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HomeMy WebLinkAboutMiscellaneous - 607 TURNPIKE STREET 4/30/20180�; C 0 O � C Q z O � $i m om o m o m Date. 2 " a TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ..... .. ��. has pemission to perforin4---.54Z--� ......... 4 v .... . wiring in the building of�, , , , .. , 60 7-7 ...at� rth Andover, Mass. 2 a t l.r .... . Fee . ....-.`. Lic. No.. 3 ELECTRICAL INSPECTOR Check # Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only r Permit No. I ( (k !- Occupancy andeeF Checked [Rev. 1/071 (leave blank 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 ININK OR TYPE ALL INFORMATION) Date: LD -= City or Town of. NORTH ANDOVER To the Inspector of Wires:�- By this application the undersignedIves notice of his or her intention to perform the electrical work des r' ed below. Location (Street & Number) b©7 74 i"h lel �c� © otJ Owner or Tenant P44" c (Loll Telephone o. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building 160c, Utility Authorization No. Existing Service /, 06 Amps 0 / (Z 0 Vo is Overhead ❑ Undgrd ❑ No. of Meters New Service 03-00 Amps 0� ` , 0 /02O Volts Overhead Undgrd ❑ No. of Meters I Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: L14Pc1r4A ev-v 1; .sf ( S 4^e GtA IN k4, (l 2U li-AJ nyc-1 i+s'J7 ttfi)►– I)r.—I .� Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans s Total of Trsformers KVA Tran No. of Luminaire Outlets No. of Hot Tubs ' Generators KVA No. of Luminaires Swimming Pool Above ❑ In- El rnd. rnd. o Emergency Lighting Battery Units No. of Receptacle Outlets ��" No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiatin Devices No. of Ranges No. of Air Cond. Tons Tot No. of Alerting Devices Heat Pump Number Tons No. of Self -Contained No. of Waste Dis osers P Totals: I.KW Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ Municipal E] other Connection No. of Dryers Y Heating Appliances Kit Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: J Attach additional detail f,/ desired, or as required by the inspector qj rreres. Estimated Value o Ele trical Work: �O`-�C� (When required by municipal policy.) Work to Start: 7 Inspe tions 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 cov' p a is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [( BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the information on this application is true and complete. _ FIRM NAME: e,S LIC. NO.: ` f' % i IZ Licensee: �1 C� �. �rC �(iS Signature LIC. NO :. f- 2 (If applicable, enter "exempt" in the license number line I Bus. Tel. No. 7' 7) 1 Address: —0 (lv��l'� i^'i \SrL, !nl � �n me„ir� I JE l OQV 2 � Alt. Tel. No.: *Per M.G.L c. 147, s. 57 6l, security work reqtires 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/AgentPERMIT FEE: $ Signature Telephone No. J � , 7 • • J�..J�/�l.rMFLPEJMMD.. MCMLALMOPEVTR. .`�.1�.+. �'ll.+S.*.�.�.• J-'u.�.��J-`.r+c r • .. r s y .. �ns�ectoxs' �opzme�uts: , _ • - ' yS (fugeeforesignaiure-mki-i'llald) - Date 'asseci�-�' � �'aziec�--j � ate-�.speeizo�,xet�uirec�(�54.�0)�[ � aspectaxs' eoinmenis: ` (Ing Befors'. sjgnafuro - 3au falflals) Date r . 8MCITON--BEW J�CE: VVE, CAIMMBID N A S 0NAl GRI D. SSeC�--C �', !�eciaxs' eoxximep�fs: Need-- .WA A M.-. ocuspeetors,Hlgnatare-7 ua niffals) Date eci---� � �'azSer�•,j ]. '�Le �nspectfoxtxeguixe� (�50.OD) •-[ � aetoxs' cox�meafsa _ � • �lnsp ecfoxs'zgnature xtonials) date I �'assec�•-[ �'azTec�--r � � �exns�ectioxtxe�uixe� (��0.00)-- j �` ' �n.�iectoxs' c e s: . 