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Home My WebLink AboutMiscellaneous - 5 GREAT LAKE LANE 4/30/2018 Is '6� � L �./ �4 Jv ► .- �t Date....� ..................................� NORT/1 °� "`° '•�� TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHUB�t t /,( ............................................................................ This certifies that ..............Lk.,.,... �'`.... haspermission to perform .........1.1�./�',,-..C�............................................................................... wiring in the building of...........�f� Z---• " ......................................................................................... at ....-'�....�?. PU. ...... ............ r . ..., rthAndover,Mass. ................................. Fee ..r�..62....`..........Lic.NAlb. �/. .... .1 ... ................... ................................. ELECTRICAL INSPECTOR Check# 127u8 -f Commonwealth of Massachusetts Official Use Only 1 . Permit No. ' a Department of Fire Services Occupancy and Fee Checked ,M BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code ),527 CMR 12.00 (PLEASE PRINT IN NK OR TYPE ALL INFORMATION) Date: Q 11,1 r .� City or Town oh 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) � C Aj Owner or Tenant k t,(,(�. Telephone No. �26-7-2-6 3 Owner's Address 14 = `T Ow� A t - Is this permit in conjunction with as building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building c IUtility Authorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ o.of Meters New Service �_ Amps /MjjVolts Overhead❑ Undgrd No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: U/t ox -U-., i w 0 S 6 Completion of the following table 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- 11TEl o mergency ig tmg rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I 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 No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ""' ' "' '"' ......."".......... Detection/Ale ting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ElOther Connection No.of Dryers Heating Appliances jar Security Systems:* No.of Devices or Equivalent V4' No.of Water No. o of N .of Data Wiring: Heaters KSi 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: � , When required by municipal policy.) Work to Start: 14221tS 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 cover e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE WOND ❑ OTHER ❑ (Specify:) 1 certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: . &,L.•vt i}r— LIC.NO.: 64 Licensee: (&q,,} A k AN ignature LIC.NO.: 27�p � (If applicable enter "exempt"in the license number line)-, Bus. el.No.• Address: 6 o. SD 6'z— W Av1`,V! t- /A-1 Q 8-S�r Alt.Tel.No.: 37 b 5--L� *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lie.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PEIzMIT FEE:$ 76 Z d� Signature Telephone No. ❑ 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. 01 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 may be.deemed by the Inspector of Wires abandoned and invalid if he 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. ❑ 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. ❑ Rule 8—Permit/Date Closed: ***Note: Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass(] Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE PECTION: Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: .5 PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSP TION: Pass M V Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: /I FINAL INSPECTION: Pass Failed 0 Re-Inspection Required($.) ❑ . Inspectors Comments: Inspectors Signature: Of Date: Z6 - DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com 4 The Commonwealth of Massachusetts s Department of IndustrialAccidents X Congress Street,Suite 100 Boston,MA.02114-2017 �` www mass.gov/dia AV Workers,Compensation Insurance Affidavit:Buildexxs/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING,AUTHORITY. • .,Blease Print Letibly A_ hcant Information Name(Business/Oigaiiization/Jndividual): �-- Address: ,, O/ City/State/Zip: U-, 4v� Phone Type of project(required): Are yon a mployeri Check the appropriate box: 1. am a employer with _employees(full and/or part-time).' 7. W�d6nstrdction 2•0 1 an a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required]t 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 11.❑Electrical repor additions ensure that all contractors either have workers'compensation insurance or are sole ay,rs w4 proprietors with ,employee nos. I&Q Plumbing repairs or additions 5.❑I am a general coniracto and 1 have hired the sub-contractors listed on the attached sheet. 13'.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.0 Other 6.Q We are a corporatioii and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'we have no employees:[No workers'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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. ,,•, tContractors that check this Uox must attache d'an additional sheet showing the name of the sub-contractors and state whether or not those:entities•have they must provide their workers'comp.policy number. employees. If the sub contractors have employees, ovidin workers'compensation insurance for my employees. Below is the policy and yob site X am an employer that is pr g information. Insurance Company Name: -vO t-- Expiration Date:. Policy#or Self-ins.Lic.#: Job Site Address:_�o_ ___ �'l,�Csq`�-C.4C�� iU _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 MGL c.152,§25A is a criminal violation punishable by a foie 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.A copy of this statement may be forwarded to the Office of Investigations of the DTA.for insurance coverage verification. X do hereby cerfin under the pains and penalties of perjury that the information provided above is true and,correct. Date: l 0-12,L Si ature: Phone#: Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant �° n to flus statute,an employee ee is defined as ...eve person in the service o£another under an contract of hfre P Y "...every Y .� express or implied,oral or written." An employer is defuied as"an individual;partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprise,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 b6 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 may be 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 Off"icials 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 wiI1 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. 