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Miscellaneous - 52 CIDERPRESS WAY 4/30/2018
7 Providing Insurance and Financial Services Home Office, Bloomington, IL StaeFar March 27, 2015 North Andover Town Hall State Farm Claims 120 Main St PO Box 106110 North Andover MA 01845-2420 Atlanta GA 30348-6110 - a CERTIFIED MAIL: RETURN RECEIPT REQUESTED RE: Claim Number. 21-623W-174 Our Insured: Helen Piessens Date of Loss: March 24, 2015 Loss Location: 52 Ciderpress Way, MA 01845-2154 Tax Block: **TAX BLOCK** Tax Lot: **TAX LOT** To Whom It May Concern: State Farm Fire & Casualty Insurance Company writes to provide notice as required by Massachusetts law in connection with the matter referenced above. State Farm®received notice of loss or damage in excess of$1,000 at 52 Ciderpress Way N. Andover MA 01845 We hereby notify your office pursuant to General Laws c. 134, §3B that State Farm intends to make a payment of$1,000 or more in connection with the above referenced insurance claim. Further, the applicable amendatory Policy Endorsement informs the insured of the Massachusetts requirement by stating the following: "We are required by Massachusetts law that we must notify the local inspector of buildings or Board of Health at least 10 days before we make a payment of$1,000 or more for loss to a building or structure. We must also give notice if there is damage which makes a building a health or safety hazard or dangerous or unsafe for occupancy regardless of the amount of our payment. If, prior to payment, we receive official notice of a pending or existing lien against your premises, we must delay payment until the matter is settled. If we are required to pay all or part of the amount of the lien, we will not be obligated to pay that amount to you." If you have questions or need assistance, please call us at(800) 521-9486 Ext. 6103587640. Date.11 z(i . ......................... � NonrM oa ; tiao9 TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,88'�CMUS�� This certifies that .......1.......�. . ......................................................................................................... has permission to perform .... ?P..^' � A-- ................................................................................... L (("�l wiring in the buildi of... p..e...!.?.-,t C\�sq—...\.....0 tMo NS ((� ................................... at ..... .2......b. P,R r Psi, .�v. �. . ....... ........ =,North Andover,Mass. Fee 2-%..�`.9....Lic. .�................... ! .......... N � .................... 1140 ECZRINSPECTOR Check, iU' Q Official Use Only � Commonwealth of Massachusetts t Permit No. 121 2�f Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07j (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod (MEC,527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: t Z iff.1 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) OwnerorTenant Telephone No. &R7 -Zb3,�— Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate]Box) Purpose of Building1 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: (,�L LA( Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA c-= No.of Luminaires Swimming Pool Above ❑ In- ❑ oeo mergency Lighting rnd. grnd. Battery Units q- No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices ' Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ''... I.................................. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs 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: 10 �y f�.. `A (When required by municipal policy.) Work to Start: f I 2 i Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE C VERAG : 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 cove e is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE (�BOND ❑ OTHER ❑ (Specify:) Icertio,under the ains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . �,�� LIC.NO.: M 1,(, — Licensee: AIL q�,>p, A,I ignature LTC.No.:ct—,-L7 eo_o�7-- (If applicable,ente "exempt"in the license mum r line) Bus.Tel.No.- IZ IiL-L q N Address: (, -t Gm, A-,,/t::, LTJ vv',A)-J, t L( U-� S Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. • OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $2�W —' I Signature Telephone No. P ❑ 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 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 M Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass t Failed Re-Inspection Required($.) ❑ Inspecto p6nqe ts: Inspectors gnature: Date: FINAL INSPECTION: Pass Failed 'Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,,MA. .......dweinhold@townofinerrimac.com f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UV 600 Washington Street Boston,HA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): s i A.t�} L�u Address:_ A-1,23—� City/State/Zip: 03"dGS� Phone Arre�y�u an employer?Check the appropriate box: Type of roject(required): L, I am a employer with _ 4. El am a general contractor and I 6. New construction employees(full and/or part-tine).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 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.❑Roof repairs insurance required.]t employees.