17 spectoxsl &Uaturou 310 Date 'asseci�-�' � �'aziec�--j � ate-�.speeizo�,xet�uirec�(�54.�0)�[ � aspectaxs' eoinmenis: ` (Ing Befors'. sjgnafuro - 3au falflals) Date r . 8MCITON--BEW J�CE: VVE, CAIMMBID N A S 0NAl GRI D. SSeC�--C �', !�eciaxs' eoxximep�fs: Need-- .WA A M.-. ocuspeetors,Hlgnatare-7 ua niffals) Date eci---� � �'azSer�•,j ]. '�Le �nspectfoxtxeguixe� (�50.OD) •-[ � aetoxs' cox�meafsa _ � • �lnsp ecfoxs'zgnature xtonials) date I 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): t)1 Ck4.Q ( l rq m-� Address: Q\ d City/State/Zip: Phone #: Are yo n employer? Check the appropriate box: 1. ` I am a employer with 1 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have wgrking for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I'm a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �-(t' S A/lC Policy # o.,Self--ins. Lic. #: Job Site Address: Expiration Date: 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 :)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 Investigations of the DIA for insurance coverage verification. i do hereby certify unler tlpqpains and penalties of perjury that the information provided above is true and correct. W ?hone #: �d� � �i--!7717 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (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. 09999 Date ..3..�.?j.1. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..S� -t'QO—C�j . , , , ... , .. , has permission to perform. plumbing in the buildings of.. . �1 ............ . . . at ..71.0. ��,.���� � ............. North Andover, Mass. Fee d -- .. Lic. No.. Lk) . MA .................. ... PLUMBING INSPECTOR Check # kn4— P I. I� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY �' _ __11 MA DATE !� /� �( PERMIT# Olqffl JOBSITE ADDRESS lve 7��„ OWNER'S NAME POWNER ADDRESS7g5� vyj Sf /U iI W l TEL FAX TYPE OR OCCUPANCY TYPE COMME IAL EDUCATIONAL Q RESIDENTIAL TR PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: ® PLANS SUBMITTED: YES E9 NOD FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEML DEDICATED GREASE SYSTEM r DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM _=( [ t DISHWASHER DRINKING FOUNTAIN _ __F ._.__._.I _-___ _..-._._...` __�__.{ ` i [ E _____._.0 .____._ 1 ._.,__( _ , -._._J ___.__ .__.___t .__..._._.r FOOD DISPOSERI __-__. fFLOOR/AREA DRAIN 4 _._____ INTERCEPTOR (INTERIOR) KITCHEN SINK _ 1 ( I t i t I I t i i I r—1 € E LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL _WASHING MACHINE CONNECTION ATER HEATER ALL TYPES _WATER PIPING INSURANCE COVERAGE: B have a current liability 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 i BOND f 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. I CHECK ONE ONLY: OWNER R AGENT 1 SIGNATURE OF OWNER OR AGENT R hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the b st of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compli nce ertin provision of the h4assachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME -ilii - Rip2' j LICENSE #-'3la'D IGNATURE mP [r JP EJ! CORPORATION F11 #E=PARTNERSHIP 0# _ LLC D # I: L COMPANY NAME WSJ' ar+P„ �' ADDRESS�1. CIT / S_ ' STATE ZIP al�Z6 FAX �6' —�9/O F CEL R.: _. --' ,�-adv[--.-.� EMAIL .Cl Ir The Commonwealth of Massachusetts Department ofIndustrigl Accidents Office of Investigations kvi 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Nance (Business/Organization/Individual): FaWtola m tlaknL t<14 Address: kAe-\ c�f" City/State/Zip:=e,�-�J,-S ItA,�j &AA 6 t,876 Phone #: X118-1{ a 3 -d « f Are yeu an employer? Check the appropriate box: 1. UI am a employer with D 4. ❑ I am a general contractor and I employees (full and/or part-time).