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Miscellaneous - 49 PLEASANT STREET 4/30/2018
- -- '- - - / PLEASAT STREET fI 210// N055.0-0019-0000.0 i Date........AW .-. 2 -/5.... f 4ORTh 3? Olt TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHU This certifies that .................... �!. .......... ...........4G. .................. has permission to perform .....R.-ow.e&-r. ~ wiring in the building of...S/..� 1i ?+,/.............. - '.............................. at .......... 1Q�4... Ge: ...................................................North Ando ler,Mass. J d Fee..l.. ...............Lic.No. ........... ....... ..............................:.. ....... ............ ....... Check# 1-3n 5 _ Commonwealth of Massachusetts, � ��Gi�gljis�9.p�k,' � I Permit No. / �d - igen o - Services ` Occupancy and Fee Checked I { BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leavcblank-) j APPI UCATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to he performed in accordance wish the Massachusetts Electrical Gxic(1v1ECl..527 CMR 12.00 (PLLA.SE PIt[tVT Ili INK OR 7YPE.4LL In%F014TION) Date: .2i City oTown of. NORTH ANDOVER. ro the Insf..ecto ?f Wires,: By this application the undersigned gives notice of his or icer intention to perform the electrical work described below. Location(Street&Number) � -eG�S ua _ e C' Owner or Tenant .sic V-r V, Stec. Telephone No. Owner's Address �'( cr l t-�— e r c 6,t(tic pei'utit witi►-8 4"'iitlitt Permo.? Ves No {Check Appropriate Box) Purpose of Building Utility Authorization No. Existiusg Service ZO� Ainlrs_ % 1 Z4�iVoits. flverFiead Undgrd No.-Of 1C?ieters New Service .Amps I Yoits Overhead ❑ Undgrd ❑ ,No.of Meters Number of Feeders:and.Ampacity ' A.ncB''tinn's�ii'I�:stni'e nC'P�'i'`ec�eil')fl'�Ct'ric`sit��rl�: In _ I Completion(?f the following,table may he waived by the Inspector of Wires. No.of Recessed Luminaires3 No.of Ceil:Susp.(Paddle)Fans tNd Transformers of Total formers KVA No.of Luminaire Outlets No.of Hot Tubs Generators K"A Above [Iin- o.o mergency ig s sng No.of Luminaires Swimming Pool rnd. Urnd. Hattery Units r No,.of.Receptacie Outlets 7 No.of Oil Burners f FIRE ALARMS �No.of Zones No.of Detection and No.of Switches No.of Gas Burners i joitints"R Devices . Pot's No.of Ranges. No.of Air Cond. TayAlerting.s No.of Devices-. No.of Waste Disposers p ne+tsaes Torn F{l7N .leo.of Self-Contained x Meat Ptastt Totals: ..................,. . .. .. ....... ........ jDete tion/Alea'ting Devices No.of Dishwashers SlnaeelAreA lsepstirtg KW 'Lor-all E] MunicipalConnection ❑ Other. ��R'o.of Dryers Heating Appliances kW Security Systems:* i No.of's2^slew or E ass aalen No. Of Water R� No.o o.o Data Wirlig: . Heaters Si ns Ballasts. No.of Revices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP ITelecommunicatious Wiring. � I No.of Devices or Euuivalent I EI'1'FIEII: Atkwh aa'clit:onai detail if desil•ec4 oras required by the Inspector of J'Nres. Estimated Value of Electrical Work: (Whei!required by mtlnicipai pplicy. Work to Start Inspections to be requested in accordance with iv1TC Rule 10,andupon completion. d INSURANCE COVERAGVc'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 F� OTHER Q (Specify:) I .fj', t%offer t tains a poen Ctkes qfPe!jury,that este inl6rnttteon on thin eipp-lication is trite and complete.. FIRiO'F N Al6'lE: * LTC.NO.: 2�,6 Licensee: /� Sigaaa4hare LIC.NO. (1-f applicable,en r "e-empt"in di license number line.) Bus.Tel.No.;M &q-32c�St Aeldtess: f Cox c Alt, Pel,No.. *Per M.G.L c. 147,s. 57-61,security work requires Depar men f Public Safety"S" License: Lic.No BONER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. lay my signature below,I hereby waive this regarrement, lam the(check one)El om per �'owner's agent. Owner/Agent Signature Telephone No. ��R�IT�EE � r r- as _ _. .. -• � �4; .. r 11.1. ,1 • .. .. .s. 1, ..a. ... .,. .. .