[No workers' 1 comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they ate 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:. {'l,�kA/Dj 6yv, Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: �4 ,. ? —���,�,t 4 Attach a copy of the workers'compensation policy declarati n page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of 1 Investigations of the DIA for insurance coverage verification. I do hereby cerliq under the pains and penalties of perjury that the information provided ab ve is true and correct. - Simature: Date: L Phone#: 7 7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#• 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 ofhire,- express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance 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' 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 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of In VestigalloM 600 Washington Street Boston,MA 02111 Tel,#617-727_4900 ext 406 or 1-877,7MASS.AFE Revised 5-26-05 RX#617-727-7749 www-mass,govaa 4_ o :COMMONWEALTH OF MASSACHUSE: S �' • Ll • - • • i BOARD OF r ELECTRICIANS ° }55UES. THE FOLLOWING LICENSE ,AS A ` REGISTERED MASTER ELECTRICIAN f r- 4 Z , BRl:M11C ELECTRICAL SERVICES, MI CHAEL F MACDONALD � 1: y V PO BOX '8o62 ,. `MA 01835-0562 HAVERHILL .. 6 0 6Z590 F <COMMONWEALTH OF MASSACHUSETTS BOA9Q OF I I EtECTR'ICIANS, ISSUES THE FOLLOWING LICENSE AS A' REC` JOURNEYMAN;:ELECT.RI,GIAN * MICHA'EL F MACDONALD r w z : W P.Q.BOX 8062 H�4VERH`I LL AA 01835-0562' % 1116 ���n8 Date...� 8��`y............ � J11 � `V40RTs, I. TOWN OF NORTH ANDOVER o 03?�' •• oon� _ p PERMIT FOR PLUMBING �•',;.o..is This certifies that /-/A4. /°�P 1 has permission to perform....... •.� plumbing in the buildings of ;q- .............. (........L ✓LQ�v1U at......................................... ......................................................... North Andover, Mass. Fee2��.-....Lic. No. .15 1.. ............ ............................................................... Z' W- PLUMBING INSPECTOR Check# i 1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE ( PERMIT#_ JOBSITE ADDRESS OWNER'S NAME E& POWNER ADDRESS TEL - FAX TYPE OR OCCUPANCY TYPE COMMERCIAL ] EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: d RENOVATION:0 REPLACEMENT: Q PLANS SUBMITTED: YES 0 N00 FIXTURES Z FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM _., _ _ ( _} - J 1 } ,___._i ( J DEDICATED GAS/OIL/SAND SYSTEM I ._ A Lmm'( DEDICATED GREASE SYSTEM I [ DEDICATED GRAY WATER SYSTEM ., l ____( ( _ DEDICATED WATER RECYCLE SYSTEM DISHWASHER - —( 3 _,i ._ ___J ___ J __.__I � � J 4 .J DRINKING FOUNTAIN FOOD DISPOSER FLOOR/AREA DRAIN .1 .__.___} ____► ____. _.__} _.} _._.__.} ._..__i INTERCEPTOR(INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE!MOP SINK TOILET URINAL �I— WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING 0 HER Ar INSURANCE COVERAGE: f 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES[✓€J NO 0 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY d OTHER TYPE OF INDEMNITY Q BOND MJ _ 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 (2 AGENT �] hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Perlin e tt rt f the / r hAassachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME LICENSE# SIGNATURE PVIP m,----JP D CORPORATION 0#=PARTNERSHIP P# (LLC COMPANY NAME ` f ADDRESS CITY ISTATE1 ZIP TEL _.. FAX ���CELL _ ..� l.__ MAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No AAf THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES r The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations IN 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Naive(Business/Organization/Individual): 11—/)eKr " Address:_626d&��A04-- Af City/State/Zip: oy hone Are,you an employer?Check the appropriate box: Type of project(required): 1.FI am a employer with 4. ❑ I am a general contractor and I 6 ❑New ` employees(full and/or part-time).* have hired the sub-contractors construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑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.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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.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 requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well.as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certo under the pains andpenalfies ofperjury that the information provided above is true and correct Si ature: Adze_� Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: �4 y 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 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-contractor(s)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 Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ewt 406 or 1-8777MASSABB Revised 5-26-05 Fax#617-727-7749 www-mass,govfdia Date...........�.. $. .............. NOwrli TOWN OF NORTH ANDOVER ` = PERMIT FOR GAS INSTALLATION $B�cHU k.� P Thiscertifies that ..... .. . ..... ................................................................................................... has permission for gas ' stallation .... in the buildings of,......... 74 .... e .. .............................................................. ,.l7.4-a- -..................... ! '.!'j s............ at....... a--................................ J.2 Q......:......� J ,.., North Andover, Mass. Fee1.................. Lic. No. .....