* have Hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have . working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. F] Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' camp. 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:. AA _�.!T_A iuV4 1,qa Policy # or Self -ins. Lic. #: I M n Expiration Date: 1 Job Site Address: (ODZ �Pt k e r _ City/State/Zip: lk�- nc NLS 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 andpenalties of perjury that the information provided above is true and correct. W����JMIO Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire,. express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into .any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or' -permit not related to any business or commercial venture (i.e. a dog license or permit to 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 est 406 or 1-877rMASSAF,E Revised 5-26-05 Fax # 617-727-7749 vw=ass.gov1dia LIC_ ENSED AS,A.MA51tK rLUwlorr%` ISSUES THE Ab SS LICENSE TO = I 304 Date . c� �l`.' ........ . OF NORTH TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION P �a \j This certifies that .......... has permission for mechanical installation in the buildings of ... 47 ..I �: '`�--- at .. t .....ll . � ...... , North Andover, Mass, Fee.' . Lic. No.�6.)n.o.... �!t%/.�---------- GASINSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date � h01-5 113 Estimated Job Cost: 10)S-0-0- Plans 0)S-0-0- Plans Submitted: YES NO Business License # Business Information: Name: 144aio AM, at4A iM G Street: -k3 U=PgAQ� City/Town: _ Me XI v,, Telephone: jj- (o3-7-200-0 Photo I.D. required / Copy of Photo I.D. attached: B'ailding Type: Permit # Permit Fee: $ ,-t Plans Reviewed: YES NO Applicant License # Property Owner / Job Location Information: Name: PWI TAvt M Rj 4A, Street: beq wav f� 14Q City/Town: �i V� CL ll Telephone: YES NO Residential: 1-2 family -)ce Multi -family Condo / Townhouses Commercial: Office %1 _ Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC- Metal Roofmg Kitchen Exhaust System Chimney / Vents Provide brief description of work to be done: �wvcJ c i Sr i n 9 o, oco 11ru :ru"a.ea W emc� iA9 L"D61r � p d 4f1 Got b a-_0 C0 -K &4e,'t iC F&I &4T %tk O COOC � yti.,p�-1�� Ouc.�' f�e�x� �t l J �-e l� ►'1 �®vt,. ��D m 11 0 INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yesg No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[:], I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master -Restricted City/Town ❑Journeyperson Signature of Licensee Permit # ❑Journeyperson-Restricted License Number: Fee $ ❑ Check at www.mass.gov/dpi 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 iQ All sheet metal work being performed with proper joumeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper cld`ances, fire rated enclosures and pressure testing required. Seisu:ric e ,,:aunts instal I6d ,Oi6tr required 'on equipment and Duct penetrations in fire'r6tQtvaD3 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 -ofd Sheet Metal Residential Guidelines / Inspection Checklist Yes leo N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) VAL E R 1 O SERVICE & INSTALATION • Heating • Sheet Metal AIR SYSTEMS •Refrigeration •Furnace REFRIGERATION • HEATING -AIR CONDITIONING • Ventilation • Heat Pump 978.687.2000 il 978.788.3511 • Air Condition • Humidifier 170 Broadway, Methuen MA 01844Elm •Commercial Kitchen • Filters • Exaust INVOICE ❑ - - - QUOTE ❑ - BILL TO TIr EMERGENCY SERVICE 24 HOURS A DAX 7 DAYS A WEEK III No. 1001 NAME _4\ �i.. - nuswomuS.0 -�.