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 bum leaves etc.)said person is NOT requited to complete this affidavit. The Department's address,telephone and f'ax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Date..//.14:1`45...... 114. 9' 7 "ppT" TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING s3ACMU5E 11-e This certifies that.... ......1. .........�........ ................................................... {has permission to perform........ .. ,,a..... ......................................................... plumbing in the buildings of..- ........ .,L.l -... ............. at.......... ................................ North Andover, Mass. Fee?4.........Lic. No. l'r/..5 7... ................................................................................. PLUMBING INSPECTOR Check# �� F MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY _ i MA DATE _( PERMIT# 41 19 JOBSITE ADDRESS �„ 1G. OWN R'S NAME POWNER ADDRESS TEL _ FAX TYPE OR OCCU7RENOVATION: TYPE , COMMERCIAL EDUCATIONAL RESIDENTIAL T PRINT CLEARLY NEW: REPLACEMENT:©1 PLANS SUBMITTED: YES® NOD! FIXTURES Z FLOOR--s BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB TI __. ( I j I } I ____j ._.._..I CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/01L/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ( DEDICATED WATER RECYCLE SYSTEM I _._. ._.} .._._.___I _.} � I _.I _ ._J ..-_ _. _..._I i I ( __I _. DISHWASHER I __ _._..__ ___R _ ____I .__- I __ 1 _._-._ _-__! _..1 ___.._...j .____} l ___.__I DRINKING FOUNTAIN I .___.._} I _._._J I _____.._.} _-,-__ I •___-} ..__.__� ._.._....} -__-._- .___.._1 _X ....__ FOOD DISPOSER FLOOR/AREADRAIN INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN ! f I .___I � } i ._._.J .__. ...___._I 1 .-_..___.E l I SHOWER STALL SERVICE/MOP SINK __.I ._ I I 1 ._.._.__! T_ J J I -_____.I -..I ..__ TOILET N I _ I ( _I _._.� J �. .._! } ri URINAL _..__ } _..._.J 1 } --____-� i J __.._.__.._I .._ .._.__} ..._.._.__f ..____...1 J WASHING MACHINE CONNECTION WATER HEATER ALL TYPES i ( I J } I I _.._._J __..___1 L_j I W,1lR PIPING OTHER I _ I -__—I __.__I I _.__.__JE=11 _ _I INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES VNO _; IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY _s OTHER TYPE OF INDEMNITY DI 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 0 AGENT IEA SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with a Pertinent provi ' f (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME� � � VP _ i(__.A,_____ LICENSE# , } SIG ATUR IMP d JP Ell CORPORATION Q1#PARTNERSHIP 0# ;LLC COMPANY NAME ADDRESS CITY f STATEI ZIP TEL O FAX � � CELL 1f&-.. .3= _.. v1AIL H PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES L� 1 Yes No 6 / THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES d� .. The Commonwealth of Massachusetts i Department of lndustt'ialAccidents X Congress Street,Suite 100 2017 Boston,MA 02114 www mass.gov/dia VVo�:kers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plwpabers. TO BE FLED WITH THE PERMITTING,A.UTHORITY. A ''licant Information Please Print Le 'bl Name(Business/Oigatizaiion/Individual): Address: lei tiC Phone#: City/State/Zip: Rs... Are you an employer?Check the appropriate box: Type of project(x'equired): to Hill and/orpart-time).' 7. Netiii donstriiction a employer with � • em P yees( 2. 1 am a sole proprietor or partnership and have no employees Working for me in 8. E]Remo deliiig anycapacity.[NDemolition oworkers,comp.insurance required.] 9, ❑ t 3.E]I am a homeowner doing all work myself,.[No workers'comp.insurance required.] 10[]Buildnng addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. Twill 11.[]Electrical repeals or additions ensure that all contractors either have workers'compensation insurance or are sole s':. proprietors with no employees.12.J Plumbing repairs or additions 5.❑T am a general contracto Viand Ihave hired the sub-contractors listed on the attached sheet. 13'.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.0 Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),,and We have no employdes.[No workers'comp.insurance required.] *Any applicant that checks box#1,must also 511 out the section below showing their workers'compensation policy information. 11Homeownerswho submit•this affidavit indicating they are 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 state whether oy not(hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer tliat is providingworkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Expiration Date; Policy#or Self-ins.Lic.#: 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 MGL c.152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify un r thepa' s and enalties of r'u tat the information provided above is true n correct • / Si ature: Date: Phone#: 6 S 35 official use only. Do not write in this area,to he completed by city or town official City or Town: Permit./License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: �� Information and Instrnctions 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 ofthe foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receivef'oir 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 b6 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 xegiaired." Additionally,MGL chapter 152,§25C(1)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 certificates)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 may be 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 carnpanies 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"fob 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Date........11.�AYI >................ NQpTM o? °9 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION HUs�t4 This certifies that ................ ..�.............................LP.....Pxl...... ...................................... has permission for gas installation .....+J.. ! �-............................... in the build* s of..... �.��-�-...�E`�................................................................. at......... .................`-� Li—\��....1��............... North Andover, Mass. Feef .'"...... Lic. No./ S7........ ..................................................................... -� GASINSPECTOR Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK uvp � I rCITY MA DATE JJU PERMIT# GJOBSITE ADDRESS _ �- DOWNER'S NAME ��L:J/�- . , , OWNER ADDRESS L ITEL FAX TYPE OR OCCU7ENOVATION:E] YPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: REPLACEMENT:® PLANS SUBMITTED: YES FO NO F APPLIANCES 1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 12 11 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER J ( 1 L FIREPLACE FRYOLATOR FURNACE GENERATORz,1 GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNITS OVEN POOL HEATER ROOM/SPACE HE _ ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER -- J= J INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES NO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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 El 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 II Pert' ent pr isio70�9f � Massachusetts State Plumbing Code.and Chapter 142 of the General Laws. PLUMBE -GASFITTER NAME LICENSE# S_ SIGNATURE MP MGF 0 JP ® JGF 0 LPGI E1 CORPORATION F.11# PARTNERSHIP©f#=LLC[j#= COMPANY NAME: _ ADDRESS CITY _i STATE ZIP IT I - 7 FAX CELLMAIL 1 �l OUGH GAS INSPECTAYN NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of IndustrialAceidefits r I Congress Street,Suite 100 F Boston,MA 02114-2017 0 www mass.gov/dia ' •, Wa�:kers'Compensation Insurance Affidavit:Builder/Contxactoxs/Electricians/i.'lumbers. • TO BE FILED WITH THE PERMITfMG,AUTAOP4 - Please Print Le 'bl A licant Information Name(Business/Organization/lndividual): Address: 3 / 6� City/State/Zip: Phone#: pP p Type of project(required): Are you an employer?Check thea ro rlate box: em to ees full and/orpart-time).' 7. El NdVdo'ns"6tion 1,� am a employer with P Y ( 2.Wam a sole proprietor or partnership and have no employees Working for mein 8. []R.emodeliiig any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.❑I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no'employees. 12,L]Plumbing repairs or additions 5.❑I am a general contractpr f and I have hired the sub-contractors listed on the attached sheet. 13•,E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 14.0.Other 6.Q We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and'we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.- i Homeowners,who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such $Contractors that check this iiox 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: Expiration Date: Policy#or Self-ins.Lie.#: 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 MGL c.152,§25A is a criminal violation punishable by a fitib up to$1,500.00 and/or one-year imprisonment,as r as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a ay be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy of this statement m coverage verification. XjSii�ature: dhereby certify under the pat sand es of perjury that the information provided/a`bo is true and correct. Date: !6 G ` S 2 Phone#: J official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i Is Board u Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 1.6.Other' Phone#• Contact Person: i 1 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'd'efuied as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enferprise,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 applicaiitwho has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(1)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 certificates)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 au LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be 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 b eing 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. 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 wwwmass.gov/dia • sr ::COIIAMONWEALTH OF MASSACHUSETTS. • • - • • , PLUMBEO`>:A." GAS,I*.I TTERS'= ISSUES;THE FOLLOWING tIOENSE i r ' t#OEkSED AS A ':MASER,Ptt1 BER cr' I �. L W K E L L E R' 20 KENNED'Y` UR J HAM ;I!}H 03076-260 ; . 21288 .. 399 Date. �1�.. .1. . ...... .. HORTN TOWN OF NORTH ANDOVER �2 ya' a pL f PERMIT FOR MECHANICAL INSTALLATION F � r SSACMuSEt l This certifies that . . . . ` . . . . . . has permission for mechanical installation . . .. .... . . in the buildings of . ` . . . .. . . at --� Z . . . . . . . . . . . . . . . . . . . . . . . . . . .. North r/Andover, Mass. Fee.�� . . Lic. No.. . . . . . . . . . !? . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. • PINK:Treasurer ��, av u Commonwealth of Massach setts R Sheet Metal. Permit Date: Permit# Estimated Job Cost: $__3 , 0 C2 0 , 06 Permit rcc: $ Plans,Submitted: YES NO Plans Reviewed: YES S NO Business License 11 196 Applicant License 11 is(0 8' Business Information: Property Owner/Job Location Information: Name: J&J Beating. & Air Conditioning Name: V --LL`-,. j Street: 17 Arlington St.:. Street: $ Je" rcic(. LG r2 City/Town: Dracut, MA 01826 City/Town: North Andover, MA 01845 Telephone: •978-454-8197 Telephone: Photo I.D. required/ Copy of Photo I.D. attached: YES NO it Stnff]ultinl J-1 /M-1-unrestricted license i / J-2 /Nl-2-restricted to dwellings 3-stories or less and conuncrcial t p to l0000 s q. ft. 2-stories or less Res ideutial•f-T-2-faliuly ••'.-`Milti-family Condo/Townhouses- Other Coniniercial: ' Office Retail Industrial _ Educational Institutional Other Squ, re Footage: under' 10,0.00 sq. ft. ✓' over 10,000 sq. ft. Number of Stories: - Sheet inctal work to be completed: New Work: ►' Renovation: HVAC ✓ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: �; / � •� i'h��a l l /til��a / d u �7'`-"cu o r!� -Fm,� />u�c s y s I'e� �, 4 INSURANCE COVERAGE: 1 ❑ I have a current liability.insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 12 Yes eNo If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liabilitytnslurance policy Other type of indemnity ❑ Bond ❑ � p Y 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 PI•ot;t'ess Inspections Date Comments F4 incl Inspection Date Comments Type of License: By ❑ Master a Title ❑ Master-Restricted city/Town ❑Journeyperson Signature of Licensee Permit It ❑Journeyperson-Restricted License Number. Fee$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval , , I The Commonwealth o f Massa chcrsetts _ ;�;—�u—'-- - i�ii�Ciir�L/?a '2J 1/rGci.ur'iCtr _ Ac.Cfflc:ilrS 1 Cont cess Street, Suite 100 -.._.._..__....._.-.-....__,...Boston, MA 02114-2017 ..-. ....-.: ti lifliw hash goWWIr 11 orlcers' Compensation Insurance Affidavit: Biiildet•s/Cont[actors/Elect ic)ans/Plumbers. TO BE PILED WITH THE PERMITTING AUTHORITY. AP12licant Information Please Print Lc ibly Name (Bu'siness/Organization/individual): J & J Heating & Air Conditioning, Inc. Address: 17 Arlington Street City/State/Zip: Dracut, MA. 01826 p1jone#: 978-454-8197 Are you an employer?Cheek the appropriate box: Type of project(required): 1.E3 1 aim a employer with 4�employees(full and/or pan-time).* 2.❑I am a sole proprietor or partnership and have no employees working for me in [7. ❑New construction any capacity.[No workers'comp.insurance required.] 