�.1 h. .. .................................................................. GAS INSPECTOR Check# �� `f` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ✓ MA DATE / d PERMIT# b JOBSITE ADDRESS OWNER'S NAME LjJ GOWNER ADDRESS TEL _ FAX TYPE OR OCCUPANC YPE COMMERCIAL _I EDUCATIONAL PRINT ® RESIDENTIAL CLEARLY NEW: . RENOVATION: REPLACEMENT:13 PLANS SUBMITTED: YES 0 NOF APPLIANCES 7 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 ��–.1J GRILLE INFRARED HEATER _ �— LABORATORY COCKS MAKEUPAIRUNIT OVEN ( . ._. _ POOL HEATER ROOM/SPACE HEATER T� ROOF TOP UNIT .. _. TEST UNIT HEATER UNVENTED ROOM HEATER I �� WATER HEATER OTHER ....... _ INSURANCE COVERAGE _ have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES j[dN0 D— I 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVE E BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY& OTHER TYPE INDEMNITY 0 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 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 all Pertinerd provi ' e Massachusetts State Plumbing Code and Chapter 142 14.2�of the General Laws. - - . 41M��A-10-1-�/ PLUMBER-GASFITTER NAME , lle— E/ ---- LICENSE# SIGNATURE MP ZMGF ED JP 0 JGF LPGI© CORPORATION[j# PARTNERSHIP 0#=LLC E]# J! COMPANY NAME:r � oG ��ADDRESS � CITY _ _� STATE ZIP 6 TEL FAX CELLA �J ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No hy THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES f ' The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations kvi 600 Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: V City/State/Zip: C Z� Phone#: 13 1 Are y an employer?Check the appropriate boa: Type of project(required): 1. I am a employer with 4. ❑ T am a general contractor and I employees(full and/or pgrt-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.1 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. Building addition [No workers' comp.insurance 5. El We are a corporation and its required.] officers have exercised their 10.F1 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.❑Roof repairs insurance required.]i employees. [No workers' comp,insurance required.] 13.[i Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 7 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 their workers'comp.policy information. lam 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.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 xequiredunder 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. Ido hereby certi under hepai s andp l' perjury that the information provided above is true and correct. - Si ature: Date: —J. / Phone#: 3 ` 3 cl Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. r r 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 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 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The COMMORWealth ofMassach-usetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston}MA 02111 Tei,#617-727-4900 eyt 406 or 1-877:MASS.AFE Revised 5-26-05 Fax#617-727-7749 WWW-mass,gov/cJja UP COMMON OF MASS S MI!, IRA,almoliffill� f PL1!! 3EFtS AND CASFiTTEF?S ' LICEi�S"D AS A MASTER PLUP�iBE � 1SSUES.THE,ABVELICENSE 70 - ICHAEL. ,W ,KE'LLEK ' Ta KENN-E-DY DH 1 a Pf LHAhf •1515 wJ7cii5,6i •. i . Ot 10RTH °1tie II 9 ,SS�CHUSEi CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 559-14 on 1/24/2014 Date: May 22, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 52 Ciderpress Way MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetinghouse Commons, LLC 78 Great Pond Road North Andover, MA 01845 124 01 Building Inspector Fee: Pre Paid $100.00 Receipt: 27252 Check : 3936 i NORT#j t E Town of ndover 0 0 No. - h ver, Mass, 0 _q COCNICMlwic" S V BOARD OF HEALTH PERMIT T LD Septic System THIS CERTIFIES THAT ... � ..lemp......0I /. ... . .. ..T................................. UILDING IN c F un atio ! has permission to erect .......................... buildings on ............61D......a$4&..P-"4...&0 t. to be occupied as ..�ow�. 00��!0...... .. .. .......................................................... Chi y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ou � � Final / PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT S S 3 -1-7-IL 111_�711 O Service.OWN— ............. .... . ..... .......... ................................ BUILDING INSPECTOR —� GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final IQZ- No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. aF NORTH 1 3�s�cR�SEt� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 559-14 on 1/24/2014 Date: May 22, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 52 Ciderpress Way MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetinghouse Commons, LLC 78 Great Pond Road North Andover, MA 01845 Building Inspector v Fee: Pre Paid$100.00 Receipt: 27252 Check : 3936 OF t%ORrH q 6 O -V • APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION �9SSs►cHusBUILDING PERMIT # S s ADDRESS/LOCATION OF PROPERTY: Sz CteS S Map 0�{G Parcel St Lot Number_ N SUBDIVISION: M�l� DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE (5)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WI IN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) BE CHARGED IF THE-STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE Permit Issued to: Address:_ Z (�� ` 1, N • iC` D ROUTING /Q TOWN ENGINEER, SITE PLAN— RIVE-WAY REVIEW �✓ /k�� CONSERVATION PSP 2,qZ PLANNING N Cl.4AD13 DPW-WATER METER P�000 SEWER CONNECTION G% DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE ANCY/INSPECTION REQUEST DPW - SIGNATURE File:Application for OC form revised Jan 2007/2011 Ho e71/ 01 �l�^4i.o '1t49 SS4CINSE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 559-14 on 1/24/2014 Date: May 22, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 52 Ciderpress Way MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetinghouse Commons,LLC 78 Great Pond Road North Andover,MA 01845 C Building Inspector Fee: Pre Paid $100.00 Receipt: 27252 Check : 3936 NORry O ,LED q�r � 6 0 APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION eft 1Z eya y* T op Coe.1m 1-1% 9001 ��SSacHusEBUILDING PERMIT # S S ~ ADDRESS/LOCATION OF PROPERTY:_ sZ C 74!v KS S Map 0 G Parcel 31 Lot Number SUBDIVISION: N` g DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE (5)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WI THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) BE CHARGED IF THE-STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE Permit Issued to: _M=eC�6",("6t4- Address:_ IZJ �q QC NJCOl3G,�' vel D l ROUTING TOWN ENGINEER, SITE PLAN- RIVE-WAY REVIEW �� /�s CONSERVATION Ot 0" VtZ(L!