- . i ��•1 r-/s :)11111 �, r /a•1• 5 1 l ab i a 1.t •.t,r . 1-. t. ..1 . •k1. \ a. a - •v Y.KS.•.1fa • .15Rxi \ ..\, a ., A4r r..t1. • .1.1, 1 The Commonwealth ofMassachusetts . - Department of lndicstrigl Accidiints Office oflnvestigations 600 Washington Sireet Boston.,MA 02111 vww.massgov/ciia Workers'Compensation Insurance Affidavit:Builders/Cony°actor/Elec€ri.clansfPliunbers A lieant Information Please Prim X.e 'bl Name(Businesslorganization&dividual): Address: e15_ ,Vd,� City/State/Zip:Lt'UA) -c.,1.C_,d_ ZM o/S-� Phone#: T7$- S-0 Y- -z>;ZC2 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 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 orpartaer listed on the attached sheet. 7• ❑Remodeling 2? ship and`havano employees These sub-contractors have 8. E]Demolition working for me in.any capacity. workers'comp.insurance. y, F1 Building addition [No worlors' comp.insurance S. ❑ 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 11.❑Plumbingrepairs or additions myself[No workers' comp. c.152,§1(4),and we have no UP Roofxe airs insurancere ed. i employees.[No workers' a 13.❑Other comp.insurance required.] xAny appIicantthat checks box 41 must also fill out the section bel6w showing their Workers'compensation policy information. 7-Homeowners who submit this affidavit indicating they kedging all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that cheekthis 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 joh site information. Insurance Company Name: Policy/#or S el£im.Lic.#: 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 requixedunder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a flue up to$1,500.00 and/ox one=year imprisonment,as wallas 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. Mo Hereby cartjV unifer the pains and pen ie fperjury that the information provided above is true and correct. - Si afore• e Date: f Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permif/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructi®ns Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an em toYee is defined as"...ever y parsonhi the service ce of another under any coriixact I of hire,- express orimP lied oral or written." An employd is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the Foregoing engaged in a j oint enterprise,and including the legal representatives of a'deceased employer,or tb e 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 s persons to do maintenance,construction or repair work on such dwelling house dwelling house of another who employ, or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employes." 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 shalt enter into any contract for the performance ofpublic 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'compensailon affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)andphone 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 thatthe affidavit is complete andprinted 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 inthe pemait/license number whichwill be used as a reference number. In addition,an applicant that must submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant shouldwrite"all locations in (city or towh)" copy of the affidavit that has b een officially stamp ed or marked by the city or town.may be provided to the applicant as pro of that a valid affidavit is ou file for future permits or licenses. Anew 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 orpermit to burn leaves eta)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and shpuld you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: `1.'ho CQMMonwmTtbL of to - Depat�.ext�o�Zx�dual.