❑C.b.D. .L�`�'�.��. - ❑CHARGE. 0 N CHARGE - STREET o �' � DATE�) � I euxe .Moon Mnrte ems" t >I� N. - / A °{✓ I K �7" - r 'PROMISED PHON �^�y J ? q CALL BEFORE. ❑ A.M. sraruHun+ee,+- seawee,ueEn TECHNW� rA _64 " ti -1 � AUTHORIZED BY . WOR6JP BE PERFORMED " QTY. MATERIALS & SERVICES UNIT PRICE AMOUNT DESCRIPTION OF WORK PERFORMED REFRIGERANT R ....a1 LEIS. l - .l .................. �j ... 1 .:....P� ..:..,Y� ..1.:. ....,'. ,. , .:.._.._...._?zI .:.M, Yl f� % 1.... 1 nG i d �•t tr.Yl .:..::. _.....o4,. .....6... .... *n....6.......-..4.. ..._........ �.1� .....� ......... Oh l..:.:.....:...�.:I: ��e» n6n Off' Hou � D nth( 416k:K a in—G n ....... 1 fn r....... f ►�? ....: ... 4�.:.:... l '?�::. It - n- Tt"' 1 �­. -2V »..... _-VPQ_...............�1_% ....... ..»4..... op�v-.R . ............. ....... ........ �.� Ay -) ?� tL pt I ..... ..... .a .... ».. »_.... », �:`.... � ...................... u O :......,...... ... ......I I ...._... FILTERS x2 �01�7 ......I ...... .............. ? ..-.... +.� I�LZ .....: .. ..... Q 1 _.... ..._....................................................... FILTERS_ 0 ..... ...,..... ......... Y — ( F )ill t� I .._..... »...... ......... ... ...... ..... BELTS ) UH q�I 1/ t2LC� TOTAL MATERIALSRECOMMENDATIONS •� 5.k:t� .............................. ................ HRS. LABOR RATE AMOUNT © 3 ...... ............. »a � 141 zp rn ._........ n .............._ fG ... MATERIALS & LABOR MAY BE - - - . v %.... CONTINUEDONOTHER SIDE - TOTAL LABOR - TERMS LIMITED WARRANTY: All materials, parts and equipment are warranted by the TOTAL SUMMARY manufacturers' or suppliers' written warranty only. All labor performed by the above named TOTAL MATERIALS company is warranted for 30 days o. as otherwise indicated in writing. The above named TOTAL company makes no other warranties, express or implied, and its agents or technicians are - not authorized to make any such warranties LABOR i I nave authority to order the work outlined above. I agree mar _ - Y ro equipmenvmaterlatsffumished unW final payment Is rrade: ll payment is W made Serer retai *k TRAVEL CHARGE as agreed, sel efcan remove seWFeQulymentlmatedats at Seller's expense. Any damage resuttMg tram said removal shell not be the resporiiiii ty of seller. f / ( f 3 on behalf of above named company. ❑ REGULAR _AWARRANTY TAX ❑ SERVICE CONTRACT .T�ra no a TOTAL .oro R s"cxnru rz CERTIFICATE OF LIABILITY INSURANCEI'DA"E"m"Y"'4/11/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS SATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORD BY THE EDI' BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORPlED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT- ff the eerbficabe holder is an ADDITIONAL INSURED, the pofic NS) rrarst be endorsed. ft SUBROGATION IS WAIVED, sub}ed to the terms and cwWRIOos of the policy. certain poft" may �I an � A statement on this certificate does not txmier rights to tM certificate hokW in "fim of such ffidmPsenwiUsh ....... PRODUCER. - ` FAX Hq{ONE 877-873-4883 Lockton Affinity., LLC P.O. Box 410679 aDDREss Kansas City, MO 64141-0679 DISURERM AFFORUNG HAIC0 OSA. Certain Underwriter's at Lloyd's, Londo M1128987 eNURED INSURER B: Valerio Air Systems b Plumbing DISURER C:- 170 -170 Broadway INSUH�tp: Methuen, MA 01844 INsum E COVERAGES a.c,c POLICY PEW THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE INDICATED. NOTWITHSTANDING ANY REQUI EEMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EFF POLICY E)XWP La TYPE OF INSURANCE mu ary polm �� 1,000,000 A L;Ft1ERAL LIAaB.HIY SM1000202-01 05/12/2013 05/12/2019 S nAurrA To REMbu 1- 100 000 LwT APPLIES PSi I I I I I i )5 BO�LY O UURY (Par Pamon) S ■ • -, r ❑. I'•"'. •t ■ ■ �, '00 "�.