� ClrQ AA AZ7A PLANNING DPW-WATER METER , SEWER CONNECTION G DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE ANCY/INSPECTION REQUEST DPW - SIGNATURE File:Application for OC form revised Tan 2007/2011 No X17 O1nn.r.�`S49 SS,,CHO"' CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 559-14 on 1/24/2014 Date: May 22,2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 52 Ciderpress Way MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Meetinghouse Commons,LLC 78 Great Pond Road North Andover,MA 01845 Building Inspector Fee: Pre Paid $100.00 Receipt: 27252 Check : 3936 NORTh4 " O .t t.ED t q/1r =6 ra �•Z071 � w APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION Q <oche iwx:w 1� ACHuBUILDING PERMIT it S S ADDRESS/LOCATION OF PROPERTY:_ S- C i 4_1, KS S &Ad Map Parcel 31 Lot Number- SUBDIVISION:— umberSUBDIVISION: M WAS DATE REQUESTED FILED/R.EADY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE (5)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WI THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) BE CHARGED IF THE-STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE II� Permit Issued to: Address: IT (Ar �f` D t S"l ROUTING TOWN ENGINEER, SITE PLAN- RIVE-WAY REVIEW V1 �� /� 3)i�ty CONSERVATION M16to" ZAtZ t L l UJ 4A PLANNING N I cL4ADB DPW-WATER METER SEWER CONNECTION ' DPW MUST INDICATE THAT THE WATER METER HAS BEEN IN PRIOR TO SUBMITTAL OF THE ANCY/INSPECTION REQUEST DPW - SIGNATURE File:Application for OC form revised Jan 2007/2011 Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 190,500.00 m $ - $ 2,286.00 Plumbing Fee $ 285.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 285.75 Total fees collected $ 2,957.50 52 Ciderpress Way 559-14 on 1/24/2014 Single Family Home Town of 561— °No. 14 - �` z h ` " ver, Mass a o y COC NIC N!WICK 1• RATES U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT G............................................... BUILDING INSPECTOR has permission to erect .......................... buildings on .. ..�--a....( .�.. .!�...,1 . ...... ... � ................ Foundation If L.�.�Al� Rough ..................... to be occupied as ............ ......................................................................... ....................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST RTS Rough .................. Service ................. ..... . 71)4 h.R...u.+,.... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT 1 Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 1) THE BOUNDARY INFORMATION SHOWN HEREON WAS TAKEN FROM A / MAP 104C LOT 29 PIAN ENTITLED "PLAN OF LAND, MEETINGHOUSE COMMONS AT N/F ESSEX COUNTY SMOLAK FARMS, SOUTH BRADFORD STREET, NORTH ANDOVER, GREENBELT ASSOC., INC, MASSACHUSETTS"; SCALE: 1" a 80; DATE: JULY 20, 2001 BY THIS OFFICE, RECORDED AS PLAN #14828 IN THE ESSEX COUNTY NORTH DISTRICT REGISTRY OF DEEDS. 2) THE INTENT OF THIS PLAN IS TO SHOW THE AS—BUILT LOCATION OF THE FOUNOA71ON ONLY, MAP 104C 3) THE FOUNDATION SHOWN HEREON IS NOT WITHIN THE 100 YEAR LOT 28 1229 FLOOD ROTHE TOWN OF NORTH AAS TAKEN NDD MASSAE FLOOD CH SETTS COMMUNITY SURANCE RATE � PANEL NUMBER 280088 0007 C. MAP REVISED; 8/2/83, .4) THE CONCRETE FOUNDATION SHOWN HEREON HAVE BEEN INSTALLED ------ �5�� 1.08 APPROVED 9Y THE TOWN OFCNORRTTHH THE PLANNING BOARD, 0.34 I HEREBY CERTIFY THAT THE LOCATION OF THE TOWNHOUSE UNIT / NUMBERS 20-23 FOUNDATION SHOWN HEREON IS THE RESULT OF A i 4v// FIELD SURVEY BY THIS OFFICE MADE ON DECEMBER 30, 2011. N, r* OHM OTOpNER FRANOHER Na SBIla ,ry AL / \\ LICENSED LAND SURVEYOR DATE Al` AL CERTIFIED FOUNDATION PLAN MEETINGHOUSE COMMONS TOWNHOUSE UNITS 20-23 \` GRAPHIC SCALE CIDERPRESS LANE ALNORTH ANDOVER, MASSACHUSETTS Alk PREPARED FOR ''°` MEETINGHOUSE COMMONS, LLC (IN PUT) 121 CARTER FIELD ROAD 1 Inch - 50 !L NORTH ANDOVER, MASSACHUSETTS ofte Read,NIN One 6 ' / ` \ aalun.le'o eoe-o�oao» �j .,i \ MHF DoolpOonw tt Ine. ENOINIM-FLMNIRO-ONRVtYORS SCALE: 1" - 60' GATE: JANUARY J, 2012 ORAWINO SLC & ,dk / 1Mq� � \ � N0. DESCRIPTION 8Y DATE DRAW r D e R NAME L f '� REVISIONS CMF 250508 2805CFP.DWO cans Subm�d Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL ublic er TannineWassageBody Art Swimming Pools Well Tobacco Sales Food Packaging/Sales i Private(septic tank,etc. Permanent Dempster on Site I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT = y- COMMENTSg CONSERVATION Reviewed on i Si nature -Ao i << Vj COMMENTS HEALTH — Reviewed on Signature COMMENTS I ` 6 J Zoning Board of Appeals:Variance, Petition No: —Zoning ning Y Decision/receipt submitted es Planning Board Decision: Comments Conservation Decision:--a11� 2-� CommenLs /� �� Water & Sewer Connection/si nature _Date 7-��-t-4 ' ` . Drivewa Permit � —' DPW'I own Engineer: Signature: Located 384 Osgood Street FIRE.