�ccxc�a;�t� 600 Washh ggt .Sixap4t Bost n?MA021.Xx TO, 617-7-2,.7-4900 at 406 or 1-8777 A i�S, 1 Revised 5-26-05 Fax 0 617"727'77¢9 WWW.zuass,go��c�`a AORTH TOWN OF NORTH ANDOVER PERMIT FOR WIRING SAC14US This certifies that ...... ....................... has permission to perform ................................................ wiring in the building of.... ................................:j ......... .North Andover,Mass. Fee,.' ....... Lic.NA.1 .......... ..n. ..... ELECTRICAL IN ECTO Check # c--)2,, 9103 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance-with the provisions of M.G.L.c.143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed " on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an electrical permit shall be issued to the person,firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,.§3L. Permits shall-be limited as to the time of ongoing construction activity,and maybe_deemed.by--the-Inspector_of_Wires abandoned.and_invalid_ifhe—. ._ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or.the installing entity stated on the permit application. 1. The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending"through August 15,2012. le —Permit/Date Closed: G ***Note:Reapply for new perm' ❑Permit Extension Act—Permit/Date Closed: �/ M 64cc�'� c'] Permit No. d 2.r,a ,Wnt 0/ ire Service6 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C 12.00 (PLEASE PRINT IN INK OR TYP AL INFORMATION) Date: _ 1©I a O q City or Town c� To the Inspector of Wires: By this application the undersign gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) Owner or Tenant C t e—bed-ry n s, 4- �Po_0Telephone No.179-(g9- 966 7 Owner's Address 5t F/eg_<g�k4- <<'IYee4- Is this permit in conjunction with a building permit? Yes ❑ No EL (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: ( ©y� lbwYJ C_ Com letion of the following table may be waived by the Ins ector of Wires. f No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans o.of ot Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA /Q / No.of Luminaires Swimming Pool Above n- o.o Emergency ig mg g rnd. ❑ rnd. ❑ BatteEl Units No.of Receptacle Outlets No:of Oil Burners FIRE ALARMS. No.of Zones No.of Switches No.of Gas Burners No.-Of.netpetion an Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump Number ons o.o Self-Contained p Totals: Detection/Alerting Devices al No.of Dishwashers Space/Area Heating KW Local❑ onncipectiu ection ❑ OtherCuriy No.of Dryers Heating Appliances KW eCNo.of Devices or Equivalent No.of Water KW o.o o.of Data Wiring: Heaters Signs Ballasts No.of Devices or E uivaglent mmunications r+ No.Hydromassage Bathtubs No.of Motors Total HP a of Devices or Equivalent OTHER:Zig S I et�io c P? 14 ws Sca: ttach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Elec cal Work: /0,000 — (When required by municipal policy.) Work to Start: • 3 p Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO GE: 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:) 1 certify,under the aims and penalties of p 'ury,that the information on this application is true and complete- FIRM ompleteFIRM NAME: ; LIC.NO.: 14103qo� Licensee: At-644 V, TO L�_s , S' • Signature v LIC.NO.: 5'�J (If applicable,enter"exempt"in the license number line.) Bus.Tel.No.:603-35.9 Address: 3 /006 Alt.Tel.No.: *Per M.G.L.c. 147,s.57-61,security work requireSATartment 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)[Iowner Elowner's Owner/Agent ATe PF.RM7T FF.F. . 287 Date. . ... .. i 'kORTIy TOWN OF NORTH ANDOVER 0 �` PERMIT FOR MECHANICAL INSTALLATION 110 SA US This certifies that . ./� 5�/1. . . /I .