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Miscellaneous - 55 MARBLERIDGE ROAD 4/30/2018 (2)
55 MARBLERIDGE ROAD 210/037._ A_00140000.0 Date..... U .A1.'. ......................... �NOnrM o �, TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION `S`in►CHUS� This elertifies that ........ C)L?- ..!....... .`.!.. .......................... ....................... has permission for gas installation ...................... in the buildings of............... /1...e--.................................................................:........... at..... 6-_�..�...............�'b..ec.�.(........................, North Andover, Mass. Fee. p............ Lic. No.'Vf;-........ ..................................................................... GAS INSPECTOR Check 3 2- 10227 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY North Andover MA DATE 14-Oct-2015 PERMIT# itZ.�� JOBSITEADDRESS 55 Marbleridge Rd OWNER'S NAME Rae GOWNERADDRESS 130 Marbleridge Rd TEL 508-509-9430 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW: ❑ RENOVATION:® REPLACEMENT:F71 PLANS SUBMITTED: YES® NO❑ APPLIANCES Z 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 b GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER ROOF TOP UNIT TEST U 1 UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER r INSURANCE COVERAGE I have a current liabili 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurte to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in c Iia /a- - ent provision bbthe Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME Robert J. Frazier LICENSE#13425 SIGNATU MP® MGF❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME Bomar Plumbing & Heating ADDRESS PO Box 694 CITY Derry STATE NH ZIP 03038 TEL 603-325-8958 1 FAX CELL EMAIL Bob@BomarPH.com , Uk a1 � ..........�. COMMONWEALTH OF MSSACHUSETTS I BOARD OF t PLUMBERS AND GASFITTERS r 1 ISSUES THE FOLLOWING LICENSE f LICEN5EU AS;:A MASTERRLUMBER�� ROBERT J FRAZI ER PO BOX G9�+ � J DECRY NH 03038-0694 lorGIALIMS Viol. COMMONWEALTH OF M—.,,' 11SETTS . F , BOARD OF t PLUMBERS AN`D GASF ITERS I S,$UES THE FOLLOWING L,I CENSE L I CENED AS A JOURNEYMAN �F<L—UMB; log f Sl J.; I : {IBERT J FRAZIER i y PO Box 6g4 IVH 03038-0 DI RRY i J Date....... ..f..7... ................ NORrh �3? °9 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ;oo o ssACHUS� .. . ..........G�:...am...fi.......�...e......../4This certifies that .......... . , ............................................ haspermtssion for gas installation ........... ...... ..z.............r....A........�.........................L. inthe buildings of.......... .................................. ................................................................... at.........� ........ .? -.�...ut�............. . ....::p...., North Andover, Mass. Fee.../6.... ...... Lic. No. ...... ..................................................................... GAS INSPECTOR Check# PIN MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK '�UW, CITY North Andover MA DATE PERMIT#1ZI lT JOBSITEADDRESS 55 Marbleridge Rd OWNER'S NAME Rae GOWNERADDRESS 130 Marbleridge Rd TEL 508-509-9430 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL Q PRINT CLEARLY NEW: E] RENOVATION:❑ REPLACEMENT:❑ PLANS SUBMITTED: YES® NO❑ APPLIANCES Z FLOORS BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE 1 9, DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE D 1 1 GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT In OVEN POOL HEATER �m ROOM/SPACE HEATER c ,j\ `ROOF TOP UNIT %TEST UNIT HEATER �'UNVENTED ROOM HEATER WATER HEATER 1 OTHER INSURANCE COVERAGE I have a current liabili 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. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the -my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in eb�beP inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. (�J] PLUMBER-GASFITTER NAME Robert J. Frazier LICENSE#13425 SIGNATURE _ MP® MGF❑ JP❑ JGF❑ LPGI ❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME Bomar Plumbing& Heating ADDRESS PO Box 694 CITY Derry STATE NH ZIP 03038 TEL 603-325-8958 FAX CELL EMAIL Bob@BomarPH.com 1 , .COMMONWE/ LTH OF MASSACHUSETTS. r ® a o • • o ® , PLUMBfvS 'ANO GASP PETER `�.