®EPARTMENT -Temp Dulter on site. . es ,/ . no . Lo at 124 Main Street J Fire De artmen t si nature P _. g !date � COMMENTS 13 8 . . Date.i�') . .., - . HpRTM TOWN OF NORTH ANDOVER F� y+. PERMIT FOR MECHANICAL INSTALI ATION . � ,SSACHUSEt This certifies that .► 1. . . . . . yL` . . . . . . . . . . . has permission for mechanical installation in the buildings of :77—A-�- . . L.fir. G/. .. . . . . . . . . . at . . C . . . 'Cd'ei3fp. . .. . . . , North Andover, Mass. Fee.,q,?. . . Lic. No.. .i°%:re . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. IPINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date: Permit# Estimated Job Cost: $3 Doo Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 196 Applicant License Business Information: Property Owner/Job Location Information: Name: J&J Heating & Air Conditioning Name:Tara Leigh Development LLC Street: 17 Arlington St. Street: 52 Ciderpress Way City/Town: Dracut, MA 01826 City/Town: North Andover, MA 01845 978-454-8197 Telephone.. 978-687-2635 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1 /M-1-unrestricted license J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential:1--2`fatnily `Iv7ulti-family Condo/Townhouses Other Commercial: ' Office Retail Industrial Educational Institutional Other l Square Footage: under 10,000 sq. ft. ✓ over 10,000 sq. ft. Number of Stories: 1 Sheet metal 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: �`�, �l�7a l d��7`ca o r k �F B►^ /�v�c s s T� INSURANCE COVERAGE: I have a current liabight insurance policy or its equivalent which meets the requirements of M.G.L.Ch..112 YesfNo❑ 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 boxy,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master-Restricted City/Town ❑Joumeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dnl Inspector Signature of Permit Approval OMM ,,NWEALTIi OF MASSAt h1 U E1`TS -D . . - A, BUSINESS iS5UES.TNE ABBE LICENSE TO f D:WAR I`t A;yOTTE rt" J J HEATING A:IR ON011 -10-KI' 17' ALINC�`tON S7,REETJ ' MA '018 2 1q6: 01/1'4/1'4 954 The Commonwealth of Massachusetts s .. _ . Department of Industrial.Accidents. Office of Investigations I Congress.Street,Suite 100. Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name.(Business/Organization/Individual): J&J Heating&Air Conditioning,Inc. Address:17 Arlington St. City/State/Zip:Dracut, MA 01826 Phone#:978-454-8197 Are you an employer?Check.the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑✓ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me.in any capacity. employees and have workers' comp.insurance.; 9. ❑Building addition [No workers'comp.insurance P• . required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' .13.❑Other . comp.insurance required.] *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit.a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of•the sub-contractors and state whether or not those entities have 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:Great American Policy#or Self-ins.Lic.#WC 6418907 04 Expiration Date:06/02/2012 Job Site Address:All locations in City/State/Zip: . Attach a•copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a. fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the. IA for insurance coverage verification. I do hereby c d r na tie ury that the information provided above is true and correct. Signa 19 Datel ' 71 Phone#:978-454-8197 Official use only. Do not write in this area,to be completed by city or town ofciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MM/DDIYYYY) ` CORnM CERTIFICATE OF LIABILITY INSURANCE 06/06/2011 PRODUCER 7$,8$7.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 9 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Edward F. Sennott Insurance Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 16 South Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 457 NAIC# Topsfi el d, MA 01983 INSURERS AFFORDING COVERAGE INSURED ]&] Heating & AirCon it on ng, Inc. INSURER x. Great American 17 Arlington SINSURER B: Dracut, MA 01826 INSURER C: INSURER a.. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANYN OF ANY CONTRACT OR REQUIREMENT,TERM OR CONDITIOOTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLIC XPIRATION LIMITS INSR DD' LTR NSR TYPE OF INSURANCE POLICY NUMBER M D TE MMIDD GENERAL LIABILITY PAC6418906-04 06/01/2011 06/01/2012 EACH OCCURRENCE $ 1,000,00C. COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence E 30OOO CLAIMS MADE a OCCUR MED EXP(Any one person) E 10,00 PERSONAL&ADV INJURY $ 1 OOO,OO ol A X GENERAL AGGREGATE $ 2 OOO r OO PRODUCTS-COMP/OP AGG S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY jEC7 LOC AUTOMOBILE LIABILITY CAP6418957-02 06/01/2011 06/01/2012 COMBINED SINGLE LIMIT $(Ea accident) 1,000,00j ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) A X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ (Par accident) X NON-OWNED AUTOS PROPERTY DAMAGE y (Per accident) AUTO ONLY-EA ACCIDENT $ GARAGE LIABILITY ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EACH bCCURRENCE $ EXCESS I UMBRELLA LIABILITY OCCUR D CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ TATU WORKERS COMPENSATION WC6418907-04 06/02/ZO11 06/02/2012 X TORY LIMITS ER AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT S 1,000,00( A OFFICER/MEM ER EXCLUDED?ECUTIVE❑ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 1 000,00C 11 es,describe under E.L.DISEASE-POLICY LIMIT S 1,000,00( SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT[SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Evidence of:Insurance Peter Sennott LA t-»-►^�' ACORD 25(2009101) ©1888-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD v•► IOOV/ 'VHF 19UJ/L4/0 �' 0503031 GREAT AMER I CAN 'ALLIANCE INS CO N7 AdmfnistraWe Offices WC 00 00 O 1 A ( Ed . 