�! . . . . . . . . . . . . . . has permission for mechanical installation . . /,��3' -:. . . . . . . . . . . . in the buildings of . . . . . . . . . . . . . . . at 7:,j . . . . . . .. North Andover,"Vlass. Fee. . . . Lic. No.. . :lU . . . � --. . . . . . . . . . . GAS INSPECTOR WHITE:Appli antCANARY: Building Dept. PINK:Treasurer t� lbv� i I i nearing, ventilation & Air Conditioning Sales, Service & Installation - Gas&oil forced hot air furnaces - New Construction Energy recovery ventilators - AMSON 24Dexterarrear �i y Haverhill,MA 01830 § amson@me.com www.amsonhvac.com i 24HR (888) 856-1331 l 78 815-5124 Cell (9 ) " Sean Corcoran ,.� Heating&Air Conditioning Specialist Fax (978) 945-0518 ---��-rreei�vreidi t erm1� �' Date -� Permit# Estimated Job Cost: i * 2 Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# C Business Information: .,Property Owner/Job Location Information: 50X) 72&11&- Name: / I� Name: y Street: �- - � �I'L ""\ v�` Street: 'T U�I�'� N� s� City/Town: 114k VY/�� City/Town: ✓"' AUOL Telephone: 9 2E lJ �_) / Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family r Multi-family Condo/Townhouses j Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. V-- over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: ��II�IIIIIII� II rte► INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes No❑ 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. Progress Inspections Date Comments a Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation , . Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required)and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all scams and connections welded airtight with properly located cleanouts. Proper clea`ances, fire rated enclosures and pressure testing required: installed�xr bto required'on equipment and d:u,t,,.3;r Duct penetrations in fire'rdQ--wall and flaors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct reins installed 6'-0"maximum length Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-oft) 4 . ` A f Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating/cooling load calculations Duct work sized per manual "D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean -properly sized filter installed(final inspection) j ,Testing and Balancing report complete(final sign-off) �—, OP ID: PS DATE(MM/DDKYYY) CERTIFICATE OF LIABILITY INSURANCE 06/03/2014 ,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, 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 CONTACT Pete Sullivan North Andover Insurance Agency NAME:PHONE FAX M.J.Foster Insurance Services o .978-686-2266 No):978-686-6410 163 Main St. E-MAIL sullivan@fostersullivan rou .com North Andover, MA 01845 ADDRESS: Stephen Sullivan PRODUCUSTOMER D .AMSON-1 _ INSURERS AFFORDING COVERAGE NAIC# INSURED Amson Companies Incorporated INSURER A:LIBERTY MUTUAL INS CO 23043 Amson HVAC 24 Dexter Street INSURER B: Haverhill, Ma.01830 INSURER C Sean Corcoran INSURER D: 24 Dexter St INSURER E: Haverhill, MA 01830 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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYW MM/DD/YYW GENERAL LIABILITY EACH OCCURRENCE77$ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8609720 02/06/2014 02/06/2015 DAMAGEPREMISES S( RENTED 100 000 Ea occurrence $ � CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X1 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N LIMIER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ MUM??