� I SSU.ES THE, FO�.LOWtNG L(CENSE L(1 5.WEU AS .A JOWRNOMAN PLUMBW RpBERT J FRAVIR �s Po Box... 94 OfftRY NH` 03038 0694 •1D�'1. - 0ACNUSETTS, --"pj M VIt E�► ?H o �r C ONW •�' AN1 GASB 1' T PLUMBS NE F0►.LOW� G '�"10ENSE ISSUES Ap ER .PIUMBfR fR�ZtER NN o30, 38-069 t�E�RY The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Applicant Information b /InPlease Print Le ' l Name(Business/Organization/Individual): C, 1"{�)a i�'_ e t� Address: '% AoV 1 City/State/Zip: &fl` oW Phone#: i Are you an employer?Check the appropriate box: Type of project(required): 1.❑lama employer with employees(full and/or part-time).* 7. F1 New construction 2.Q l am a sole proprietor or partnership and have no employees working for me in 8. Remo deling any capacity.[No workers'comp.insurance required.] 9. [1 Demolition 3.F]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 F]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL C. 14.Q Other 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 Us 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. lam an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: } F �� c 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 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. Ido hereby certify yuunder h , ai and penalties 9 f perjury that the information provided above is true and correct. Signature: Date: "Iz Phone#: Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts 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 fox 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 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.., 11047 ................ ....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING of 4rQo This certifies that.20&6T.. .............................................. has permission to perform.,j ...... . .. /*.......... ...... plumbing in the buildingsof.........../......k...... ....�xl..................................... at..........)—�....... ...... over, Mass. Fee AM........ Lic. No. ............. . . . .................. cT6� P L ULJ';BI N Ii P Etc T 0 R Check# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY North Andover MA DATE 12-Mar-2015 PERMIT# 491 JOBSITEADDRESS 55 Marbleridcle Rd OWNER'SNAME Rae POWNERADDRESS 130 Marbleridge Rd TEL 508-509-9430 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL PRINT CLEARLY NEW:❑ RENOVATION:® REPLACEMENT:® PLANS SUBMITTED: YES❑ NON FIXTURES-1 FLOOR BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 2 _ CROSS CONNECTION DEVICE S DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER 1 DRINKING FOUNTAIN 3 FOOD DISPOSER FLOOR/AREA DRAIN _ INTERCEPTOR INTERIOR KITCHEN SINK 1 N LAVATORY 3 ROOF DRAIN SHOWER STALL SERVICE/MOP SINK TOILET 2 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES W TER PIPING 1 '41HER Bar Sink 1 INSURANCE COVERAGE: I have a current liabili insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES® NO ❑ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this applicatiot' mtf true t�`j ttthbof my knowledge and that all plumbing work and installations performed under the permit issued for this application will be visio f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME Robert J. Frazier LICENSE#13425 '816NATURIf MP® JP❑ CORPORATION❑# PARTNERSHIP❑# LLC❑# COMPANY NAME Bomar Plumbing& Heating ADDRESS PO Box 694 CITY Derry STATE NH ZIP 03038 TEL 603-325-8958 FAX CELL EMAIL-Bob@BomarPH.com \ 914 /G lJ The Commonwealth of Massachusetts i Department of Industrial Accidents Office of Investigations v 600 Washington Street - Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Bomar Plumbing & Heating Address: PO Box 694 City/State/Zip. Derry, NH 03038 Phone #: 603-325-8958 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2. X❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.]]ui5. E] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑X 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 13.0 Other 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. 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: Liberty Mutual Fire Insurance Company Policy#or Self-ins.Lic. #: WC2-31 S366059-022 Expiration Date: 22-Apr-15 Job Site Address: 55 Marbleridcte Rd City/State/Zip: N Andover, MA 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er e p ins penalties of perjury that the information provided above is true and correct. Signature Date: 12-Mar-2015 Phone#: 603-325- 8 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#: u ONWEALTH O MF ASSACHUSETTS:, t BOARi3`."F ' PLUMBERS' AND GASFITTER5 r ISSUES THE FOLLOWIfdG'tICE-NSE 1,11~EtJ`SEb AS A MASTERfPLUhI R� ` '' �r �IleF REIBERT J FRAZ(ER � PO BOX v9 f DERRY �H 03038-o6...94 E � .