01 /97) 301 E Ah Street r. Cincinnatl OH 45202.4201 .. RjCf1 N. 513 369 5000 ph Policy No . (lW I C I I 1 6 1 4 i 1 18 19 10 1 7 I 10 14 I INSURANCE GROUP LL--'. • Prior Policy No . IWICI 1161411181910171 I 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE I nsurance is afforded by the Company named below, a Capital Stock Corporation : GREAT AMERICAN ALLIANCE INSURANCE COMPANY NCCI Company No . 14028 .... ..... .. .... ... ..:. :, r,•; ..:.. ; ... :. :.::rY•:,:;YY..........:+•.YIti.Y'rr::Y•YY:•:4:Y••.Y.Y'{'.•:•:.:v:• :'i:: :<'^� i:`,:'::::Y• ... ............... ... ..:..::,,•:::::. •. ..:. o r•.. Y. r l i' :; .:Y3.. r.r;./m•r .Y:r.r..r..:. . .......... ............ > .try .,. :: r : 6C 3 :..;;'�:?.'•:::•.,`: ;r; :3:i:'s"Y.'�'Y'S'••% '` i.� ��y �Y• .r.Y.,. r/.?., .'y�.r mr.tri �'i+,r�•Y.•.�?!.f.,.Fr•:••r�,n,..,>:.5}'!�::.•3t:•,u..,:•r.••/.:,•,:�::s t;;•:.Y••::::>:+.::::::.:: ..f•:}'::•'t:. '�'1`+X511•Y"rrf�iki'�..::;•«:•:;:•����#1'At�t'•"••"�Y: '1�'� �.V �'S.rz�s%' :rii��. r�°�' f :. :r. .. :.. :�':...;....•..:. :. ..... 'he Insured : J&J HEATING & AIR CONDITIONING Legal Entity : j INC . CorRoration 'I failing Address : 17 ARLINGTON STREET FEIN No . : 042488433 DRACUT, MA 01826 Ith.er Identification Number : See Extension of Information Page . I( Ither workplaces not shown above : See Extension of Information Page . .. .. . ....... ..... ............. .. .. ... r... .vr.: .:... ..: ::.r • r:: .,:: . r.:...:,:.:'::YY:ryY•.:t::..:.;.Y:••::.YY:t;:::: .................. ............:.... .. .... n r.r..r r r..r.r v.,. r r:r i r r r : :. : . r .r.....i. .::: ,,>:;�Y':,i?'::'.•.,:5'r.•i::•.::v}::•';::<: i 1.�. ...it;r i..:.. .;t;,a.i•Y... rf.r ?•!/1 r Y�r+r' :r ,,iv!rr/.,•>'•::.Y'•.'•y::9i'r,•:+�:5: :,•:,:;•,:•:;k;::.r,:::..,u...'.,/.,.•.•::r.r ;.�:: •}•� :S.Y••'hfj+ ? r:S.I�.�r.•r.S,.,c.//.:»r.�rr}r'/,...trim.. ..Y.:..... ..:u,.•.r,.:..:•:::r. ...:...:..:.. ..:::•::::;.. ..::.:. .. ..' •»::.,,,,,.YY•.':iys',E•yyrr .t.XrI•'}Y... .{. i�{..�r rrr .�':Y:1 r%✓'1'.. ..F.r:........l..:: .. . ..:•. •.........:. ....::. :.. .. } r'...:.Y f,•Yyff,.i. :'6Y: :. ,,/•.....:::..:h• f..r. :{•r'r•••i....::.::•. €�':1r.. ;#:"i�`:.illt><;::<::«;:>r>>:Is:.•:Lt:I:. Y:,>:::IY' •:.::::• ::t:<...:?Yt•.,. ...:;..r .. . '• .... 'he policy period is from 06/02/2011 to 06/02/2012 12 :01 A.M. Standard Time at he Insured ' s mailing address . ' ..................... .... .. ............v:.x:r. r:.... :.. .,, .•. r r^Yr rY+:...A,..•: .Y..;Y'Yr 4Y'ri:+•YYYY1:tt•'+�':t+rY rr iF Ji+iY%vi}:},:::•:•iii}:{:::.YXr ti•v.:•.:if4;:; :t•tat.. ,,:Y r r r q rriY : r r rG.>:f:. 16 {. ,u�r::k!i3.tfi..;p.<;r,.>:tr<,:a+.f.:..r,+rf.,•:Ii ii::::..rni..:•:i:;:w::::<, •i.Y'•u•t•:Y:?.,.;. f' 3::t�: arY ry •':'•:•:.. »..,•.•• :.': :. .. .»xYi•:,.i•':'•1.:.:;5�:t;�4Y,'rtr,$'�f,.�s,•7.r?Y.i.: .,r,.T.... t;�yrp,+ .�{'�+%/,d'/.,f;itY.•.:.•.•::•?r•t:.•.•:i:t.Y+.r..Y..r,.YY/.;i.:.,rr.�,.:tY:;!6YY'r.'•:::•t• ::.`1�:•�VIYY:.:�`:i�1#.�.E:.Y;:t•.�.:Y:: • : :•.. •••;.&i�. '�•:•r �. .., •: .. :., ,. ..:..;:• 1. Workers Compensation Insurance : .j Part One of the policy applies to the Workers Compensation Law of the states listed here : MA, NH 1 1 . Employers Liability Insurance : Part Two of the policy applies to work in each state listed in Item 3 .A. The Limits of our Liability under Part Two are : Bodily Injury by Accident $ 1 ,000 ,000. each accident Bodily Injury by Disease $ 1 ,000 ,000 policy limit Bodily Injury by Disease • $ 1 ,000 ,000 each employee Other States ' Insurance : Part Three of the policy applies to the states , if any , listed here : All states except ND , OH, WA, WY states designated in Item 3 .A. 1. 1, This policy includes these endorsements and schedules : See FORMS AND ' ENDORSEMENTS Schedule , WC 99 06 22A (01/97) . ... ... ..... ...... ............:... •: n• •::.;:r r. ..:•:•r:.:.r r ::.::::::::::•r•:::.J::.YYr+:t:?4iYrYtn t'0*.•::::4Y•Y'.Yr:•YY'l..i::YY:'r''S•::::::5:%::t•Y?•>:::;:::::•i�l ..................:............................:•:•:•. ........ .,•...::r:..,::::i•. •:::::. r.:,•i:r. .:r,.r <r:.:,•• .u::,r :r.::a: : :tt/,r `a � ...aF. r... ., .^'Yv fa tr;,• ,'{y:•.i,. {..l :}r.r./.�•../,,..,,<•?+:'r i.:..r,rr,.;•'•<t.....r r•t+:r.t.'•i.'tr:r q'!.;:.,:::r::,•::•r.,::;ivfrl.>YY y •YY: ,/ y.:::.Y•:.YY•:: .,.;:• •:.Y..Y;.;YY:;•;•tr•.r..•.::::...;.. .5 r.r..,....:r: £;.:.:' a::. ••��••:p�y:•Y::••::YY:{{•��• �j,i��• .�;.rf:•:.�i:i.y::•v..:r:.Y:i....:ttt#!::iY:•:!Yi+^i.:.�%:55.��'.'rr,:.:•. is i:. ;,k.,i,.,:fr`X;r..f.:.i.4:�x,+!YY:..r:..•,.t.,r..;.,.''/v;.tY..:;n•::..xt::.r i.i,.;... .C.� .�:�iarJ:.Y:.:.><?:G7.':R•:.Y:.Y:�YYY:.Y�`::i'ii::' •r:::::.::::..,.::::.•:•::.;..rt•,• .: i "T . ..•: .. : .. ...:r.r::rr:•::i:ry....:•t22•:i:.tr:;;:Y::r: . `he premium for this policy will be determined by our Manuals of Rules , :lassifications , Rates ' and Rating Plans . All information required below is ubject to verification and change by audit . See E.xtension of Information Page :...::.; .:...:.....:.:::.:.r•::: ::<.:::;.Y.::.rr. Y:•;..Y:.Y>:.;Y::.:t•>::.>•>Y::.Y:.YY..YYY.r.Y. ....::....:... ...•::..:.::..n..n.v.... r...:: .,•r .i••Y rr. r rr:}.ry ry:.; .' nrw:v:r. r •::.ivrrr;•:rr::..