ ❑ rnd. rnd. 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 Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: I I Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Si ns Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: Op (When required by municipal policy.) Work to Start: Q.-C .-�LA 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 V BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties of perjury,that the information on thisapplication is true and complete. FIRM NAME: 1�c��au �Ct�f%c ly�C , ` LIC.NO.: G( 1n A Licensee: f;mom, \ma k`SV-ISignature LIC.NO.: (If applicable,enter"exempt"in the lic nse number line.) Bus.Tel.No.: C,..1 11- - . 130 Address: 3\ \l�ak1 l�Vc �S� rr� (Ul Alt.Tel. 1 *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)❑owner ❑owner's a ent. Owner/Agent Signature Telephone No. PERMIT FEE. $ I 1 t e i 1 COMMONWEALTH OF MASS1CHl3SETTS ,,8'dAR Q E.C;I=CUsTR I Cl ISSUES THE FOLLOWING I1C`ENSE `AS A i 12�D MAST. .1 N, A.*LL, Y ELECTRIC "INC Bit`IAN A ::WRtS-14— Z 21 HYATT AVE ,; A RD:.... ><:>;.:€' >'= o t _8221:::: FtAD 835 <` t t 3 t 20180 A 0 /t& ':; _._ .acoRo° CERTIFICATE OF LIABILITY INSURANCE 706127/2014 (MMIDDM YI) ` 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the 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 Phone: 978-688-4474 Fax: 978-327-6558 CONTACT DEGNAN INSURANCE AGENCY DEGNAN INSURANCE AGENCY NAME: AX 86 SALEM STREET acNe Ext: 978-688-4474 1FAIC,No 978-327-6668 LAWRENCE MA 01843 ADDRE E-MAIL SS: cdeg nan@ deg naninsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER :MOUNT VERNON FIRE INSURANCE COMPANY 26622 VALLEY ELECTRIC INC. INSURER 21 HYATTAVENUE INSURER HAVERHILL MA 01836 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 24544 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 TYPE OF INSURANCE ADD'L SUBR POLICY EFF POLICY EXP LTR INSR ww POLICY NUMBERMMIDD MMIDD LIMITS A GENERAL LIABILITY CL 2661642 11/14/13 11/14/14 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea omurence) $ 100,000 CLAIMS-MADE D OCCUR MED.EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEI'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- POLICY JECTLOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOSAUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS' LIABILITY TORY LIMITS ER $ YIN E.L.EACH ACCIDENT $ ANY PRMEMBEORIPARTNERIEXECUTNE OFFICER/MEMBER EXCLUDED NIA iMand°tory in NH) E.L.DISEASE-EA EMPLOYEE $ f yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I-IT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Hall THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01846 AUTHORIZED REPRESENTATIVE Attention: Electrical Inspector ��.%�►�1 `, l�� L'2/� Carla M. De nan ACORD 26(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORO° CERTIFICATE OF LIABILITY INSURANCE °A'� (N"DNYYY) '' 06/27/2014 TKIS 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the 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 Phone: 978-6884474 Fax: 978-327-6558 CONTACT DEGNAN INSURANCE AGENCY DEGNAN INSURANCE AGENCY NAME: 86 SALEM STREET aoNn Exl: 978-688-4474 FAX No 978-327-6668 g � LAWRENCE MA 01843 ADDREnan E-MAIL SS: g cde de naninsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER :NORFOLK AND DEDHAM INSURED VALLEY ELECTRIC INC. INSURERB 21 HYATT AVENUE INSURER HAVERHILL MA 01836 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 24543 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 TYPE OF INSURANCE ADD'L SUBR POLICY EFF POLICY EXP TTS INSR WVD POLICY NUMBER MM/DD MNwD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ CLAIMS-MADE F—I OCCUR MED.EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ PRO- 1-7 POLICY1-1 JEC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS UTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE UTOS (per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ E--ES. LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WE132614A 11/13/13 11/13/14 WCSTATU- OTH AND EMPLOYERS' LIABILITY TORY LIMITS ER $ ANY PROPRIETOR/PARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? I NIA $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 600,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Hall THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01846 AUTHORIZED REPRESENTATIVE '( ' Attention: Electrical Inspector Carla M. De nan ACORD 26(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD
