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Miscellaneous - 600 FOSTER STREET 4/30/2018
600 FOSTER STREET 210/104.8.0047_ 0000.0 BUILDINu FIS. Date... ............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING HU This certifies that .....A LLL ...................................................................................................................... rm ................. ..... ....................... has permi ssion to pef. ...... wiringin the buildinmf..........AZI................................................................................. at ...........(.(.X.)...... I.nlv.....4.................................North AndoverMass. Fee... ... ..........Lic.No.17Z.L ... ... ....... ........... ....... ...... °.. u"f... /. ELE6fiucAL INspEcroi-,' Checko ZIAI�I X11544 r C®f+F➢MotPwealth of MassachusettsFoccupancy Official Use Only Department of Fire Services eYll6C�.'s . BOARD OF FIRE PREVENTION REGULATIONS I (Please��a�zip c®�'es electrician's cc!! and Fee Checked a CO�YfYc'dCt�&blCY�7e6'6dYB1��9��dJR9l1C��/e� (leave blank) � ApP❑CAgI®M IF®G3 M PERMIT OPERFORM ELECTRICAL WORKAAI work to be performed in accordance the Massachusetts c aCMR (PLEASE'PRINTININK OR TYPE ALL INFORMATION) Date: Ogg or Town of: �To the Inspector of Wires: 1 By this application the undersigned gives notice of his or her intention to perform the electrical work described below. i Location(Street&Number) Cp `, ®canerorTenaaLt ' t Telephone No. ' I Owner's Address Is this permit in conjunction with a building permit? files ❑ No (Check Appropriate Bou) )Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead❑ Und rd _ g ❑ No.of Meters � 0fpeeders acid Amliacity Location and Nature of Proposed Electrical Work: �� ����� �) �Ccs_rL � � S i ern Cofnpletion of thefollowing table may be waived by the Inspector of Wires. i a No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.—of Total Transformers RVA No.of Luminaire Outlets No.of Hot Tubs Generators IVA No.of Luminaires Swimming pool Above ❑ In- ❑ .o mergeBey ig i ng rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners ? FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices } No.of Ranges No.of Air Cond. Tonsl No.of Alerting Devices No.of Waste Disposers Heat pump Number Tons I£W No.of Self-Contained Totals: ............................................... Deteeffon/Alertina Devices No.of Dishwashers Space/Area Heating IOW Local❑ Municipal Connection ❑ Other I No.of Dryers Heating Appliances IOW Security Systems:' No.of Water No. of No.of Devices or uivalent RW Heaters No.of Data Wiring: Si ns Ballasts No.of Devices or Equivalent No.hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: ` OTHER. No.of Devices or E uivalent f 4ttach additional detail if desired,or as required by the Inspector of JI'ires. Estimated Value of Electrical Work: D e (Wizen required by municipal policy.) Work to Start: P Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless i the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER X (Specify:) Self Insured X certify,under the pains mid penalties of perjury,that theirzf0t7.yzador on this application is true and complete. �`l FIRM NAME: ADT LLC DBA ADT Security , /" LIC.NO.: C-172 Licensee: Thomas J,Lee ignature LIC.NO.: C-172 (If applicable.enter- "exempt"in the 1' ease nunz er line) Bus. Address: t CL Bus.Tel.No.:(o U� q 'U 1 � 0�''c.ct' Alt.Tel.No.: . 'Security System Coni'actor License required for this work;if applicable,enter the license number here: 001779 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/Agent ❑owner's agent. Signature Telephone No. PERMITFEE.S �� :C0MMONIM AL T 61 OF MASSACH SETT,. ' s�`��,.�ajSl�o,(���laf f tittJiyiit f!Jff"I _{al{� I Tj�!Inrar�oj,l. ' f ELECTRICIANS ' X..REGISTEREO SYSTEM CONTRALTO " ISSUE^a.i HE, 6gbN E LICENSE FO: '':p.D7DBA` 1 �C �A ADTSECUR:ZTY,'. i 'l,-140MAS -J LEE.. :: ; s 4z o :UNIVERSITY AVE S� :' WE'STWOOD MA 02090-231. •. 172 C 07/31/13 20_1934'_ =��+C(y=1i(�1"•t#Y'" i >1 II t''L�IC l�Jlafall= t����1-t°!