8• Remodeling 3.0 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]' �• El Demolition L❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.0 Electrical repairs or additions 5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.: 13.F]Roof I'epairs 6.❑We are a corporation and its o0icers have exercised their right ofexemption per MGL c. 14.0Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I mustalso fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 a111 an employer that is providing Workers'compensation instu•a11ce for my employees. Belau is the policy andjob site information. Insurance Company Name: A.I.M. Mutual Insurance Policy#or Self-ins. Lic. #: WMZ-8006553-201506/02/16 Expiration Date: Job Site Address: n G g City/State/Zip: p 1) 0 A-v I b t s Attach a copy of or cc ' compensation policy declaration page(showing the policy number and expiration date). Failure t cure coverage.a equired under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/ one-year imprison ent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of tip to$250.00 a d against the violat . copy tatement may be forwarded to the Office of Investigations ofthe DIA for insurance c verage.verif)ca n. I(to hereby cerci ura r pains and ena/ties of perjury that the information provided above is true and correct. Si nature: f Date: III Phone#: 978-454-8197 Officio!use ally. D1)trot write in this area,to be completer/by city or 10)1)11 afflcial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of health 2. Building Departnici t 3.City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone i ACORD CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) 05/27/2015 PRODUCER 978.t87,4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P. 0. Box 457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC 4 INSURED J&J Heating & Air Conditioning, Inc. INSURER A: Great American Alliance Ins Co 17 Arl;ington Street INSURERS: Safety Insurance Company 39454 Dracut, MA 01826 INSURERc: A.I.M. Mutual Insurance Co INSURER D: INSURER E: 7 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN JS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LLT R SFI POLICY EFFECTIVE POLICY EXPIRATION I LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM DD DATE MM DD YY LIMITS; GENERAL LIABILITY PAC6418906-09 06/01/2015 06/01/2016 EACH OCCURRENCE ..'$' 1000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE1 k)PREMISES Ea occurrence $ '300,OO A CLAIMS MADE I OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY El PRO- JECT El LOC AUTOMOBILE LIABILITY 2434550 06/01/2015 06/01/2016 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY B X 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 $ AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY UMB6418958-08 06/01/2015 06/01/2016 EACH OCCURRENCE $ 2 000,00 A X OCCUR FICLAIMS MADE AGGREGATE $ 2,000,000 - $ DEDUCTIBLE $ RETENTION $ �• WORKERS COMPENSATION �. WMZ-800-8006553-2015 06/02/2015 06/02/2016 X AND EMPLOYERS'LIABILIT ANY TORY LIMITS ER $ ANY PARTNER/E C OFFICER/MEMBER/EXCLUDED?ECUTIVEYIN E.L.EACH ACCIDENT $ 1,000,00 (Mandatory In NM) E.L.DISEASE-EA EMPLOYEE $ 1 000 00 If yes,describe under SPECIAL PROVIISIONS pelow E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER I: ' DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS f i CERTIFICATE HOLDER CANCELLATION I' 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 i' REPRESENTATIVES. Evidence of Insurance AUTHORIZED REPRESENTATIVE Peter Sennott/LAR 1 ACORD 25(2009/01) ©1,988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD v :C>OMMONW[ ni_TII OF MM t,n( lI(15�..7TS. 11 APID iz SI-1Err°`:Mf`I'n`U<.wa��.�<Ec I SSUES -11-1 POLI OWl N(2 I °I CCNSC Mns rcli.-UN.rzt;.sY11 I cT[.1�, ATI NG b 'nc` `.. ' .'iRIC:;R )(I_;i11r; ;:`< 17 ARI.::1 NGTON „S1 =� UlkA( ul Mn orzG 3936 l7CJlaF111[it°.]�`111:1&73��r:LjV1��..7 YIL=_1gE44��9:7.r�1T1�11`�.'I.°.1�'.- (X&S'ACI-CUjSE,TT`S1 DRIVER'S LICENSE yA 4?IS0 Be END 4J NUMBER f105-03.2011i:kNONE,..S996,55.8.71:.: '41,.E%P M;2,2'T;OF1s 05 2 1900 ' ..CLASS 12 REST 15 SEX M, �fl,IF(i�4. 9"; .. �" fi.. a•r N ADM NONE Iph ii KLINE'' 1� 2 ERIC RJ wb3]a 1460.•:. s 83 LONG DR DRACUT,MA 01826.2048 5 DD 05-04-2011 Riv 07.162009 i II w .4 '.ro;,> OMiVIONWALTH d� Ml. '.'' HUS SHEC'� > �AL'WoRK;,�RS +� j I SSUCS. THE FOLL0W1 N;G° L I�CEIfSEr,,; #;f- ; AS A BUS X; .SS Y . . bWARD T AYOTT J J" HEgTING IR C0NDIT1.0NING I.... 1 ARLi'N." N STREET F pR�tru ria 01826 144485 ' Al 4 1 S • Load Short Form Job: Lot 5 Great Lake Lane - Wrightsoft°' Date: Entire House By: J&J Heating and A/C 17 Arlington St.,Dracut,Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com I For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 � - • e s Htg Clg Infiltration Outside db (°F) 12 88 Method Simplified Inside db (°F) 68 75 Construction quality Average Design TD (°F) 56 13 Fireplaces 1 (Average) Daily range - L Inside humidity (%) 50 50 Moisture difference (gr/Ib) 43 28 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 876 cfm Actual air flow 876 cfm Air flow factor 0.022 cfm Btuh Air flow factor actor 0.046 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat P Load sensible heat ratio 0.96 ROOM NAME Area load Ht I g C g load Htg AVF CIg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) Garage 441 6493 3629 144 165 WIC 45 400 69 9 3 Mast. Bath 121 1072 690 24 31 Laundry 60 140 46 3 2 Lav 24 40 6 1 0 Master Bed 321 3567 1660 79 76 Great Room 1032 10062 5121 223 233 Room9 320 3045 1313 68 60 Room10 100 457 165 10 8 Room11 170 2723 812 60 37 Room12 374 4375 2410 97 110 Room13 220 1499 1272 33 58 Room14 192 3182 1584 71 72 Room 15, 24 299 52 7 2 Room16 88 2141 432 48 20 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wri htsoft® 2015-Nov-1614:18:34 ,A::. g Right-Suite®Universal 2015 15.0.12 RSU05790 Page 1 14CC0. ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJB Front Door faces: N Entire House 3532 39497 19261 876 876 Other equip loads 2725 0 Equip. @ 0.93 RSM 17835 Latent cooling 715 TOTALS 3532 42223 18550 876 876 �I Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. ti wri htsoft° 2015-Nov-1614:18:34 9 Right-Suite®Universal 2015 15.0.12 RSU05790 Page 2 ACO, ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Building Analysis Job: Lot 5 Great Lake Lane - - wrightsoft� g Y Date: Entire House By: AJ Heating and A/C 17 Arlington St., Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.iiheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: HeatingCooling Moisture difference 42.7 27.8 Dry bulb (°F) 12 88 g Infiltration: (gr/Ib) Daily range °F) - 15 ( L ) Method Simplified Wet bulb - 72 quality ( Construction ualit Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) ( 9 ) Component 2 0 Btuh Btuh a /ft Bt h / of load Walls 4.4 12006 28.4 Glazing 28.8 11089 26.3 WW Doors 16.1 3451 8.2 Ceilings 1.8 3759 8.9 Floors 1.4 3457 8.2 Infiltration 4.9 5735 13.6 Ducts _ b 0 0 Piping 0 0 Humidification 2725 6.5 ' Ventilation 0 0 Adjustments 0 Total 42223 100.0 Component Btuh/ft2 Btuh % of load Walls 0.3 781 4.1 Glazing 33.6 12930 67.1 Doors 7.7 1645 8.5 Ceilings 1.6 3381 17.6 Floors 0 0 0 Infiltratidn 0.5 525 2.7 Ducts Ventilation 0 0 Internal gains 0 0 Blower 0 0 Adjustments 0 Total 19261 100.0 Latent Cooling Load = 715 Btuh Overall U-value= 0.074 Btuh/ft2-°F Data entries checked. 2015-Nov-16 14:18:34 Jim - -',wrightsoft® Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 1 ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane wrightsoft� p Date: Entire House By: AJ Heating and A/C 17 Arlington St.,Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com 0 e e I For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 �' tlf - e • • o Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ft2-°F/Btuh Btuh/ft2 Btu Btuh/ft2 Btu Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, n 642 0.073 8.0 4.35 2795 0.24 156 r-8 ins,8"thk,1/2"gypsum board int fnsh a 820 0.073 8.0 4.46 3658 0.32 264 S 487 0.073 8.0 4.05 1974 0.20 95 W 800 0.073 8.0 4.47 3579 0.33 265 all 2749 0.073 8.0 4.37 12006 0.28 781 Partitions (none) Windows 2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4" n 60 0.470 0 26.1 1568 11.8 710 thk:2 glazing,cir low-e outr,air gas,vnl frm mat,clr innr,1/4"gap, a 20 0.470 0 26.1 523 35.0 700 1/4"thk;6.67 ft head ht s 60 0.470 0 26.1 1568 19.5 1168 w 60 0.470 0 26.1 1568 35.0 2101 all 200 0.470 0 26.1 5226 23.4 4679 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 n 30 0.570 0 31.7 951 17.9 536 glazing,clr,outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; e 45 0.570 0 31.7 1426 59.7 2688 6.67 ft head ht a 15 0.570 0 31.7 475 59.7 896 s 25 0.570 0 31.7 792 31.7 791 s 30 0.570 0 31.7 951 31.7 950 W 40 0.570 0 31.7 1268 59.7 2389 all 185 0.570 0 31.7 5863 44.6 8250 Doors 11 P0:Door,mtl pur core type n 42 0.290 10.5 16.1 677 7.68 323 S 172 0.290 10.5 16.1 2773 7.68 1322 all 214 0.290 10.5 16.1 3451 7.68 1645 Ceilings 166-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 2113 0.032 30.0 1.78 3759 1.60 3381 r-30 ceil ins I wrightsoft Right-Suite 'Universal 2015-Nov-16 14:18:34'Universal 2015 15.0.12 RSU05790 Page 1 ACCp. ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 2044 0.025 0 1.39 2841 0 0 443 0.025 0 1.39 616 0 0 all 2487 0.025 0 1.39 3457 0 0 wCigf'11tSOft" Right-Suite® 2015-Nov-16 14:18:34 Universal 2015 15.0.12 RSU05790 Page 2 ACCK ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane wrightsoft� P Date: Garage By: AJ Heating and A/C 17 Arlington St., Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dr bulb Infiltration: Dally range°F) 12 8 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions or Area U-value Insul R Htg HTM Loss Clg HTM Gain ftz BtuhN-°F ft2-°F/Btuh Btuh/ftz Btu Btuh/ft2 Btu Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, a 159 0.073 8.0 4.37 695 0.25 40 r-8 ins,8"thk,1/2"gypsum board int fnsh s 45 0.073 8.0 1.36 61 0 0 W 72 0.073 8.0 4.56 328 0.40 29 all 276 0.073 8.0 3.93 1084 0.25 68 Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 e 15 0.570 0 31.7 475 59.7 896 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; a 15 0.570 0 31.7 475 59.7 896 6.67 ft head ht all 30 0.570 0 31.7 951 59.7 1792 Doors 11 P0:Door,mtl pur core type s 144 0.290 10.5 16.1 2322 7.68 1107 Ceilings 166-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 441 0.032 30.0 1.78 785 1.60 706 r-30 ceil ins Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 441 0.025 0 1.39 613 0 0 WA'1 htsoft0 2015-Nov-1614:18:34 ,�. 9 Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 3 .M.� ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane - ' wrightsoft`" p Date: w'C By: AJ Heating and A/C 17 Arlington St., Dracut,Ma 01826 Phone:978-454-8197 Fax 978-454-8615 Email:Jeff@jjheatac.com Web:www.ijheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 � ' o • • Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (OF) 12 88 Infiltration: Dail e Y range (o� - 15 ( L ) Method Simplified Wet bulb (OF) - 72 Constructionualit Average Q Y Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft, Btuh/ftz-°F ftz-°F/Btuh Btuh/ft2 Btu Btuh/ftz Btu Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, a 45 0.073 8.0 4.56 205 0.40 18 r-8 ins,8"thk,1/2"gypsum board int fnsh Partitions (none) Windows (none) Doors (none) Ceilings 1613-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 33 0.032 30.0 1.78 59 1.60 53 r-30 ceil ins Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 45 0.025 0 1.39 63 0 0 2015-Nov-16 14:18:34 - wrightsaft' Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 4 ACCK ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N i Component Constructions Job: Lot 5 Great Lake Lane - ' wrightsoft� p Date: Mast Bath By: J&J Heating and A/C 17 Arlington St.,Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com r For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dr bulb Infiltration: Daly range 12 8°F) 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/112-11' ftz-°FBtuh Btuh/112 Btu Btuh/ft2 Btu Walls 15B-8s3c-6:'Bg wall,heavy dry or light damp soil,concrete wall, a 89 0.073 8.0 4.45 396 0.31 28 r-8 ins,8"thk,1/2"gypsum board int fnsh Partitions (none) Windows 2 glazing,clrioutr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 e 10 0.570 0 31.7 317 59.7 597 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 6.67 ft head ht Doors (none) Ceilings 1613-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 16 0.032 30.0 1.78 28 1.60 26 r-30 ceil ins Floors 21A-24t:Bg floor,heavy dry or light damp Soil,6'depth 121 0.025 0 1.39 168 0 0 ti wri htsoft° Right-SuiteO Universal 2015 15.0.12 RSU05790 2015-Nov-1614:18:34 RCCA ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Page 5 i Component Constructions Job: Lot 5 Great Lake Lane wrightsoft� p Date: Laundry By: J&J Heating and A/C 17 Arlington St.,Dracut,Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 fig; �..� :,�� "�- ® • o • a Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dr bulb Infiltration: Dally,range°F) 12 188 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ftz-°F ft2-°F/Btuh Btuh/ft2 Btu Btuh/ftz Btuh Walls (none) Partitions I (none) Windows (none) Doors (none) Ceilings 16B-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 32 0.032 30.0 1.78 57 1.60 51 r-30 ceil ins Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 60 0.025 0 1.39 83 0 0 I 2015-Nov-16 14:18:34 14 rF wrightsoft' Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 6 ACCP ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane wrightsoft� p Date: Lav By: JW Heating and A/C 17 Arlington St.,Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 �' �'_� �,.� � • e • • til Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily!range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions or Area 11.1-value Insul R Htg HTM Loss Clg HTM Gain 112 Btuh/ft2-°F ftz-°FBtuh Btuh/ftz Btuh Btuh/ft2 Btuh Walls (none) Partitions (none) Windows (none) Doors (none) Ceilings 16B-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 4 0.032 30.0 1.78 7 1.60 6 r-30 ceiI ins Floors 21A-24t:Bg fl,00r,heavy dry or light damp soil,6'depth 24 0.025 0 1.39 33 0 0 -fp- wrightsoft°' Right-Suite@ Universal 2015 15.0.12 RSU05790 2015-Nov-16 14:18 Page age 7 7 ACCP. ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N I I Component Constructions Job: Lot 5 Great Lake Lane - - wCightsaft� p Date: Master Bed By: AJ Heating and A/C 17 Arlington St., Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dr bulb Infiltration: Daily'range °F) 12 185 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ft2-°F/Btuh Btuh/M Btu Btuh/ftz Btuh Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, n 123 0.073 8.0 4.32 531 0.20 25 r-8 ins,8"thk,1/2"gypsum board int fnsh a 115 0.073 8.0 4.39 504 0.26 30 all 238 0.073 8.0 4.35 1035 0.23 55 Partitions (none) Windows 2 glazing,clrI outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 n 30 0.570 0 31.7 951 17.9 536 glazing,clr outr,air gas,vnl frm mat,cir innr, 1/4"gap, 1/4"thk; e 20 0.570 0 31.7 634 59.7 1195 6.67 ft head ht all 50 0.570 0 31.7 1585 34.6 1731 Doors (none) Ceilings 16B-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 16 0.032 30.0 1.78 28 1.60 26 r-30 ceil ins Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 321 0.025 0 1.39 446 0 0 I wrightsoft°' Right-Suite(�Universal 2015 15.0.12 RSU05790 2015-Nov-16 14:18:34Page 8 /'M1iC1� ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Com onent Constructions Job: Lot 5 Great Lake Lane - wrightsoft`� � Date: Great Room By: AJ Heating and A/C. 17 Arlington St., Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com "MM 9k. • 0 • For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 » e • • • Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Dally,range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ftz-°F ftz-°F/Btuh Btuh/ftz Btuh Btuh/ftz Btuh Walls 15B-8s3c-6;Bg wall,heavy dry or light damp soil,concrete wall, n 201 0.073 8.0 4.35 874 0.23 47 r-8 ins,8"tlik,1/2"gypsum board int fnsh s 149 0.073 8.0 4.17 621 0.09 13 W 356 0.073 8.0 4.45 1583 0.31 110 all 706 0.073 8.0 4.36 3079 0.24 170 Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 s 30 0.570 0 31.7 951 31.7 950 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; w 40 0.570 0 31.7 1268 59.7 2389 6.67 ft head ht all 70 0.570 0 31.7 2218 47.7 3339 Doors 11 P0:Door,mtl pur core type n 42 0.290 10.5 16.1 677 7.68 323 S 28 0.290 10.5 16.1 451 7.68 215 all 70 0.290 10.5 16.1 1129 7.68 538 Ceilings 1613-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 457 0.032 30.0 1.78 813 1.60 731 r-30 ceiI ins Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 1032 0.025 0 1.39 1434 0 0 2015-Nov-16 14:18:34 A wrightsaft° Right-Suite®Universal 2015 15.0.12 RSU05790 Page 9 ACCK ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane Wrightsoft P Date: Room9 By: AJ Heating and A/C 17 Arlington St., Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jiheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 I OEM fill,gg r ak gt ®, • • e Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating. Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ftz-°F ft2-°F/8tuh Btuh/ftz Stuh Btuh/(tz Btu Walls 1513-8s3c-6 I Bg wall,heavy dry or light damp soil,concrete wall, n 180 0.073 8.0 4.56 821 0.40 72 r-8 ins,8"thk,1/2"gypsum board int fnsh a 124 0.073 8.0 4.40 545 0.27 34 all 304 0.073 8.0 4.49 1366 0.35 106 Partitions (none) Windows 2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4" a 20 0.470 0 26.1 523 35.0 700 thk:2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap, 1/4"thk;6.67 ft head ht Doors (none) Ceilings 1613-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 320 0.032 30.0 1.78 569 1.60 512 r-30 ceiI ins Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 40 0.025 0 1.39 56 0 0 I rF 2015-Nov-16 14:18:34 wrightsoft" Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 10 ACCP, ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N i I i Component Constructions Job: Lot 5 Great Lake Lane wrtghtsoft p Date: Room 10 By: AJ Heating and A/C 17 Arlington St.,Dracut,Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 ------------ Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor': Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Dally range (OF) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Cig HTM Gain ftz Btuh/ftz-°F ftz-°FBtuh Btuh/ftz Btu Btuh/ft2 Btu Wal I s 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, a 45 0.073 8.0 4.56 205 0.40 18 r-8 ins,8"thk,1/2"gypsum board int fnsh Partitions (none) Windows (none) Doors (none) Ceilings 16B-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 100 0.032 30.0 1.78 178 1.60 160 r-30 ceil ins Floors (none) I ,.,_. 2015-Nov-1614:18:34t WII htSOf � Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 11 t .C� ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane wrightsoft` p Date: Room 11 By: AJ Heating and A/C 17 Arlington St., Dracut, Ma 01826 Phone:978-454.8197 Fax:978-454-8615 Email:Jeff@jiheatac.com Web:www.iiheatac.com ala AMMFor: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 �s � - a - a • • Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Cig HTM Gain ftz Btuh/ft2-°F ft2-°F/Btuh BtuhN Stuh Btu h/ftz Btuh Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, a 99 0.073 8.0 4.56 451 0.40 40 r-8 ins,8"thk,1/2"gypsum board int fnsh s 160 0.073 8.0 4.43 709 0.30 48 W 45 0.073 8.0 4.56 205 0.40 18 all 304 0.073 8.0 4.49 1366 0.35 106 Partitions (none) Windows 2 glazing,cir low-e outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4" s 20 0.470 0 26.1 523 19.5 389 thk:2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap, 1/4"thk;6.67'ft head ht Doors (none) Ceilings 16B-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 170 0.032 30.0 1.78 302 1.60 272 r-30 ceil ins Floors (none) 2015-Nov-16 14:18:34 .-_;z_ wrightsoft' Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 12 /QCCCp1 ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N i Component Constructions Job: Lot 5 Great Lake Lane wrghtsoft� p Date: Room 12 By: AJ Heating and A/C 17 Arlington Si., Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com 10 For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 � - o e • • Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) i Construction descriptions Or Area 1.1-value Insul R Htg HTM Loss Clg HTM Gain ft, Btuh/ftl-°F ft2°F/Btuh Btuh/ftz Btu Btuh/ftz Btu Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, s 133 0.073 8.0 4.38 582 0.26 34 r-8 ins,8"thk,1/2"gypsum board int fnsh w 133 0.073 8.0 4.65 618 0.47 63 all 266 0.073 8.0 4.51 1200 0.36 97 Partitions (none) I Windows 2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4" s 40 0.470 0 26.1 1045 19.5 779 thk:2 glazing,cir low-e outr,air gas,vnl frm mat,clr innr,1/4"gap, w 20 0.470 0 26.1 523 35.0 700 1/4"thk;6.67 ft head ht all 60 0.470 0 26.1 1568 24.7 1479 1D-c2ov:2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap, s 25 0.570 0 31.7 792 31.7 791 1/4"thk;6.67 ft head ht Doors (none) Ceilings (none) Floors (none) 2015-Nov-1614:18:34wri htso# " Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 13 ACCA ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane wrightsoft`' Date: Room 13 By: J&J Heating and A/C 17 Arlington St.,Dracut,Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jiheatac.com For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 � ` i - o • k • eaim Location:: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ft2-°F/Btuh Btuh/ft2 Btu Btuh/ft2 Btuh Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, w 70 0.073 8.0 4.27 299 0.17 12 r-8 ins,8"thk,1/2"gypsum board int fnsh Partitions (none) Windows 2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4" w 20 0.470 0 26.1 523 35.0 700 thk:2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap, 1/4"thk;6.67 ft head ht Doors (none) Ceilings 1613-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 220 0.032 30.0 1.78 391 1.60 352 r-30 ceil ins Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 99 0.025 0 1.39 138 0 0 2015-Nov-16 14:18:34 - - wrightsoft' Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 14 ACCX ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane wrightsoft`� p Date: Room 14 By: J&J Heating and A/C 17 Arlington St.,Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com fs For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 i o • • e Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss CIg HTM Gain ft' Btuh/ft2-°F ft2-°F/Btuh Btuh/ftz Btu BION Btuh Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, n 68 0.073 8.0 3.97 270 0 0 r-8 ins,8"thk,1/2"gypsum board int fnsh w 88 0.073 8.0 4.33 381 0.22 19 all 156 0.073 8.0 4.17 651 0.12 19 Partitions (none) Windows 2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4" n 40 0.470 0 26.1 1045 11.8 474 thk:2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap, w 20 0.470 0 26.1 523 35.0 700 1/4"thk;6.67 ft head ht all 60 0.470 0 26.1 1568 19.6 1174 Doors (none) Ceilings 1613-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 192 0.032 30.0 1.78 342 1.60 307 r-30 ceil ins I Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 192 0.025 0 1.39 267 0 0 i 2015-Nov-16 14:18:34 "Z::- rF wrightsoft' Right-Suite®Universal 2015 15.0.12 RSU05790 Page 15 ACCK ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Lot 5 Great Lake Lane wrightsoft p Date: Room 15 By: J&J Heating and A/C 17 Arlington St.,Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com NEIMMEM • • • For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 Location': Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor, Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ftz-°F ftz-°FBtuh Btuh/ft2 Btuh Btuh/ftz Btu Walls 15B-8s3c-6:Bg wall,heavy dry or light damp soil,concrete wall, a 36 0.073 8.0 4.56 164 0.40 14 r-8 ins,8"thk,1/2"gypsum board int fnsh Partitions (none) Windows (none) Doors (none) I Ceilings 1613-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 24 0.032 30.0 1.78 43 1.60 38 r-30ceiI ins' Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 24 0.025 0 1.39 33 0 0 2015-Nov-16 14:18:34 irF wrightsoft' Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 16 ACCK ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N I Component Constructions Job: Lot 5 Great Lake Lane - - wrightsoft� p Date: Room 16 By: I AJ Heating and A/C 17 Arlington St., Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com �'s}'e't°3� L''�� • e e e For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 � • e ..o e Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified We: bulb (°F) - 72 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area LI-value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ft2-°F ftz-°FBtuh Btuh/ftz Btu Btuh/ft2 Btu Walls 15B-8s3c-6:gg wall,heavy dry or light damp soil,concrete wall, n 70 0.073 8.0 4.27 299 0.17 12 r-8 ins,8"thk,1/2"gypsum board int fnsh a 108 0.073 8.0 4.56 492 0.40 43 w 36 0.073 8.0 4.56 164 0.40 14 all 214 0.073 8.0 4.47 956 0.33 70 Partitions (none) Windows 2 glazing,clr low-e outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4" n 20 0.470 0 26.1 523 11.8 237 thk:2 glazing,clr low-e outr,air gas,vni frm mat,clr innr,1/4"gap, 1/4"thk;6.67Ift head ht Doors (none) Ceilings 16B-30ad:Attic ceiling,asphalt shingles roof mat,r-20 roof ins, 88 0.032 30.0 1.78 157 1.60 141 r-30 ceil ins Floors 21A-24t:Bg floor,heavy dry or light damp soil,6'depth 88 0.025 0 1.39 122 0 0 i 2015-Nov-16 14:18:34 wrightsoft' Right-Suite®Universal 2015 15.0.12 RSU05790 Page 17 ACCK ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N '- - wrightsoft Project Summary Date: Lot 5 Great Lake Lane m Entire House By: J&J Heating and A/C 17 Arlington St.,Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com d ILay •I MAI • For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 Notes: Weather: Boston Logan Int'I AP, MA, US I Winter Design Conditions Summer Design Conditions Outside db 12 OF Outside db 88 OF Inside db 68 OF Inside db 75 OF Design TD 56 OF Design TD 13 OF Daily range L Relative humidity 50 % Moisture difference 28 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 39497 Btuh Structure 19261 Btuh Ducts 0 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 2725 Btuh Blower 0 Btuh Pi in Btuh Equipment load 422230 Btuh Use manufacturer's data n Rate/swing