� < <COMMONWEALTH OF M ASSAN Cm- VA ° N M01011912U: u BOARD O r PLUMBERS AND GASFITTER'S; I SUES THE F0LLOWI "IJG L I.CENSE ; L I CEN5�0 AS A JOIURNM; AN,P M i R3BERT J FRAZ I ER PO BOX 1;94 DERRY NH 03038 0.694 A 171Ciz f 352 Date. .1�/./.�/ ...... . Of,NpRTM TOWN OF NORTH ANDOVER ,e�•y0 O m PERMIT FOR MECHANICAL INSTALLATION t • si �,SSACHUSEI This certifies that � ��� • • • • • • • ;• has permission for mechanical installation . .i7 I/. . . . . . . . . . . . . . . in the buildings of . . .64.(.b gid. . . C v n S T"; • . at . . .6 . . (y)k/Lb 1(4,. .�+� 0(North Andover, Mass. U Fee.7�,-.G.d . . Lic. No.. .. . . . . . . . .. > - GAS INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer �� ! i -�' Commonwealth of Massachusetts Sheet Metal Permit Permit# s 7' Date : �� �� ,i Permit Fee: $ '�Z Estimated Job Cost• Plans Reviewed: YES NO Plans Submitted: YES ✓ NO Business License# r a Applicant License# 3�3 Property Owner/Job Location Information: Business Information: Name: 1�,��`3 (n NA Name:�-��•t�`�-� Name: __—__�--- c�t�� �• � Street: Street: City/Town:- �,�'i r City/Town:- �'s�``� Telephone: �q c6)e6 S "y y °3 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. f over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: F/ Kitchen-Exhaust System Chimney/Vents HVAC Metal Roofing R' Provide brief description of work to be done: .1 (( r a.A-clt5 ( w► / C- INSURANCE COVERAGE: d� I have a current liability insuranceotic it p y or s equivalent which meets the requirements of M.G.L.Ch.112 Yes P No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy 21" 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 t Massachusetts General Laws,and that m signature o p he Y 9 n this permit�t application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxN,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued forthis application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Insuections Date Co- Final i InsU ecton � Date t" Comments Type of License: ' BY ❑ Master Title ❑ Master-Restricted �— ' City/Town Journeyperson Permit# Signature of Licensee ❑Journeyperson-Restricted ( Fee$ License Number: 5) EJ Check at www.mass.gov/dpi i Inspector Signature of Permit Approval Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes No N/A., Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required)and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper cleal`ances, fire rated enclosures and pressure testing required: f _; Seierri� esI.c.ntb installer WU.ic required'oinequipment and Duct penetrations in fire,'ratc vvall:3 and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct nuns installed 6'-0"maximum length Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off) • M - /Y ' C r Sheet Metal Residential Guidelines/Inspection Checklist Yes No N/A' Detailed description and sketch of sheet metals stem to be installed has p Y been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating/,cooling load calculations Duct work sized per manual "D"calculations v"- Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct r/ Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean-properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-off) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ;,. Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Bulders/Contract rs/Elec ricians/ lumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): i 1`}iA i S (o t p A (f 11 4 S f �� ► Address: S S S U 0 Xt h City/State/Zip: ;wK � r /v4Uig)b Phone U3 Are you an employer?Check the ap ropriate box: Type of project(required): 1.21 am a employer with � O 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New constriction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers9. ❑Building addition [No workers'comp.insurance comp•insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.[]Roof repairs insurance required.] t c. 152, §1(4),and we have no l employees. [No workers' 13.Q Other H V A L comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tCoritractors 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. -Iam ane nployer Matrs pros workers'compensation-msurannce for ii employees. Be(~uthe po an job sem— -------- information. SS Insurance Company Name: -- \ QA1h(.e. Policy#or Self-ins.Lic.