•ir,.:::i:i:^�yi'rl:i:::'.:,:'i'.::• �y :.ir.,:::.r::r.r•.:..: rr ::,. ..r 4':{,5 .'4 rr.H. w, t;'.,H•:•r' : t {:t?Yxx.YY:??.,.a•.•::r: �J ...t..r r..a r. : .6:}}'•. ..�•:....+kJn :.dr...ry/r ::w:,r,.. : �.t•YrYYY.'•:tt:..'•.r .......}.......:.... ::::.:.. ::::. � .t.. :.Y:. •• •• .: ...::, l.:rtY1...r .r,Y t:... . .ry.•':.• r s.%:....:S:...; t.: .. Key: ..,��.ii�y.. .. ti•Y::•: .. .....f,.:.t:`:::::.::r?::ri••.r:r. .t.r ,7,,.Y::y :Yi .;r ::•:r:•Y•:'t�.}....::••:• :.rt.;:,/..,.;;...r..?r;...::.t..;..;a..r•::;••:::... i ..:::•:;:•,tt:•::•:.'•.n••:•.:....... .:. .. t :•::.YYY••YYY;•YY:t•Y.'•:.YY+YYY•YYYY:Yua•::.: 'OTAL ESTIMATED ANNUAL COST : $ 46 ,014 Minimum Premium: $ 750 leposit Premium: $ 46 ,014 Date of Issue : 06/22 /2011 .. ............................ .. ......... ....... ....:. .:.. :.:: •:::••.•.,..: r::::::...vrr:•:.YYY%:.Y:•YYY':t•;.':r?ti{::ry:1:: •Y.?<{•YY i::::?%:,i:::�{tYY:'it'i'i':.i:iS:t.Y:.: ..... .............................. .. .:.....: :.:.:.... :•::. •: •. :...:::..•:;..r:v;;..r:.. :.:• it ra?t•:�}. rr•'r:::xrr. .r tF,.•:rr..vY vn#A ..t: : :./ rr'.r ,•r• r.. .::tYr :>r..li+lrt:i•AxlGY.i•tr::r::,r}fr..Il.::?tr: i,'r'••r.•.,'o:,'••!Y•+:,r....t....:Y:.. Y::•f::Y:•::c•.;t.{t;:tr:•>:• .: � .::, ..... : •. .r:...:..rr .,..:ryi.. ,ys.. :rY }�if.,rx�': '•7.a,•:,•:f r.../..!,.. ...ir.... ...r/...r.. , ...:• .. •:i::+ ::YYiit,•v X! r� /. •$'.£...n.'r'✓.t•i4......;.n �f..•r.Y..,'i+:?Y::.;. ��`:.:. .:>:I:: .�IO.:.v�3. tr<R: t.�:: :�:::>1�::Y:�;:':�l' r'•i:;'-i.:;t.::.•:n•:it•'.,.•tY;pi.'�.r . .,.�... s �•.,... .>:ti:;Y:•»:.:;YY::::•.;::>:.>.:::::<::>'.: lame of Producer : EDWARD F . SENNOTT INSURANCE A Servicing Office : PO BOX 457 SPECIALIZED MARKETS TOPSFIELD 01983 657 :ountersigned by : Copyright 198.7 National Council on Compensation Insurance 4rsoQRG11100 01A ( Ed . 01 /97 ) PRO (Page 1 of 4 ) Load Short Form Job: 52 Ciderpress press AMR Date: Apr 26,2012 Entire House By: JW Heating and Air Conditioning 17 Arlington st,Dracut,ma 1826 For: Tara Leigh Development 115 Carterfield rd, North Andover, MA Htg Clg Infiltration Outside db(°F) 12 88 Method Simplified Inside db(°F) 68 75 Construction quality Average Design TD(°F) 56 13 Fireplaces 0 Daily range - L Inside humidity(%) 50 50 Moisture difference(gr/Ib) 43 28 HEATING EQUIPMENT COOLING EQUIPMENT Make Goodman Mfg, Make Goodman Mfg. Trade GOODMAN Trade GOODMAN, JANITROL,AMANA DISTI... Model GMH950703BX Cond VSX130301D* AHRI ref no2002182 Coil CA*F3030*6D* AHRI ref no.4717955 Efficiency 95 AFUE Efficiency 11.5 EER, 14 SEER Heating input 46000 Btuh Sensible cooling 19880 Btuh Heating output 44000 Btuh Latent cooling 8520 Btuh Temperature rise 42 OF Total cooling 28400 Btuh Actual air flow 947 cfm Actual air flow 947 cfm Air flow factor 0.038 cfm/Btuh Air flow factor 0.050 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.91 ROOM NAME Area Htg load Cig load Htg AVF Cig AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) kitchen 180 2239 2172 85 108 hall 60 407 72 15 4 living room 195 3092 2135 117 107 dinning room 225 1556 1180 59 59 stairs 105 603 107 23 5 entry 180 3092 1879 117 94 m bath 108 1691 1053 64 53 laun 72 503 187 19 9 elev 60 420 156 16 8 Loft 264 3379 978 128 49 Bedroom 2 180 2628 3765 99 188 2nd stairs 105 629 253 24 13 1/2 bath 90 539 217 20 11 master bed 330 4223 4815 160 240 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wri htft� 2012-Apr-26 08:07:24 Sso CA 9 Right-Suite®Universal 8.0.24 RSU05790 page 1 ...ts and Settings\Owner\Desktop\Tara Leigh 52 Ciderpress way.rup Calc=M.18 Front Door faces: Entire House d 2154 25001 18970 947 947 Other equip loads 8696 2389 Equip. @ 0.93 RSM 19779 Latent cooling 2170 TOTALS 2154 33697 21949 947 947 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. ` wri9 .,. htsoft° Right-Suite®Universal 8.0.24 RSU05790 2012-Apr-2608:07:24 . AC,CKPage 2 ...ts and Settings\OwnerlDesktop\Tara Leigh 52 Ciderpress way.rup Calc=MJ8 Front Door faces: �r' Buildin Analysis Job: 52 Ciderpress press a g y Date: Apr 26,2012 t., Entire House By: JW Heating and Air Conditioning 17 Arlington st,Dracut,ma 1826 For: Tara Leigh Development 115 Carterfield rd, North Andover, MA 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 0 Component Btuh/ft' Btuh %of load Walls 3.6 7145 21.2 walls Humidification Glazing 16.7 3102 9.2 I _ Doors 21.7 911 2.7 Ceilings 1.4 1748 5.2 Ventilation Floors 1.4 1310 3.9 k: Infiltration 2.6 5701 16.9 Glazing_; Ducts 5084 15.1 Piping 0 0 °0Ors Ducts Humidification 5312 15.8 Ceilings , Ventilation 3385 10.0 Floors Adjustments O Infiltration Total 33697 100.0 00 0 Component Btuh/ft' Btuh %of load Walls 1.0 1966 9.2 walls Blower Glazing 43.6 8101 37.9 Doors 10.3 434 2.0 Internal Gains Ceilings 1.3 1572 7.4 Floors 0.3 297 1.4 Infiltration 0.3 646 3.0 Ducts 3694 17.3 Ventilation 0 0 Glazing Internal gains 2260 10.6 Ducts Blower 2389 11.2 Adjustments 0 Ingltm6on Total 21359 100.0 Doors CeilingOth ser Latent Cooling Load=2170 Btuh Overall U-value= 0.060 Btuh/ft2-°F Data entries checked. Wrl htsoft' 2012-Apr-2608:07:24 9 Right-Suite®Universal 8.0.24 RSU05790 ...ts and Settings\Ownehl3esktop\Tara Leigh 52 Ciderpress way.rup Calc=MJ8 Front Door faces: Page 1 Component Constructions Job: 52 Ciderpress press Date: Apr 26,2012 Rim Entire House s J&J Heating and Air Conditioning 17 Arlington st,Dracut,me 1826 t1 0 - For: Tara Leigh Development 115 Carterfield rd, North Andover, MA D _ • c rJ. c 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 0 Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft' Btuh/ft?