• 'r �. :•.�� ..__ , M,,EN ra •.'1; 1AIMMM COMPEMMM MD EOIPLUOYERS LL48R rY YIN J_ EACH ACCO ANY P N/A EEL D - (Ala UMM irl qNj _. OE "KM OF OPHt M" I LOCATIONS I vgMXES 1ft-h ACORD 101. Add16ar1 Remarks *hO& Q ff more space is required) Proof of Coverage = Proof of Coverage ACORD 25 (201010 5,000 1,000,000 2,000,000 SHOULD ANY OF THE ABOVE DESCMW POLK:IES BE CAWa.L.® I EFORI THE EXPIRATM DATE THE iSOF, NOTICE WILL 13E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR® REPRESENTATIVE The ACORD name and Pogo are nWIstand burks of ACORD 11226362 1149334 AI rights reserved. • VAL,ER 1 OPID. R URANCE L GIM7113- A� CERTlFiCATE TE ,. YM TwN ONLY AND CONEF% pirl s_ UPON T� � gy Tm POUCm Tfi1S t RTIFlCAiE is tai® A NIAT!Bi OF OR ALM Tim toVHtAGE TiV®Y �t NEGATIVELY ANE 1D, �CiE41O THE [SSUIN6 INSUREgSi. AVMRM BELOW. CAS MIMCATE OF OR CE WES. NOT CONSTIME A CONTRACT BEI�YEES ATiVE OR PRODUCEK AND THE (�=� 4iOLOEfi. R tS WAIVED, �Q ff the �G�. h0t� is ata A05 MONAt- ms i 8� Po6cyC�esy mnA no don confer n9tds to the the teems and co ons of the P.W.C.. PA Y S anendots cwacata holderh. Geu of sled+ 617-847-0 xn ox .. A#h km Parkiem (.LC 647-847-0 . _tom t A=r I..-ttrance CO. tusuRED vateno #uu Q7-- .., .._- 170 Bmadway men, C ASIS" iA6FS - TO TWMtOtEDfoRro WHtt t TFC tS TO Catl'tFY THAT THE POt1CiES OF iNSI> UST e!� HAVE t3�t iSStl� T• T: RM OR COtSD1TSON OF AMY 07itFR. Ett�N tS SitS 1ECT TO ALL THE Tl, �pqN� �� OR�tiAAY P'@tTAIN. TKE �E �R� itlf 7HE POLIgES _ _ _� ..,..,*,.,,nr t1F SUCH POttCtt'S lltLl IS SHOWN SAY HAVE tit RWtJCID BY Pato CIAUNS orn _ >� POil�F� I.ttS15 o nc�Aa1aae uaaumr f e�t_ i � s pgttAL8A01r84NftY S owm --J gW �vAHunir YIN ol/llll3= 01114M rt E cttac� s O A NIA { ELE>1-EAi s POM t ELoiSFA�-LOSE S }Aco'W"L s ammtr ceg,ea paFOE�a+ATtotlStuocA-rE�+s/VEfflCLW issued��as Ta9.s ypte is.- her�3T - - Vaferio Air %P tems, Inc. 170 Bm ftw Meuse , "Wit" ACORD M WS" SHOULD ANY OE THE ABOVE poLg �a BE CANOE t tat BEFORE .TtE EM3MA-HON DAM MMMOF NOiIt� WILL BE o� � AtxORDaNCEWRHtHE PO11CYE+�Bl�lSltttRs- AU HORMEO Tire ACORD rtwm and to" are I arks ofiACORD - A ao eights rmem3d• -AGG 5 PRO-: s up�;1�1f:' - gpDiLYtttltlRY�P�1 $ 80D�1YWNRYIPer S ANYA= tlt� zm pRpP6t11rDAErAGE S Zi OWNED $ NMAUM ADIOS" EZHo S O=ot AS TE EXCESSum `. QAtE E _- vuCSTARr OTE! I s gW �vAHunir YIN ol/llll3= 01114M rt E cttac� s O A NIA { ELE>1-EAi s POM t ELoiSFA�-LOSE S }Aco'W"L s ammtr ceg,ea paFOE�a+ATtotlStuocA-rE�+s/VEfflCLW issued��as Ta9.s ypte is.- her�3T - - Vaferio Air %P tems, Inc. 170 Bm ftw Meuse , "Wit" ACORD M WS" SHOULD ANY OE THE ABOVE poLg �a BE CANOE t tat BEFORE .TtE EM3MA-HON DAM MMMOF NOiIt� WILL BE o� � AtxORDaNCEWRHtHE PO11CYE+�Bl�lSltttRs- AU HORMEO Tire ACORD rtwm and to" are I arks ofiACORD - A ao eights rmem3d• 521,5113 T6n # 1001 M%&-P� P/aMC- V, 1picy �T Y un," ctm v-, o ro `1S C ©" r O — C MCLA P— I-A ova a og Lo LL i1 � v A Cgs wrL L"l N M%&-P� c n C T.6 Mc cru Q Set p(A a/--v 4v�&\-C $X� �lc�OXB C�,1 11 i n Se � 1w LJO ._ 1X `10 New England ffmue Energni Audits 4 R i. d I z. Duct Tightness 'fest C::ertificat:e. `'est Date: 081?2120] 3 Address: �6977-j North Anclover, Ma. 01845 Tested With Mhtre.