/t5b���°t# ' r=aid,fhcn DetechAicn�rUI Pedolations Xil „ r. Division of Professional Licensure: License Search Page 1 of 1 10 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home State Agencies A-Z Topics Home>Division of Professional Licensure> ONLINE SERVICES ........................._...................................................................................................................................................................................................................._................... ......... Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change Contact the Agency LICENSEE More... Name:THOMAS J. LEE REFERENCES& Business:ADT LLC DBA ADT SECURITY RELATED INFO WESTWOOD,MA Disclaimer Regarding I`iE�" SLA"f_ti Website License Searches **This Licensee has additional Licenses,click here to view them.** Enforcement Process Glossary Licensing Board: ELECTRICIANS Glossary of License Status Codes License Type: SYSTEMS CONTRACTOR TYPE CLASS:C More... License Number: 172 Status: CURRENT Expiration Date: 7/31/2013 Issue Date: 1/1/1992 Exam Date: School: This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Monday,April 29,2013 at 2:52:49 PM. ©2007-2011 Commonwealth of Massachusetts Site Policies Contact Us http://Iicense.reg.state.ma.us/public/pubLicenseQ.asp?board_code=FA&type class=_C&li... 4/29/2013 Date . . . . . . . . . . . . . TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . .Vezej oos wiring in the building of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . North Andover, Mass. Fee %o.-,3-�.�ic. No.14$1g2-A. . . . . . . . . . . . . . . . . . . . . . . . ELECTRICAL INSPECTOR Check# 798 1.1026 S Commonwealth of Massachusetts official Use Only Permit No. / i/0 2-4 Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1 q (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: 7 Pv — J City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intentiontoperform the electrical work described below. Location(Street&Number) 040o P��ez\ Y� 0 Owner or Tenant A 4L Z , AJ 6 Telephone No. Owner's Address S-75, Is this permit in conjunction with a building permit? Yes Ad No ❑ (Check Appropriate Box) Purpose of Building -S i N 61e 1-4m Utility Authorization No. 44y3j Existing Service f&y Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service X�— Amps / Volts Overhead Undgrd ❑ No.of Meters 1 Number of Feeders and Ampacity OC Location and Nature of Pro osed Electrical Work bQ E Ivek 4F CAI EXi S-T Id 04 Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets t-(U No.of Hot Tubs Generators KVA i Above In- o,o mergency ig ting No.of Luminaires G Swimming Pool rnd. ❑ rnd. ❑ Batter Units No.of Receptacle Outlets 70 No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches -L4 d No.of Gas Burners No.of Detection and Initiating Devices Tot No.of Ranges 6A S No.of Air Cond. Tons S No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Dete-tion/Alerting Devices Municipal Other No.of Dishwashers Space/Area Heating KW Local❑ ElConnection ' No.of Dryers GA J 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:ent No.of Devices or E uival OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: K (When required by municipal policy.) Work to Start: Tuff A`) Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE JI BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: . LIC.NO.: Licensee: e%✓ Signatur LIC.NO.: (If applica le,e ter "exempt"in the license n m r line. S Bus.Tel.No.: d� Address: �t114C1, / / /aR,67 /N 01FP- 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: $ Signature Telephone No. r 1 ` i J i • lG.1J1Ltil..rl..�L+..yryi�(Hyyy'''�e(�y�-{�x4�J`e.�Y'./�lyR.�����}yaP`��{};e�y' p/''p�`�p--�� F�1�.L2�s.R..R�A'1 J.ev�®��� On I.XtOvlwW 1101, �'asset�.--•j _W- 12' CTX YnsPectors,iva exifs: i .1/z. k ( Tspee p sy Zgl7a e�3�o reit date �'assek:, ailet��� esectio�xect�ixe ( 0.00}- j izs�ecta v comm.mts: (� 'ectoxsl�Ipafre 3z ' xtzaXs) date assed--f I YAW-[ � ate-�uspeetzo��ecXu'rxe����0.�0)�j � q]Betoxs'commentst �lnspec O&LSignawe-3.oU-EIaTs) date ' as--[31 . ?'a'.�Ia.. oectbks9 eo�t.e�zfis: . (�Cusectoxs',�zguatuxe� atutzaxs) Date nspeetlonxe0piz'ed($50AD)-- ) :ctaxs�co�znerifs: _ , S •018P ectoxg'Signature-no inztzaTs) date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 6Washington ree 00 Street Boston,AM 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name (Business/Organization/Individual): Address: City/State/Zip: CAZ1 P1.0l olU Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time)." have hired the sub-contractors 2.UJI am a sole proprietor or partner- listed on the attached sheet. ? ❑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 10.