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. AUTHORIZED REPRESENTATIVE @ 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ` The Commonwealth of Massachusetts - -' Department oflndustYialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 kvtj www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizationifndividual): Address:_`7`�� � N� �/ . ✓ys �/��/ /h City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I 6. E]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. El Remodeling ship and'have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9 ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.r]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑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' 13.❑Other comp.insurance required.] *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 t�e doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: 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 requixedunder 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 cert der the pains and penalties of perjury that the information provided above is true and correct. signafore: 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#: I Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,- express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in 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 producedacceptable 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(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew 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: `I`he CQr monwealt�of Mfassa.,chvsotts Dopar nm t of f dusfdal.Accidents Office of Investigations 6.00 WashiVon Street Boston,MA 0.21.1.1 `QL 0 617- 2,7K4900 oyt 406 ox I-877-MAS SAFE Revised 5-26-05 Fax 0 617-727-7749 www.ma.ss,gov0a J i f 1 z i I I 4 t COM�UI�NW�ALTA.OE MA-R�SA`�kliJ�� i+r��;- 5HEET. METAL'-N1lO.Ft1tE(tS C � ,`a,',ASAwMASTER-UNRESTRICTCD {sFF r ISSOESdTHE ABOVELICEL 919 TOk SEAN PGDRCORAN S ^wr !m 24 DEXTER -STREET, " ,y I . f HAUERHILL�` '.'NA 0;1830=3953 1 rr b97011/28/14 .`29607:3 ' Fold Multiple Times Along Pertorations Before Detaching y�, l ' Yif 41 '�4•'"fP�t 3 tl. k 9231 Project Summar Job: Oct 24,2014 ,._. � Y Date: Oct 24,2014 l0 � ) Entire House By: NEHVACHL a a For: 51 Pleasant Street Notes: HVAC Install D - • a e I Weather: Boston, MA, US Winter Design Conditions Summer Design Conditions Outside db 12 OF Outside db 87 OF Inside db 70 OF Inside db 75 OF Design TD 58 OF Design TD 12 OF Daily range L Relative humidity 50 % Moisture difference 26 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 36172 Btuh Structure 21545 Btuh Ducts 6177 Btuh Ducts 2077 Btuh Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 42349 Btuh Use manufacturer's data n Rate/swing multiplier 0.92 Infiltration Equipment sensible load 21780 Btuh Method Simplifiedlifi ed Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 975 Btuh Ducts 1064 Btuh Heating Cooling Central vent(0 cfm) 0 Btuh Area (ft2) 1614 1614 Equipment latent load 2039 Btuh Volume (ft) 12913 12913 Air changes/hour 0.50 0.26 Equipment total load 23819 Btuh Equiv. AVF (cfm) 108 56 Req.total capacity at 0.70 SHR 2.6 ton i I Heating Equipment Summary Cooling Equipment Summary Make Generic Make Generic Trade Trade Model AFUE 96 Cond SEER 13.0 AHRI ref Coil AHRI ref Efficiency 96 AFUE Efficiency 11.6 EER, 13 SEER Heating input 44500 Btuh Sensible cooling 21783 Btuh Heating output r 42720 B Latent cooling 9336 Temperature rise 37 OF Total cooling 3 119J Actual air flow 1037 cfm Actual air flow cfm Air flow factor 0.024 cfm/Btuh Air flow factor 0.042 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.92 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. �ttSi{7 2014-Oct-2818:14:29 ' wt1iRight-Suite®universal 2013 13.0.09 FSU09171 Pagel at Loads 2014Wmson HVAC 51 Pleasant Street.rup Calc=MJ8 Front Door faces: N _ Pro ect Summar Job: 20141019230 i Date: Oct 24,2014 I f l yu iy Zone 1 By: NEHVACHL For: 51 Pleasant Street Notes: HVAC Install Weather: Boston, MA, US Winter Design Conditions Summer Design Conditions Outside db 