#: J U 11 ` 0 0 Expiration Date: Q30A.5 Job Site Address: �Jl City/State/Zip:A)yrtL "ve( AA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under tls and penalties of perjury that the information provided above is true and correct Signature \ Date: ) Phone M 9�� )s S I —9 1 0 3 Official use only. Do not write in this area,to be completed by city or town offrcW 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#• Client#: 53676 HILLISFRAN2 ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY) 6/27/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS G_ ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES fiOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED = .-,PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT HUB Int'I New England(WILSB) HcIN Ext: 657-5100 ac No: 978-988-0038 299 Ballardvale St E-MAIL Wilmington,MA 01887 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL N INSURER A:Independence Casualty Ins Co 11984 INSURED Hillis Corp INSURER B: DBA Frank's Heating Service INSURER C 555 Woburn St INSURER D Tewksbury,MA 01876 INSURER E INSURER F:' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLSUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADD WVD POLICY NUMBER MM/DD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ pAMAGETO RD COMMERCIAL GENERAL LIABILITY PREMISES Ea oau,ra. $ CLAIMS-MADE F-]OCCUR MED EXP(Any one person) $ PERSONAL 6 ADV INJURY $ GENERAL AGGREGATE. $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ JECT POLICY PRO-- LOC s AUTOMOBILE LIABILnYCOMBINED SINGLE LIMIT Ea,cadent ANY AUTO - BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) j AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RE_T_ENTION$ $ A WORKERS COMPENSATION WC100113101 6/30/2014 06130/201 X ANY PROPRIETORIPARTNERIEXECUTIVWYINW AND EMPLOYERS,LIABILC STATU- OTH- RY E.L.EACH ACCIDENT f5O0 OOI) OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 5500,000 LIi yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE.WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1163977/M1140054 DKO04 ACCORD -CERTIFICATE _QF UABIUMINSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED .REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.It SUBROGATION IS WAIVED,abject to the terms and conditions of the Policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such s. PRODUCER CONTACT CLIENT MMrM,CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE:PA.BOX 328 :888,433-4949 R PNONE .Hai:507446-4664 OWATONNA,MN 55060 ESL INSURER AFFORDRIG OOVERAGE NAIC p INSURER A:.FEDERATED MUTUAL INSURANCE COMPANY 13935 E0 360-541-7 INsur"B: HAILS CORP INSURER Q 555 WOBURN ST TEWKSBURY,MA 01876 INSUIMR D: INSURER.E: RNSUWR.F. COVERAGES CERTIFICATE NUMBER 0 REVISION NUMBER 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE UDW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINO ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THUS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS.OF,SUCH POLICIES,LIMITS:SHOWN.MAY HAVE BEEN,REDUCED,BY;PAID.CLAIMS. NLTR SR TYPE OF INSURANCE TSMRUBR POLICY NUMBER POLICY EFFJMpwOEXP LIraTS GENERAL UABRM EACH OCCURRENCE $1Ao0,000 X COMMERCIAL GENERAL UABSITY Dz:u TO RENTED $100,000 EOCCUR MED.EW(Aivew pMON EXCLUDED A N N 9385795 06/30/2014 06/30/2015 PERSONAL t ADV INJURY =1,000,000 GENERAL ACOREGATE $2,000,000 OEML APGREGATE OMIT APPLIES PER: PRODUCTS e COMWMP AAO 52100.000 X POLICY MJ01CT LGC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 X ANY AIRG BODILY INJURY ow p ALL OWNED SCHEDULED A AUTOS AUTOS N N 9365794 06/30/2014 06M=15 BODILY fumy Px eodit4 HIRED AUTOS NO WNED PROPERTY.G/IMAGE X MUMMA UABOCCUR EA04 OCCURRENCE 53,000,000 X A EzcEss LWB ctaM"Am N N 9385796 06/30/2014 06/30/2015 MabRECATE 53,000,000 DED RETENTION WORKERS COMPENSATION WC STATU• GTW AND EMPLOYERS'UABLITY TORY LMTS ER ANY PROPRIETGRIPARTNEPAM ECUiIVE EJ-EACII ACCIDENT OFROERRAEMBER EXCLUDEDT N I A spy in I" EL DISEASE•.EA EMPLOYEE Rv�der EL DISEASE.-POLICYLOA1T SCRIPTION OF OP DEERATIONS blow DESCRFn0N OF OPERATIONS-I LOCATIONS I VEH ES f ACCORD In A"tkrW Remarks.Sdmd/e,it arose spa*Is . THIS. COPY IS: NOT, TO, BE REPRODUCED, FOR ISSUANCE OF CERTIFICATES. CERTIFICATE HOLDER CANCELLATION 01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED.REPRESENTATIVE O 1988-2010 ACORD CORPORATION.AN rights reserved AOORD 25(MOM) The ACORD name arid logo are registered wants of ACORD Load Short Form Dat Date: Apr 22,2015 tv22MZ (Rest of House) By: HEATING SERVICE Franks Heating Service 555 Woburn St,Tewksbury,MA 01876 Phone:978-851-4403 Fax:978-851-0398 MMIIF11 • • For: 55 marbleridge rd north andover ma Htg Clg Infiltration Outside db (°F) 1 88 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 