❑Electrical repairs or additions required.] officers have exercised their 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' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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. 'am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site nformation. nsurance Company Name: 'olicy#,br Self-ins.Lic.P Expiration Date: ob Site Address: City/State/Zip: Utach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of avestigations of the DIA for insurance coverage verification. do hereby certf i d r the pains and penalties of perjury that the information provided above is true and correct. ;igrtature: Date: hone#: G 2 o7 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#: f 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 k that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT 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 ext 406 or 1-877-MASSAFE Zevised 5-26-05 Fax#617-727-7749 www,mass,gov/dia h' Date-7.)Z.7. 9506 �'.".O RTM'�o TOWN OF NORTH ANDOVER o PERMIT FOR PLUMBING CHUS This certifies that . . . . . . : . '�r" . . . . . . . . . . . has permission to perform . ' 4.c� . . . . . . . . . . . . . . . . . . . plumbing in the buildings of . ... . . . . . . . . . . . . . at. . . . . .' ` S�.F— " .�. . . . rth ndovegass. . . . . PLUMBING INSP TOR Check ." MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA DATE PERMIT# JOBSITE ADDRESS 00 �S�C�� Sje� OWNER'S NAME �clg P OWNER ADDRESS ' Q -�: TEL 21M CC-2-Eo FAx TYPE OR OCCUPANCY TYPE COMMERCIAL Ell EDUCATIONAL © RESIDENTIALIA- PRINT CLEARLY NEW: Ell RENOVATION: - REPLACEMENT:Ell PLANS SUBMITTED: YES 0 NOR FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB I I I J _(==i € I f _i J ---J=1= CROSS CONNECTION DEVICE ( _. _f I _.-.._...j __i DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM I I f --._-._.._ DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN _f .___....J ___ J _.__._..___f --__._� 1 _._...._I _-_.___i ._.._.__.'• .__...._J ___.-..J -.-_--_-t ---.._..J __ I ....__. FOOD DISPOSER FLOOR/AREA DRAIN —f _.___ -______ ______ J __€ .-._.___1 1 -___.-___.5 ____..__J .--____I i f. ..___.J € ------- INTERCEPTOR(INTERIOR) f _� f E _.._-.� __ _f ____._€ .�....._..J KITCHEN SINK .-_._.€ _. ._.__I 1 _..___.F J LAVATORY —E ( _____I ROOF DRAIN SHOWER STALL a_D SERVICE/MOP SINK TOILET —_ URINAL € J € ._..._._..._x _-_._--( WASHING MACHINE CONNECTION --AE71 WATER HEATER ALL TYPES _I _i I _...__._i ( WATER PIPING _-- OTHER __ ___ .__- __j ............ I -- 771 _ _.____ -___.__I INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES Q NO Ell IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYl OTHER TYPE OF INDEMNITY Q BOND P 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 .f AGENT 10 SIGNATURE OF OWNER OR AGENT B hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME r f o �� --JILICENSE 1# 2a, SIGNATURE MPO- P i JP Q CORPORATIONE I# �--i� �---� � - ._11PARTNERSHIP Q#��LLC COMPANY NAME ( p6 / ADDRESS� d CITY f J(-erfJr0 i STATE /} ZIP d I` �dl TEL FAX i CELL 7)'1 loEMAIL ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ FEE: $ PERMIT# 1,2)— PLAN REVIEW NOTES 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: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 61 f py k/ (-2(-),Pk O`f Address: Ce City/State/Zip: t3f fol(c/- A/. Phone#: & �' �"�" -4� y �5 C[ 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• El New construction 2. am a sole proprietor or partner- listed on the attached sheet.I ❑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.