multiplier 0.93 Infiltration Equipment sensible load 17835 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 1 (Average) Structure 715 Btuh Ducts 0 Btuh Heating Cooling Central vent (0 cfm) 0 Btuh Area,(ft2) 3532 3532 Equipment latent load 715 Btuh Volume (W) 11978 11978 Air changes/hour 0.47 0.19 Equipment total load 18550 Btuh Equiv.AVF (cfm) 94 38 Req. total capacity at 0.60 SHR 2.5 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 876 cfm Actual air flow 876 cfm Air flow factor 0.022 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 0.96 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wrightsoft' R 2015-Nov-16 14:18:34 AC—CK ight-Suite®Universal 2015 15.0.12 RSU05790 Page 1 ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJ8 Front Door faces: N AED Assessment Job: Lot 5 Great Lake Lane - - wrightsoft, Date: Entire House By: AJ Heating and A/C 17 Arlington St.,Dracut, Ma 01826 Phone:978-454-8197 Fax:978-454-8615 Email:Jeff@jjheatac.com Web:www.jjheatac.com 0 • For: TKZ LLC 78 Great Pond Rd, N Andover, Ma 01845 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 68 75 Elevation: 30 ft Design TD (°F) 56 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 42.7 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range °F) - 15 ( L ) Wet bulb (°F) - 72 Wind speed (mph) 15.0 7.5 MEN Hourly Glazing Load 18,000-- 16,000-- 14 8,00016,00014 000-- 12,000-- 10,000-- 8,000-- 6,000-- 4,000-- 2,000-- 0 0012,00010,0008,0006,0004,0002,0000 8 9 10 11 12 13 14 15 16 17 18 19 20 Hour of Day AMY ✓A—g. /AED limit Maximum hourly glazing load exceeds average by 20.2%. House has adequate exposure diversity(AED), based on AED limit of 30%. AED excursion: 0 Btuh 2015-Nov-1614:18:34Q1WCI 7tS0 ° Right-Suite®Universal 2015 15.0.12 RSU05790 Page 1 �� ...Wrightsoft HVAC\15 St.James way Andover Ma.rup Calc=MJB Front Door faces: N I Date..0 tP..i.o..;................... ' r►ORTN O? '•,,```,•,SOOT TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION S•�CMUS� Thi4+ certifies that .......� ...... C ^` \�-�C . has permission for gas installation ^' in the buil ings of......�' IA .�?. u,} `-d................................................................ r at..... ................................ .. .. .... tea,.............., North Andover, Mass. Fee u. ....... Lic. No.Dle.......... ..................................................................... GASINSPECTOR Check# 'I 0 2 b 3 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY NORTH ANDOVER MA DATE I OCT.26 2015 71PERMIT# 16003 �V JOBSITE ADDRESS 15 GREAT LAKE LANE OWNER'S NAME I TKZ-LLC-5 TOM ZAHORUIKO GOWNER ADDRESS TKZ-LLC-5 TOM ZAHORUIKO TE 978-852-4002 IFAX® TYPE OR OCCUPANCYTYPE COMMERCIAL[] EDUCATIONALRESIDENTIAL PRINT ❑ CLEARLY NEWE] RENOVATION:❑ REPLACEMENT:® PLANS SUBMITTED: YES[] NO❑ , APPLIANCES-1 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER. ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT_ HEATER UN NTED ROOM HEATER _ WATER HEATER 0Th°R INSTALL AN UNDERGROUND 1 �� GAS LINE AND CONNECT TO A ECIED—MaJINE INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ❑NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 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. SIGNATURE OF OWNER OR AGENT CHECK ONE ONLY: OWNER ® AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in com is ce with all Pert' rovi ' n f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I JOHN MARSHALL LICENSE# 778 SIGNATURE MP❑ MGF❑ JP❑ JGF❑ LPGI 0 CORPORATION❑#®PARTNERSHIP❑#®LLC❑#® COMPANY NAME: EASTERN PROPANE GAS ADDRESS 1131 WATER ST. CITY I DANVERS STATE MA ZIPJ 01923 TEL1-800-322-6628 FAXI CELLI EMAIL f ' The Commonwealth of Massachusetts rA Department of Industrial Accidents vi01 Conress Street, Suite 100 Boston,MA 02114-201 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: 3 Phone #: 7' -' .; J FAre you an employer?Check the appropriate box: Type of project(required): �1 y . i.(JIamazmployerwith 1 � employees(full and/or part-time).* 7. New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property.e I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.r7I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.[—]Roof repairs 6. We are a co 14. Other ; , H oration and i ❑ corporation is officers have exercised their right of exemption per MGL c. u P P 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 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.#: C ::„ rte, l Expiration Date: Job Site Address: ��e4 �ke �—O^ . � � �. fJ l gcis City/State/Zip:nom 1M Attach a cony of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyunde sins and penalties of pe'ury that the information provided above is true and c&recl. Signature: Date: Phoneme-- Official use only. Do not write in this area, to be completed by city or town official. City or'Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 5.Other Contact Person: Phone#: I DATE(1,1 Z. YY DIYY} ACORD CERTIFICATE OF LIABILITY INSURANCE 3/3/20.5 k�� 5 .krTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORN1ATION ONLY AND CONFERS N0 RI3HT3 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 B=TWEE'N THE ISSUING INSURER(S), AUTHORIZED { REPRESENTATIVE OR PRODUCER,AND THE CERTIMCATE HOLDER. IMPORTANT: if the cartificate holder is an ADDITIONAL INSURED, the oolicy,'es) must be andorsad. If SU3ROGATiON IS WAIVED, subject to the terms and conditions of the policy,cartain policies may require an endorsement. A statemert on`'his car ificata does not confer rights to the certificate holder in lieu of such erdorsament(s). ' NTAD7 .uaz-yarn ?-a33 PRODUCER ' NA31E: , ?HONE FAX .G i A i-SL- 3&CE, TNC , = tSv3t i l?-2b d i IAc.vor . ar -t' Road ='DM!= 34 L,o r__ Point' S�DREss: :NS RER;SI A."CRDING 'OVERAGE I MAIC Dove_ N 0332.E INSURER.a. ?-33R.IV3 A�ERICA. IMS i INSURED I INSURER 3: East:3LR propane Ga3 TRO. I INSURER D P.O..'O. BoX 13.0% !INSURER D I23 laciustria: WaY I INSURERS: Roche3.er MSUR=RF: COVERAGES CERTIFICATE NUMBER CL15330=T!3 REVISION NUMBER: _ THIS iS TO C=RTI=Y T4AT THE POLICIES OF INSURANCE i IST=D 3ELOW HA.`/E 3E--:.N iSS�cD ' THE NSURc'D NAMED.ABOVE rCR T'�= POLICY PERIOD - _ - J T�=R , • "` l`rl-tiC4 THIS 1NDiCATE� N0^071,41STAiIiDING ANY REQL[R MEN7 i=RL1 OR "ND!`ION 0 Apt' C;01N-RA, OR 0,' _ JCS 1 IE.1� `i 1T1 RESPECT R7FICA MAY 3E ISSUED OR MAY PER AIN, ,HE INSURANCE AFFORDED 3' "= POLO S DESCRIBED hERE'^I IS 3U3JcCT TO ALL TPtE T=RMS, E;tCL!,'SiONS AND CONDITIONS 0=SU'Cti?OL.CIES. _:ibll-S 3H0'P1N 41A'!HA'/5 BEEN'=DUC=.�. 3Y?AID CLa1�,IS i INSRAu;,L, L3R:' XXOY EFF ?OL:Cf-X? 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