12 OF Outside db 87 OF Inside db 70 OF Inside db 75 OF Design TD 58 OF Design TD 12 OF Daily range L Relative humidity 50 % Moisture difference 26 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 24398 Btuh Structure 15650 Btuh Ducts 4167 Btuh Ducts 1509 Btuh Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 28565 Btuh Use manufacturer's data n Rate/swing multiplier 0.92 Infiltration Equipment sensible load 15820 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 506 Btuh Ducts 697 Btuh Heating Cooling Central vent(0 cfm) 0 Btuh Area (ft2) 1058 1058 Equipment latent load 1203 Btuh Volume (ft') 8461 8461 Air changes/hour 0.40 0.21 Equipment total load 17023 Btuh Equiv. AVF (cfm) 56 29 Req. total capacity at 0.70 SHR 1.9 ton Heating Equipment Summary Cooling Equipment Summary Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref n/a Coil n/a AHRI ref n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 4 wPlihtsoft 2014-Oct-28 18:14:29 Right-Suite®lhiversal 2013 13.0.09 RSU09171 Page 2 at Loads 2014Wmson HVAC 51 Pleasant Street.rup Calc=MJ8 Front Door faces: N _ Project Summar Job: 20141019231 tl� � 7�I 3,ly Zone 2 Date: Oct 24,2014 By: NEHVACHL SII For: 51 Pleasant Street Notes: HVAC Install ' Q _ • o e Weather: Boston, MA, US Winter Design Conditions Summer Design Conditions Outside db 12 OF Outside db 87 OF Inside db 70 OF Inside db 75 OF Design TD 58 OF Design TD 12 OF Daily range L Relative humidity 50 % Moisture difference 26 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 11774 Btuh Structure 6956 Btuh Ducts 2011 Btuh Ducts 671 Btuh Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 13784 Btuh Use manufacturer's data n Rate/swing multiplier 0.92 Infiltration Equipment sensible load 7031 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 469 Btuh Ducts 367 Btuh Heating Cooling Central vent(0 cfm) 0 Btuh Area (ft2) 557 557 Equipment latent load 836 Btuh Volume (ft3) 4452 4452 Air changes/hour 0.70 0.36 Equipment total load 7868 Btuh Equiv. AVF (cfm) 52 27 Req.total capacity at 0.70 SHR 0.8 ton Heating Equipment Summary Cooling Equipment Summary Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref n/a Coil n/a AHRI ref n/a Efficiency n/a Efficiency n/a Heating Input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. litSoF 2014-Oct-2818:14:29 Right-Suite®universal 201313.0.09 RSU09171 Page 3 at Loads 20141Amson HVAC 51 Pleasant Street.rup Calc=MJ8 Front Door faces: N 1 BuildingAnalysis Job: 20141019231 - Y Date: Oct 24,2014 `•►t`�l ,�y Zone 1 By: NEHVACHL For: 51 Pleasant Street Location: Indoor: Heating Cooling Boston, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 12 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.7 25.7 Dry bulb (°F) 12 87 Infiltration: Daily range (°F) - 15 ( I ) Method Simplified Wet bulb (°F) - 71 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 0 Component Btuh/ft2 Btuh % of load Walls 3.8 3408 11.9 Glazing 27.3 3598 12.6 Doors 22.6 950 3.3 Ceilings 14.9 11232 39.3 Floors 1.7 1653 5.8 Infiltration 3.3 3558 12.5 Ducts 4174 14.6 �F�R Piping 0 0 Humidification 0 0 Ventilation 0 0 Adjustments 0 Total 1 28572 100.0 Component Btuh/ft2 Btuh %of load Walls, Internal Gains Walls 1.0 873 5.1 ij pts Glazing 21.4 2819 16.4 Glazin Doors 10.2 427 2.5 nfiltration Ceilings 12.7 9595 55.9 i Floors Floors 0.3 348 2.0 Doors_ Infiltration 0.4 389 2.3 --_ Ducts 1512 8.8 Ventilation 0 0 Internal gains 1200 7.0 Blower 0 0 Adjustments 0 Total 1 17162 1 100.0 Ceilings Latent Cooling Load = 1204 Btuh Overall U-value=0.129 Btuh/ft2-°F Data entries checked. 