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 1311 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 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 Flo hereby certify under the pains and penalties of perjury that the information provided above is trite and correct. Signature: d Date: / d 76 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#: • f 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is 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 1 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"ever state or local licensing agency shall withhold the issuance or P , § O Y 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(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 Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass,gov/dia Date.. . .1 2 ' HORTh/ 'f TOWN OF NORTH ANDOVER • - PERMIT FOR GAS INSTALLATION .4 USEtI( E--. lhJI This certifies that . . . . . . . . . . . . . . . . . has permission for gas installation . . . . . . . . . . . . . .. . . . . . . . . . . . . x in the buildings off `�i�- b`(z: . . . . . . . . . . . . . . . . . . . . . . at . . . . . t?�. . . ? : . . , North Andover, Mass. !Fee)PQ . . . . Lic. Noa cVc! . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# z 8269 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i CITY _✓�t-���� �� MA DATE PERMIT# JOBSITE ADDRESS d©- � � °fie OWNER'S NAME GOWNER ADDRESS I 6 �:(�� TE "j_ ��GFAX TYPE OR OCCUPANCY TYPE COMMERCIAL F__11 EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW:13 RENOVATION:JB REPLACEMENT: PLANS SUBMITTED: YES O N00 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 _. DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR - FURNACE -_-- GENERATOR _TI I _I I ( -_ -�- j - ----J-- GRILLE INFRARED HEATER . _�. _ -_ I - I_ >- --- J LABORATORY COCKS [ I .._ l � f — - -.Jf MAKEUP AIR UNIT OVEN POOL HEATER - ROOM I SPACE HEATER -- �- _ _ _ - ----- �__ - - --T--_- ROOF TOP UNIT TEST __.I I_. a . l.� _ ! =-y 1 -YJ _. T( UNIT HEATER --. I -t . -_a UNVENTED ROOM HEATER _ L ! �I WATER HEATER OTHER - -� - INSURANCE COVERAGE 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ONO D IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY - OTHER TYPE INDEMNITY ®,ff BOND FI-] OWNER'S 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 01 AGENT [�]( SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME :f ( pj P� 5 _ LICENSE#Z-_ _.__ SIGNATURE MP MGF JPfI JGF LPG] CCORPORATION[]#[=PARTNERSHIP En#=LLC 0-1#= COMPANY NAME: `"C. 4JT _C�� ► lLs_-�ADDRESS CITY Uj7(!m I STATE ZIP `oL TEL FAX CELLO ^5--� I. ._ EMAIL p e -y- C/^C4577 - -e _ -- ROUGH GAS INSPECTION NOTES TRIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES //�� (/'� A Yds No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ /' L /� FEE: $ PERMIT# PLAN REVIEW NOTES y The Commonwealth of Massachusetts Ln Department ofIndustrial Accidents Office of Investigations k1i 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): D5 Ff m ( �1'f(CIO L Address: City/State/Zip: /to Phone#:, 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction •_,,A employees(full and/or part-time).* have hired the sub-contractors 2. m a sole proprietor or partner- listed on the attached sheet.I ❑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.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.El 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.] 1311 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they ai-e doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as 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 DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sit7nature: Date: Phone#: Official use only. Do not write in this area,to be completed by c4 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#: r i r r ` Informati®n 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 " pp nt who has not produced 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(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 Mossachvsetts Department of Industrial Accidents Office of Investigations 6.00 Washington.Street Boston.,MA.02111 Tel.#617-727-4900 ext 406 or 1-877-MASS.AFB Revised 5-26-05 Fax#617-727;7749 www-mass.gov/dia Date.. .7/4.X�....... ,FORTH OF N, 00 TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION SA This certifies that . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . .- -. .