��� t Conditimed Floor Area 1656 So, Ft. Leakage al a`re (1 125 Pascal, Notes: Post Construction Total Leakage Test s 2.5 Pa across entire system to include air srandler ) 8 Supplies 2 Returns Filter installed at unit New unit and ductwork i retro€ii Air Handier Location: Uncond=itioned Basement Duct Location: Conditioned space & Unconditioned basement, attic Patrick -Ai`van Certified HEIRS Pater # 36929(;36 918.79()-084S Prov id. r : BIii] di n g. Effi c iency Rcsourccs P -(.),Tice 't North C ..t c \l 12 8 51 40{) 399 9(1,10 Location � D 9 / Urti P r k, S 7 No. —3 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # (?A& 44- 14 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING �y BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: 10A(C Building Commissioner/lEgpector of Building Date SECTION i- SITE INFORMATION 1.1 Property Address: �po� ^j1liP-.c /rpt�s 1.2 Assessors Map and Parcel Number: 5 000 Map Number Parcel Number Amr /L® , r 1.3 �Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 WaterS M.GLC.40.. 54) Public Private ❑ Zone 1.5. Flood Zone Information: Outside Flood Zone ❑ 1.8 Sew sal System: Municipal !dame°On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record - 7^5�, � �� Name (Print)— ` Signator Address for Service -7 Tel one p -Tu ew 1 KGS C/ 2.2 Owner of Record: Name Print Address for Service: Signature Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor: y Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone �w M a 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 buildipg permit. Signed affidavit Attached Yes ....... No ....... 0 SECTION 5 Description of Proposed Work check ail applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑Alterations(s) Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: S �° y V t 15i L t s71 0 A Uri �1 �`�' � (3 0)L-4 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item I. Building Estimated Cost (Dollar) to bei'I£I�ON,y Completed by permit applicant (a) Building Permit Fee Multiplier 5� 2 Electrical (b) Estimated Total Cost of Construction 3 PlumbingSCS Building Permit fee (a) X (b) 4 Mechanical HVAC q- 5 Fire Protection 6 Total1+2+3+4+5 C7 Check Number. SECTION 7a OWNER AUTHORIZATIO14 TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, pSt— f �( IP 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 rint Nam Siatur of caner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TINIBERS I ST 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS MIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE n +4 607 Turnpike Road - First Floor Diagram Drawing by Jose Torres o El W -A J N ,V v PSJ '-c t- 1:5 Yom• (- AUJ,5bt-.� CbWleft� C�� '4V6 s N G +++ 2fL 6.01n x1ft3.0in :.+ � +i+ +ar 3.0irnxIft3.0In Y S_ N O O °o w v C/)w Cd ® P4 ° o o a: .� U G w x U o w c w a w W o 92 cn cis w p U o a c w W CE cn 0 cn 7� 0 O v 4.4 y y O O CD 0 _cc CL CO) 0 0 w .CL CO2 C Cc O C _cc C. CO2 I. -Mo i O v co CL H C O OM C O CD D � m m oo� 0 C!) U) M LU Erw vJ o O Ell) oc9� :cc c ac eo en � =Eat �moH 8: 0 v O. a:. a � l : oa cm eti � y 8 aim \' y W W C O s1 : o.C., y eD m P cmo o. = 0C m.r m y O CM3 Z O Q �,coo mO =0 c 0 _ ® mr o3 i CL N m to c y ®� eeL m 2- m .m r.+ ®•y cm O v coa o C -Cm F= y O_ (aA O:p i N �� C:)h- = 4- CL,m �lp 7� 0 O v 4.4 y y O O CD 0 _cc CL CO) 0 0 w .CL CO2 C Cc O C _cc C. CO2 I. -Mo i O v co CL H C O OM C O CD D � m m oo� 0 C!) U) M LU Erw vJ