2014-Oct-28 16:51:06 1N1'Ic tsO�t Right-Suite®universal 2013 13.0.09 RSUD9171 Page 1 at Loads 2014\Amson HVAC 51 Pleasant Street.rup Calc=MJ8 Front Door faces: N Building Analysis Job: 20141019231x �; -- Y Date: Oct 24,2014. `}f� ±CSU ) )IY Zone 2 By: NEHVACHL For: 51 Pleasant Street EMS Location: Indoor: Heating Cooling Boston, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 12 Latitude: 42 ON Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.7 25.7 Dry bulb (°F) 12 87 Infiltration: Daily range (°F) - 15 Method Simplified Wet bulb (°F) - 71 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 0 Component Btuh/ft2 Btuh %of load Walls 3.8 3544 25.7 „ Glazing 27.3 1636 11.9 Doors 0 0 0 Ceilings 8.6 3294 23.9 i JJ Floors 0 0 0 Infiltration 3.3 3300 23.9 Ducts 2014 14.6 Gia=,o r Piping 0 0 Humidification 0 0 Ventilation 0 0 Adjustments 0 Total 13788 100.0 A. Component Btuh/ft2 Btuh %of load Walls 1.0 907 11.9 ' / Glazing 46.3 2780 36.4 Doors 0 0 0 Ceilings 7.6 2908 38.1 Floors 0 0 0 Infiltration 0.4 361 4.7 Ducts 672 8.8 Ventilation 0 0 Internal gains 0 0 Blower 0 0 Adjustments 0 Total 1 7628 100.0 Latent Cooling Load =837 Btuh Overall U-value =0.106 Btuh/ft2°F Data entries checked. 2014-Oct-28 16:51:06 W I`iglhtSflft' Right-Suite®universal 201313.0-09 R61-109171 Page 2 ACCO ...at Loads 2014\Amson HVAC 51 Pleasant Street.rup Calc=MJ8 Front Door faces: N New construction or Name: �" �l , �s Call Received: -a'7� Existing Equipment: . Address: ' -, RA s�7 I # App. date/time: AC #cond FHA #AH City+Zip: �J ����� /14 Time: FHW---Steam---ResElect -Gravity HW #2 Referred By: Pellet---Wood---Stv# Phone: Gas convct Stv # Fuel: E-Mail: NATGAS--LP--WOOD--OIL HPwElectBU V'SO Fuel/Service Company: Calling for: House Style: SQ' # Floors Age Loc Man yp r Loc Man Typ Md1# Srl# Loc Man Typ Mdl# Srl# Loc Man Typ Md1# Srl# Loc Man Typ Mdl# Sri# Loc Man Typ Md1# Srl# Loc Man Typ Md1# Sri# Loc Man Typ Mdl# Sri# Phone: 978-815-5124 The A m s o n Companies Inc. Fax: 978-945-0518 'eb:www.web.me.com/amson 24 Dexter Street,Haverhill,MA 01830 E-mail: amsonoa-pe.eom i ; ; Existing 3 1 x 6, Solid Beam _x T- New 3 1/2" Steel, Concrete Filled Lally Column Over 2' x 2' x 1' 4" x 4" Exist. Srick Chimney 'n Wood Post Cobbled �a--support-- Concrete Pad (typ) beam - -- -- r ----------------- - ---- -- ----- -�--- -- N t__ ---- _1_, ----------------- -------- -- -- -- ----- = Existing Steel Lally Columns 6'-"i1 � Existi g ----__------ r x �" Soli Be ------- an oQ 2 3/4" x 3 3/4" ________ �q Wood Post 6' -------- ; -1-11 cn -g ------ ------- --- ----------- ------ ---- -- ----- ------ 3 3/4" x 6" Existing 3 3/4" x 6 1/4" solid Beam Wood Post New 2x wall under entire r beam, covered with 5/8" 16'-liz" \I Firer-ode and skimcoat plaster finish k�T��777TE�77 77777777 77117711117111111111 T Proposed 5assment Scale: 1/4" = I'-O" s 10'-4" ate. R.O.V-1016"x W-475" 12 TU118 . .IP-A.. -------------- --- ------- 19'-3 ' 1 I- x N - M. 5edro m o q �D leeasl rc O �S R Enclosed 6'-2 " 3' Porch =� ;n , Lav: 5o Kitt hen m ;3 ,3 _ �ry Dining20" o \ ' m V Ch HX r H /i VAC Ghase ,�7 oet f3)13/4°x 9 1/a"Yerm-Lem�1 P at �•-+�,y{) Poot 20 2600 OF or Equal «_ Living 7L� room ---- -- Proposed First door Scale: I/8" = 1'-0" N D Bedroom #1 th 2'-4" 20" x 20" HVAC Chase 4'-0" � Yost i NPost" 4-0P --------- x -------x (V 2.0 2800 9 D1/P4or Eqsual �9 Hall Bedroom 2Yera-L cq Proposed Second Floor Scale: 1/5" = 1'-0" Z� �f I----------------- ---------------- a Study cm _N x A prox. 200 S� 4 a ---- 0 i Proposed Third Floor Scale: 1/4" = I'-O" f 2" x 12" 0 16" O,C. 12 Fir down existing rafters to � accommodate new Insulation +/ 10 (3) 1-3 x 9-1/4" Varsa-0 m 2.0 2800DF r- 1'-10" s ol +� o t C � O m 2" x 10"m 24" O.C. 2"x 10"O 24"O.C. b � 20" x 20" HVAC ' m\� Chase e�sall�am 2,020 0 A� 2" x 10" '4" .C. M, 2" x 10" 9 24" O.C. ; 13'-9" O 2" x 6"m 19.2"O.C. 2'x 6"644" O.C. Approximate all Grade Proposed Gross Section