- has permission for gas installation 4044�?l v A . . . . . . . . in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . . .4��q. . . . . . . . . . . . North Andover Mass Lic. No.41'019V-- Fee.9 . . . . . . . . . GAS INSPECTOR Check# .8267 ' r MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK %J CITY UU __---_ _ O�?2(� _ __ MA DATE PERMIT# JOBSITE ADDRESS (QOO_ _ 5 _ - - OWNER'S NAME GOWNER ADDRESS O }_ TE - d j�pp FAX TYPE OR OCCU7RENOVATION:D TYPE COMMERCIAL D EDUCATIONAL E] RESIDENTIALO PRINT CLEARLY NEW: REPLACEMENT:01 PLANS SUBMITTED: YES F-11 NO nj APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 78 9 10 11 12 13 14 BOILER -� I _. I I __J 1=1 BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR - - - ---I FURNACE GENERATORf -_-- _ _- GRILLE -TI INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN �� - POOL HEATER �IL �- 1L ROOM I SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER _-�.1 UNVENTED ROOM HEATER ! ' ! WATER HEATER _ _I._ __A OTHER ............ ...... .... .. . .............. ........... INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL.Ch.142 YES EI'NO 1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [./ OTHER TYPE INDEMNITY 0 BOND FJ 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 (D AGENT 0 SIGNATURE OF OWNER OR AGENT 1 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 corrwli-nce with all P inept provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME ) p cpGLd � LICENSE#-_ I SIGNATURE MP 0 MGF[:- ! JP LAI JGF LPGI _ CORPORATION J# PARTNERSHIP©#=LLC D# COMPANY NAME: .-------�ADDRESS CITY urfiP�C�,o _.._..__� STATE _, ;k ZIP 1 TEL �o `Z771 FAX CELL EMAIL _ _---_ _ I tj __ __ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ n FEE: $ PERMIT# c. PLAN REVIEW NOTES .r t ~ 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: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1444"/s Address: 69 � City/State/Zip: L4 W (2r1 v al"Or Phone#: Are an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor 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.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Ro f repairs insurance required.]t employees. [No workers' 13. ther J !S GlAe comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: A r4 1.,e4 It Policy#or Self-ins.Lic.#: • 6 '�Q Expiration Date: fob Site Address: �xoo g� City/State/Zip: &dcow kttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a :me 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 )f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of hvestigations of the DIA for insurance coverage verification. 'do here rtify under the pain d penalties of perjury that the information provided above is true and correct. ii ature: Date: —r 'hone#: 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#• 1 t 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." e or local licensing a MGL chapter 152, §25C(6)also states that every stat g enc g y shall withhold the issuance or he commonwealth for an or permit too operate a business or to construct buildings m t y renewal of a license p p g 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 spaceace 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 . r need only submit one affidavit indicating current that must submit multiple permit/license applications m any given year, y g 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 homeowner 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 Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia E Richard J. Testa Jr. PE 29 Barney Hill Rd Wayland,Massachusetts 01778 Telephone:(508)561-1260 August 10,2012 R.L.I Corporation 475 Boston Road Billerica,MA 01821 Project: 600-Foster-.Road ` North Andover,MA Dear Bob, I have inspected the house at 600 Foster Road in North Andover. The house has been constructed according to the.plans and specifications and will meet the requirements of the Eight Edition of the Massachusetts State Building Code. If you have any questions,please feel free to call me at 508-561-1260 Sincerely urs." Richard J.3resta Jr.P.E. `' ,� ' ° "°'`� ? "' f / et 41 CERTIFICATE Of f - COMPLIANCE ' SITE: DATE: �/ TIME: BUILDE Code Compliance Testing House Infiltration and Duct Leakage Test for 2009 IECC 403.2.2 Home House Area: sq.ft. Tested Volume: cu.ft. N/Alk Infiltration: CFM-50(Cubic Feet per Minute @-50 pascals) Air Change: ACH-50(Air Changes per Hour @-50 pascals) Ducts111 r i. Duct System Location: Av 0 4 - sq.ft. N/A Duct Leakage Measure ent: _0'3 CFM25 0 Post-construction Duct system:leakage: % Without air handler j N/A Duct Leakage Measurement: ? CFM25 Post-construction Duct system leakage: %' Without air handler 3. Duct System Location: sq.ft. N/A Duct leakage Measurement: CFM25 Post-construction- Duct system leakage: % El Without air handler Signed: �. Date. 402A.2.1 Building Thermal Envelo Testing Building envelope tightness and insulation installation shall be considered acceptable when tested air leakage is less than seven air changes per hour(ACH)when tasted with a blower door at a pressure of 50 pascals(1psf).Testing shall occur after rough in and after installation of penetrations of the building envelope,including penetrations for utilities,plumbing,electrical ventilation and combustion appliances: 403.2.2 Duct Sealing(Mandatory) ) ry All ducts,air handlers,fitW boxes and building cavities used as duds shall be sealed.Joints and seams t13'wrrtnly with.. . Section M1601.4.1 of flft International Residential Code Ducftightness shall be verified by either of the fb fig:" 1.Post-construction test Leakage to outdoors shalt beless than or equal to 8 dm per 100 ft2 of conditioned floor area or a total leakage less than or equal to 12 cfm per 100 ft2 of conditioned floor area when tested at a pressure dif .rentiai of 0.1 inches w.g.(25 Pa)across the entire system, including the manufacturer's air handler enclosuPe.AO 4 boots shall be taped or otherwise sealed during the test 2.Rough-In test Total leakage shall be less than or fA6 cfm per 100 ft2 of conditioned floor area when tested at a pressure differential ofV.1 inches w.g.(25 Pa)a din system,including the manufacturer's air handler enclosure.Ali register boots shall be taped or oth~' during the test.If the air handler is not installed at the time of the best,total leakage shall be less than or equal tort: ; cfm per 100 ft2 of conditioned floor area. - ian Regi,Pfinclpai 11 Broadway,Suite 3,Beverly"MA 0191 email:lar,@TheEriergyl4ound.com wuAv.TheEaergVHoundxoraa. r. " CERTUFOCATE COMPLIANCE SITE: DATE: ..y ' -.TIME: BUILDER.: Code Compliance Testing Nouse Infiltration and Duct Leakage Test for 2009 IECC 403.2.2 House Area: sq.ft. Tested Volume: cu.ft. N/A. Infiltration: CFM-50(Cubic Feet per Minute @-50 pascals) Air Change: ACH-50(Air Changes per Hour @-50 pascals) 2. Duct System Locadon: , sq.ft. N/A Duct Leakage Measure ent: ADS Post-construction Duct system leakage: 96 Without air handier L -DuctSystemtowdot - sq.ft. N/A Duct Leakage Measurement: _ CFM25 Post-construction Duct system leakage: Without air hf�dler 3. Duct System Location: sq.ft. KI/A Duct Leakage Measurement: CFM25 Post-construction Duct system leakage: 90 Without air handier Signed: Date 402.4.2.1 Building Thee=l Envelope Testing Building envelope tightness and insula-ion installation shall be consW-'m1 acceptable when tested air leakage is less than seven air changes per hour(ACH)when 4csted with.a bks-nr door at a pressure of 50 pascals(ipso.Testing shall occur after rough in and after installation of penetrations of the building envelope,including penetrations for utilities,plumbing,electrical ventilation and combustion appliances. 403.2.2 Duct Sealing(Mandatory) All duds,air handlers,rltt-t boxes and building cavities used as ducts shall be sealed.Joints and seam3 "'mss,j with Section M1601 A.1 oftt','a4r.5amational Residential Code.Ducf tightness shall be verified by either of the t7 - '19:. 1.Post-construction Hest:Leakage to outdoors shall be'less than or equal to 8 cim per 100 f12 of oenditiorr-}floor area or a total leakage less than or equal to 12 cfm per 100 ft2 of conditioned floor area when tested at tc—muure differential of 0.1 inches w.g.(25 Pa)across the entire system, including the manufacturer's air handier enclosure.AN '*boota shall be taped or otherwise sealed during the test 2.Rough-in test Total leakage shall be less than or,� �16 efm per 100 ft2 of conditioned floor area when tested at a pressure differential of 0.1 inches w.g.(25 f'h)acr- - d in system,including the manufacturer's air handler enclosure.All register boots shall be taped o?othc�` during the test.If the air handler is not installed at the time of the test,total leakage shall be less than or equal U. cfm per 100 ft2 of conditioned floor area.