°F ft'°F/Btuh Btuh/ft' Btuh Btuh/ft' Btuh Walls 12F-Osw:Frm wall,wd ext,1/2"wood shth,r-21 cav ins, 1/2" ne 342 0.065 21.0 3.61 1236 0.99 340 gypsum board int fnsh,2"x6"wood frm se 737 0.065 21.0 3.61 2664 0.99 733 sw 252 0.065 21.0 3.61 911 0.99 251 nw 646 0.065 21.0 3.61 2335 0.99 642 all 1977 0.065 21.0 3.61 7145 0.99 1966 Partitions (none) Windows 2 glazing,clr outr,air gas,wd frm mat,clr innr,1/4"gap,1/8"thk:2 ne 90 0.300 0 16.7 1501 38.0 3423 glazing,clr outr,air gas,wd frm mat,cir innr,1/4"gap,1/8"thk se 42 0.300 0 16.7 701 48.7 2047 sw 54 0.300 0 16.7 901 48.7 2632 all 186 0.300 0 16.7 3102 43.6 8101 Doors 11 DO:Door,wd sc type sw 42 0.390 0 21.7 911 10.3 434 Ceilings 16B-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 1209 0.026 38.0 1.45 1748 1.30 1572 gypsum board int fnsh Floors 19A-38bswp:Fir floor,frm fir,10"thkns,hrd wd fir fnsh,r-38 cav ins, 945 0.029 38.0 1.39 1310 0.31 297 tight bsmt ovr wri htsoft® 2012-Apr-26 08:07:24 9 Right-Suite®Universal 8.0.24 RSUC5790 ACC, ...ts and Settings\Owner\Desktop\Tara Leigh 52 Ciderpress way.rup Calc=MA Front Door faces: Page 1 Project Summary Job: 52 Ciderpress press Date: Apr 26,2012 Entire House By: J&J Heating and Air Conditioning 17 Arlington st,Dracut,me 1826 For: Tara Leigh Development 115 Carterfield rd, North Andover, MA Notes: c Weather: Boston Logan Int'I AP, MA, US 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 19916 Btuh Structure 15276 Btuh Ducts 5084 Btuh Ducts 3694 Btuh Central vent(55 cfm) 3385 Btuh Central vent(0 cfm) 0 Btuh Humidification 5312 Btuh Blower 2389 Btuh Piping 0 Btuh Equipment load 33697 Btuh Use manufacturer's data in Rate/swing multiplier 0.93 Infiltration Equipment sensible load 19779 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 1280 Btuh Ducts 891 Btuh Heating Coolin Central vent 0 cfm) 0 Btuh Area(ftz) tin 215 Equipment latent load 2170 Btuh Volume(f:3) 17496 17496 Air changes/hour 0.32 0.16 Equipment total load 21949 Btuh Equiv.AVF(cfm) 93 47 Req.total capacity at 0.70 SHR 2.4 ton Heating Equipment Summary Cooling Equipment Summary Make Goodman Mfg. Make Goodman Mfg. Trade GOODMAN Trade GOODMAN, JANITROL,AMANA DISTI... Model GMH950703BX Cond VSX130301D* AHRI ref no2002182 Coil CA*F3030*6D* AHRI ref noA717955 Efficiency 95 AFUE Efficiency 11.5 EER, 14 SEER Heating input 46000 Btuh Sensible cooling 19880 Btuh Heating output 44000 Btuh Latent cooling 8520 Btuh Temperature rise 42 OF Total cooling 28400 Btuh Actual air flow 947 cfm Actual air flow 947 cfm Air flow factor 0.038 cfm/Btuh Air flow factor 0.050 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.91 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. .� Wrl htSOft 2012-Apr-2608:07:24 9 Right-SuRe®Universal 8.0.24 RSU05790 is and Settings\owner\Desktop\Tara Leigh 52 Ciderpress way.rup Calc=MJ8 Front Door faces: Page 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION S Z C1 re rint PROPERTY OWNER ReJ C98MML44 IT Print 100 Year Old Structure yesn MAP NO: �(PARCEL: 3> ZONING DISTRICT: R ) Historic District yes n Machine Shop Village yes no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑Addition Ajwo or more family ❑ Industrial ❑Alteration No. of unitsL%F �F S u1.T ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District XWater/Sewer DESCRIPTION OF WORK TO BE PERFORMED: S R B?w �� Fa m4 5713 UzZRd. d ter¢' d C-- S L�J t7'S Idgntifigation Please Type or Print Clearly) .� OWNER: Name: L,Z C Phone:g20- 7-Z Address: 7? r h- v -7�\ I, i CONTRACTOR Name: 1 y �l LL Phone: Address: Supervisor's Construction License: Q —Exp. Date: p P Home Improvement License: Exp. Date: ARCHITECT/ENGINEER c t Phone:-...7R �1� �,I 4 Address: a 1S kA 6 a7 Reg. No. 60 1y FEE SCHEDULE:BULDING PERMIT.-$12.00 ER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 fER S.F. Total Project Cost: $ X90, , 6V - FEE: $ ZZ84vt a Z399,�.S�ehA� Check No.: 31310 Receipt No.: NOTE: Persons contracting with unregistered cont actors do not have access to the guaran pld Signature of Agent/Owner Signature of contractor Plans SubmittedA Plans Waived ❑ Certified Plot Plan _ tamped Plans ❑ Location No. f TOWN OF NORTH ANDOVER • c.�i ALU • Certificate of Occupancy $ 1,2F� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL F Check# 6 ,Building Inspector Plans Submitteh Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF`:SEWERAGE DISPOSAL Public Sewer G Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc.. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ i COMMENTS CONSERVATION Reviewed onLs/iqnature COMMENTS HEALTH pRiliewbd on_ Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tow;: Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMI_NT - Temp Dumpster on site yes no Located at 124 Mair Street Fire DepartineiA signature/date COMMENTS Dimension Number of Stories: Z Total square feet of floor area, based on Exterior dimensions. 1�5� Total land area; sq. ft.: 3 Z Lie C Cz�lh J ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use A, S� Z6� S -- 1 SZ�( SAF 1 Z.� � O B Notified for pickup - Date t Doe.Building Permit Revised 2010 Building Department The foh-3w�ing is`a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits o Building Permit Application a Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses a Copy of Contract ❑ Floor Plan Or Proposed Interior Work D Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apu.,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc-Building Permit Revised 2012