69 13 Fireplaces 1 (Average) Daily range - M Inside humidity(%) 30 50 Moisture difference(gr/Ib) 28 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 t 0 Btuh Latent coolie Heating output 9 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 1955 cfm Actual air flow 1955 cfm Air flow factor 0.033 cfm/Btuh Air flow factor 0.049 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.78 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft.) (Btuh) (Btuh) (cfm) (cfm) MUD 170 3276 948 109 46 G BATH 60 2668 1736 89 85 GUEST 161 6139 3993 204 196 KIT 279 6061 3855 201 189 FOY 286 10725 9359 356 459 COAT 63 1479 513 49 25 LIV 388 8637 4764 287 234 CLOS 52 0 0 0 0 FAM 478 19863 14706 660 721 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. 2015-May-0411:56:14 + wrilghtsoft" Right-Suite®universal 201515.0.05 RSU10062 Page 2 ACCP. ...\Project\55 marbleridge rd north andover ma.rup calc=MJ8 Front Door faces:N (Rest of House) d 1936 58848 39874 1955 1955 Other equip loads 0 0 Equip. @ 1.00 RSM 39874 Latent cooling 10940 TOTALS 1936 58848 50815 1955 1955 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. 2015-May-0411:56:14 ,� f+..r wrightsoft� Right-Suite®Universal 2015 15.0.05 RSU10062 Page 3 ACJCK ...\Projed\55 marbleridge rd north andover ma.rup Calc=MJ8 Front Door faces:N Load Short Form Job: Date: Apr 22,2015 MAS SUITE By: HEATING SERVICE Franks Heating Service 555 Woburn St,Tewksbury,MA 01876 Phone:978-851-4403 Fax:978-851-0398 For: 55 marbleridge rd north andover ma Htg Clg Infiltration Outside db (°F) 1 88 Method Simplified Inside db (°F) 70 75 Construction quality Average Design TD (°F) 69 13 Fireplaces 1 (Average) Daily range - M Inside humidity(%) 30 50 Moisture difference(gr/Ib) 28 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 844 cfm Actual air flow 844 cfm Air flow factor 0.032 cfm/Btuh Air flow factor 0.048 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.76 ROOM NAME Area Htg load Clg load Htg AVF CIgAVF (ft2) (Btuh) (Btuh) (cfm) (cfm) MAS 283 8623 4885 278 236 WIC 56 2039 780 66 38 WIC 2 53 1951 750 63 36 M BATH 120 2685 1647 87 80 M WASH 114 3091 2599 100 126 M HALL 74 4057 3811 131 184 OFF 208 3696 2993 119 145 MAS SUITE d 907 26142 17465 844 844 Other equip loads 0 0 Equip. @ 1.00 RSM 17465 Latent cooling 5470 TOTALS 907 26142 22936 844 844 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. 2015-May-0411:56:14 wrightsoft° Right-Suite®Universal 2015 15.0.05 RSU10062 Page 4 ACCP. ...\Projed\55 marbleridge rd north andover ma.rup Calc=MJ8 Front Door faces:N f Load Short Form Job: `� Date: Apr 22,2015 FU—;N-S�27z" UPSTAIRS By: HEATING SERVICE Franks Heating Service 555 Woburn St,Tewksbury,MA 01876 Phone:978-851-4403 Fax:978-851-0398 • I'll • • For: 55 marbleridge rd north andover ma r - • • e Htg Clg Infiltration Outside db(°F) 1 88 Method Simplified Inside db (°F) 70 75 Construction quality Average Design TD (°F) 69 13 Fireplaces 1 (Average) Daily range - M Inside humidity % 30 50 ( ) Moisture difference(gr/Ib) 28 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 Total cooling 0 Btuh Temperature rise 0 F g p Actual air flow 786 cfm Actual air flow 786 cfm Air flow factor 0.033 cfm/Btuh Air flow factor 0.048 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.67 ROOM NAME Area Htg load Clg load Htg AVF CIgAVF (ft2) (Btuh) (Btuh) (cfm) (cfm) BATH 3 50 1615 794 54 38 BED3 252 4776 4350 160 211 WIC3 95 2687 1314 90 64 UP HALL 90 1905 916 64 44 BED4 445 8582 5783 287 280 BATH4 101 3900 3052 131 148 UPSTAIRS d 1034 23463 16210 786 786 Other equip loads 0 0 Equip. @ 1.00 RSM 16210 Latent cooling 1 7912 TOTALS 1034 23463 24122 786 786 Calculations approved byACCA to meet all requirements of Manual J 8th Ed. 2015-May-0411:56:14 wrightsoft' Right-Suite®Universal 201515.0.05 RSU10062 Page 5 ACC{\ ...\Projedl55 marbleridge rd north andover ma.rup Calc=MJ8 Front Doorfaces:N N Qr 180 cfm Q" 18 180 cfm J� FAM j f ^�� cfm 143 cfm V� �s 308 cfm LIV 143 of �Cp V i6 � 153 308 cfm COAT 349 cfm 49 drn 333 cfm k 7 cfm 153 )e6NI 184 cfm I kA y k 126 cfm1 0 , t! 93 cfm /► Zvi► _ _ �`6 , \\ 454 cfm M W SH KIT 24 cfm 9 cfm L CLOS 2 cfm MAS J O F 201 c M H I cfm SJ� 89 cfm MUD 145 cfm V 87 cfm �GUE ,44`11) V� 109 cfm 5 63 cfm 5 66 d 204 cfm \ WIC2 WIC Job Franks Heating Service Scale: 1/8" = 1'0" Performedd for: 9 Page 1 555 Woburn St NghtSuite®Universal 2015 55 marbleridge rd north andover ma Tewksbury,MAO 1876 15.0.05 RSU10062 Phone:978-851-4403 Fax:978-851-0398 2015-Apr-2311:20:51 ...bleridge rd north andover ma.rup N level 2 148 cfm BATH4 144 cfm BED4 L 90 cfm e3-r� 3 WIC —16 I� fJ `' v� 144 cfm 144 cfm BED3 cfm UP HALL 54 dBATH3 255 dmf 105 cfm 21 �l 6 •I Scale: 1/8" = 1'0" Franks Heating Service Page 2 Job #: RightSuite®Universal 2015 Performed for: 555 Woburn St 15.0.05 RSU10062 Tewksbury,MA01876 2015-Apr-23 11:20:51 55 marbleridge rd north andover ma Phone:978-851-4403 Fax:978-851-0398 ...bleridge rd north andover ma.rup L I I i � i i i I i I � I I M f i i � i i I � I I I � I L I t I f i I I 1 �-_ __ _ ,� COMMONWEALTH OF MASSACHUSETTS o • e e o ` BOA d OF I SHEE7 METAL'WORKERS�F 'f ISSUES THE FOLLOWLNG LICENSE . I� ASA .JflURNEYPERSON ;UNRB,! D TtMOTHY R PALM4 f y 112 LOWELL AVE HAVERHILL MA 01832-3710262 9 3 31,:: . 09/28/16 3 5 Outlook.com -vinnyrae@hotmail.com https://col129.mail.live.com/default.aspx?... New Reply Delete Matthew Rae 4 Gelinas Recommendations Folders Dan L Gelinas (danlgelinas@coma Inbox 7090 To:vinnyrae@hotmail.com Junk 40 ° 1 attachment (994.1 KB) Outlook.cc Drafts 1 Sent 56- g Deleted f New folder Gelinas Recommen... Download as zip Add to OneDrive Two headers are fine, beam that receives post lorj- -�wm Sk-4 header H21 is fine Two Long beams that receive the post load from o Header H22 is overstressed when we place that+ oin - j 6� � LC away from the Lally Columns / Two Options: Drop Lally and 2x2x1 footing Option 2, no new posts in basement,add one sid"t Lute 1112- L,VL. 9/12 LVL to the existing 5-1/2 X 9-1/2 BEAM On drawing SG1 attached which is 11 x 17 C) 2015 Microsoft Terms Privacy&cookies Developers 1 of 1 03/30/2015 12:43 PM r � o pp:D U u�iWptiK ZZ d >; L CT U, J 9 Lcu J ZWo A� 15 co m ? 0� ani l$ %' ��� ��,� 5vl.l►p I{o�� �jF7`tt1�i 6l�- j � .ouprl � szz, o s. l N c 1�2x 9'l2 . r• ^uARi1i1. Y5:. GfIZX CyI /Z DV5(kt-5-S 43 G1i°AS 1z ETRUC-�JRRC l fj Ip la»P XYZ" tiMf `{` Z�X UxI POO q9-46 r-, I.evhlotA Iry*IO Job No. 15063 l r / Mar 29,2015 JOB No SHEET NO. AW i J t 5 c� nor Po►N 1� /p, c V�w G � cs. 6� � Z In c� CO a) �y �' j GEUNAS ST#ZUC'TUJZAL ENGfIV EERIAI q LW t�� o ___..:__.. ___.__._...._____..___.-. .___._.._........._._ ` Daniel L. Gelinas, P.E. L =. p A4wi ert., 579A North End Blvd. ! Salisbury, MA 01952-1738 Phone 978.465.6436 (Fax 5160) ' I .a►V'h g2 -�'rv�IAr9 cx�a i I i a '22 I 1 sQlseCeseiouble 1-3/4"x 11-718"VERSA-LAM@ 2.0 3100 SP Floor Beam1...Short Header H21 Dry 1 span No cantilevers 10/12 slope Sunday,March 29,2015 BC CALC@ Design Report Build 3272 File Name: BC 15063.bcc Job Name: Description:DesignslShort Header H21 Address: 55 Marbleridge Rd Specifier: Dan L Gelinas, PE;Gelinas Structural Engineering LLC City, State,Zip:North Andover,MA job 15063 Designer: 579A North End Blvd,Salisbury MA 01952 Customer: Company: ph 978.465.6436[danigelinas@comcast.net] Code reports: ESR-1040 Misc: 3 i C1 BO 04-00-00 131 Total Horizontal Product Length=04-00-00 Reaction Summary(Down 1 Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live BO,3-1/2" 1,120/0 684/0 1,120/0 131,3-1/2" 1,120/0 684/0 1,120/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100%" 90% 115%" 160% 125°/" 1 2nd floor Unf.Area(Ib/ft^2) L 00-00-00 04-00-00 40 10 14-00-00 2 . wall Unf.Area(Ib/ft"2) L 00-00-00 04-00-00 0 10 05-00-00 3 roof Unf.Area(Ib/ft^2) L 00-00-00 04-00-00 10 40 14-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 1,853 ft-lbs 7.6% 115% 3 02-00-00 End Shear 850 lbs 9.4% 115% 3 01-03-06 Total Load Defl. 0999(0.004") n/a n/a 3 02-00-00 � ` Live Load Defl. 0999(0.003n) n/a n/a 6 02-00-00 `. Max Defl. 0.004 n/a n/a 3 02-00-00 C,. �� j Span/Depth 3.6 n/a n/a 0 00-00-00 tjpN, =+ .c c� STRUC7 U+ ML c�1, %Allow %Allow Bearing Supports Dim.(L x W) Value Support Member Material BO Post 3-1/2"x 3-1/2" 2,364 lbs n/a 25.7% Unspecified B1 Post 3-1/2"x 3-1/2" 2,364 lbs n/a 25.7% Unspecified Notes Design meets Code minimum(U240)Total load deflection criteria. Job No. 15063 Design meets Code minimum(0360)Live load deflection criteria. Design meets arbitrary(11")Maximum total load deflection criteria. Map 29, 2015 Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8"were ignored In the results. Page 1 of 2 Boisecasc0ouble 1-3/4" x 11-718" VERSA-LAM@ 2.0 3100 SP Floor Beaml...Short Header H21 Dry( 1 span I No cantilevers 10/12 slope Sunday,March 29,2015 BC CALL@ Design Report Build 3272 File Name: BC 15063.bcc Job Name: Description:Deslgns\Short Header H21 Address: 55 Marbleridge Rd Specifier: Dan L Gelinas,PE; Gelinas Structural Engineering LLC City, State,Zip:North Andover,MA job 15063 Designer. 579A North End Blvd, Salisbury MA 01952 Customer: Company: ph 978.465.6436[danigelinas@comcast.net] Code reports: ESR-1040 Misc: Connection Diagram Disclosure r►{b d Completeness and accuracy of input must s_ be verified by anyone who would rely on a output as evidence of suitability for • r• • particular application.Output here based on building code-accepted design c properties and analysis methods. Installation of BOISE engineered wood • products must be In accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c=7-7/8" (800)232-0788 before Installation.WnBC b minimum=3" d=24" CALC@,BC FRAMER®,AJS-, ALLJOISTO,BC RIM BOARD-,BCI®, Member has no side loads. BOISE GLULAM-,SIMPLE FRAMING Connectors are: 16d Sinker Nails SYSTEMO,VERSA-LAMM,VERSA-RIM PLUS@,VERSA-RIM@), VERSA-STRAND@,VERSA-STUD@ are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 -( Bdftub#e 1-314" x l l-718" VERSA-LAM@ 2.0 3100 SP Floor Beaml...Long Hall Header H22 Dry 1 span (No cantilevers 10/12 slope Sunday,March 29,2015 BC CALL@ Design Report Build 3272 File Name: BC 15063.bcc Job Name: Description: DesignsIong Hall Header H22 Address: 55 Marbleridge Rd Specifier: Dan L Gelinas,PE; Gelinas Structural Engineering LLC City,State,Zip:North Andover, MA Job 15063 Designer: 579A North End Blvd,Salisbury MA 01952 Customer: Company: ph 978.465.6436[danigelinas@comcast.net] Code reports: ESR-1040 Misc: i i i + � t 1 T ♦ + t ► i L � w i .. 1 �j w� vim+ v. :• i � i ;� t i �: �t i 1 w. �t—i 07-00-00 80 B1 Total Horizontal Product Length=07-00-00 Reaction Summary(Down/Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live 130,3-1/2' 1,960/0 1,197/0 1,960/0 B1,3-112" 1,960/0 1,197/0 1,960/0 Live Dead Snow Wind Roof Live Trib. i Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 2nd floor Unf.Area(Ib/ft^2) L 00-00-00 07-00-00 40 10 14-00-00 2 wall Unf.Area(Ib/ft^2) L 00-00-00 07-00-00 0 10 05-00-00 3 roof Unf.Area(Ib/ft^2) L 00-00-00 07-00-00 10 40 14-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 6,323 ft-lbs 25.8% 115% 3 03-06-00 End Shear 2,623 lbs 28.9% 115% 3 01-03-06 Total Load Defl. U999(0.05") n/a n/a 3 03-06-00 Live Load Defl. U999(0.035") n/a n/a 6 03-06-00 tj¢u.a, Max Defl. 0.05 n/a n/a 3 03-06-00 , Span/Depth 6.6 n/a n/a 0 00-00-00 wVWy;, %Allow %Allow Fi L r lk Bearing Supports Dim.(L x WI Value Support Member Material �'-`t BO Post 3-1/2"x 3-1/2" 4,137 lbs n/a 45% Unspecified t" S1,RUCIKAL ! �7 B1 Post 3-112"x 3-1/2" 4,137 lbs n/a 45% Unspecified Notes ACRAL r-, i Design meets Code minimum(U240)Total load deflection criteria. - Design meets Code minimum(U360)Live load deflection criteria. Design meets arbitrary(1")Maximum total load deflection criteria. Calculations assume Member Is Fully Braced. Job No. 15063 Design based on Dry Service Condition. Deflections less than 1/8"were ignored in the results. Mal' 29, 2015 Page 1 of 2 a spiftuble1-3/4" x 11-7/8"VERSA-LAM@ 2.0 3100 SP Floor Beam1...Long Hall Header H22 Dry 1 span I No cantilevers 10/12 slope Sunday,March 29,2015 BC CALL@ Design Report Build 3272 File Name: BC 15063.bcc Job Name: Description:DesignsIong Hall Header H22 Address: 55 Marbleridge Rd Specifier: Dan L Gelinas, PE;Gelinas Structural Engineering LLC City, State,Zip:North Andover,MA job 15063 Designer: 579A North End Blvd,Salisbury MA 01952 Customer: Company: ph 978.465.6436[danlgelinas@comcast.net] Code reports: ESR-1040 Misc: Connection Diagram Disclosure b +—d Completeness and accuracy of input must be verified by anyone who would rely on a I output as evidence of suitability for • • • particular application.Output here based on building code-accepted design c properties and analysis methods. Installation of BOISE engineered wood • • products must be In accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum=2" c=7-7/8" (800)232-0788 before Installation.lnlnBC b minimum=3" d=24" CALC@,BC FRAMER@,AJS- ALLJOIST®,BC RIM BOARD-,BCI®, Member has no side loads. BOISE GLULAMTM SIMPLE FRAMING Connectors are: 16d Sinker Nails SYSTEM®,VERSA-LAM,VERSA-RIM PLUS®,VERSA-RIM@, VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Cascade Wood Products L.L.C. I I Page 2 of 2 AOL Safety Insurance Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall NORTH ANDOVER, MA 001845- NORTH ANDOVER, MA 001845- ISI RE:_ Insured: " BARBARA YOUNG = _ Property Address: 55 MARBLE RIDGE ROAD,NORTH ANDOVER,MA Policy Number: HMA 0310363 Claim Number: BOS00045400 Date of Loss: 8/22/2014 Company: Safety Indemnity Insurance Company Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Daniel Olsen Claim Examiner 9/24/2014 Safety Insurance Company Homeowners Claims Unit P. 0. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3323 Fax: (617) 531-2762 Email: Danie101sen@Safetylnsurance.com Location No. y9 3 Date NORTH TOWN OF NORTH ANDOVER 13? • 1 • L9 Certificate of Occupancy $ 1 4 Nus Building/Frame Permit Fee $ +c Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #Gb, 9z- 'I 63j9 z- 'I63j9 Q 61 Building Insp6ctor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVAT& OR DEMOLISH AONE OR TWO FAMILY DWELLING .: ..�� '[5 cy 15< 1F`•;�itFs Yy 6x 't'I� w"^ � _. .";' BUILDING PERMIT NUMBER. Lift DATE ISSUED, u I SIGNATURE: Building Commissioner/125for of BuildingsDate Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(so Frontage ft 1.6 WELDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Reglfired Provided ReqWred Provided 0 1.7 Water Supply M.G.L.C.40. 34) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O Z M Signature Telephone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ "to Licensed`Construction Supervisor. License Number aue✓ki SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all a Gcable New Construction ❑ Existing Building ❑ Repair(s) ❑ � Alteration:( TLl l Addition ❑ Accessory Bldg. ❑ olition ❑ Other ❑ SpecifyA< 60 r '• Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFF'IC1lAI:I7SE ONLY Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)X(b) 4 Mechanical HVAC / 5 Fire Protection 6 Total 1+2+3+4+5 / �L Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 'Q-i C P L C610/ L as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all atters- o rk authorized by this building permit application. . Signature o-. Edi Date SE ON 7b OWN AUTHORIZED AGENT DECLARATION I, as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Signature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TWIBERS 1 s1r2ND 3 SPAN ` DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE o Of Andover No. doves, Mass., BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT................ . ...... ....... Foundation has permission to erect........................................ uIldings an ...S... ...... )a). ....... Rough tobe occupied as. ......... .......... ....................I.....................I......................................................................................... Chimney provided that the person acceptin is permit shall in every respect conform to the terms of the application on file in Final i D �cepiii�o*thie�Ci�ooii this office, and to the provisions des 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. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough .................................A................... Service Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. BOARD OF BUILDING REGULATIONS Ucense: CONSTRUCTION SUPERVISOR Number CS 078130 BirthdaW::06=1972 i ! UpIres:06!02/2004 Tr.no: 78130 itestr Wed To' 00 RICHARD J DECOITO _ 50 WHITE STREET , . l HAVERHILL, MA 01832 Administrator ,..r North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S.1 50 A.. The debris will be disposed of in: (Location of Facility) /r~ Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector 97 a The Commonwealth of Massachusetts .:.; d Department of Industrial Accidents Office of Investigations Boston, Mass. 02119 Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Company name: Ls'�' v�' -(r IZc ! /U 9 S Address City ��/��� t' C - Phone#: Insurance.Co. o ' C Poliw# Company name: , Address City:. Phone#: Insurance Co. Policy# Failure to secure coverage as required undersection 25A or MGL 152 can lead tothe imposition of c riminat penalties c7a fine up to$1,500.00 and/or one years'imprisonment_as_v�tdLas_ciar�l•penalhesif)lbeiomid-� 79P.Y1foRKDMER-and_afine�oleo 0A)-aAw lgainst�•+— I understand that a copy of this stat ay be forwarded to the office of Investigations of the DIA for coverage verification. l do hereby certdy under the l es Of perjury 11W the irrfor k*m provided above is true and correct Signature Date y Print name Phone# � 3 7 Official use only do not write in this area to be completed by city or town official- City or Town PermitA icensing ❑ Building Dept ❑Check Y immediate response is required ❑ Licensing Board ❑ Selectman's Office Contact person: Phone# ❑ Health Department ❑ Other