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Miscellaneous - 61 ESSEX STREET 4/30/2018
61 ESSEX STREET 210/103.0-0005-0000.0 Date.......AZ�?.!.;`i:....... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that +`:..................................................................................... has permission to perform... w................................................................................ plumbing in the buildings of.... -:�................. ........................................................... at....... ...... /6r.x......... ............ North Andover, Mass. Fee.`�..D. .....Lic. No. ................................................................. Check# wl � PLUMBING INSPECTOR - - - - - -- 11�� � �V� . ,r � / ��A r - � � � l � �'" n �.'� _ ���. �c /� C ��� MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY .. �� -.._. �` - �-�!1 MA DAT -_. : _ PERMIT# JOBSITE ADDRESS /__... OWNER'S NAME OWNER ADDRESS _.. .� ' S'�._ ..� .:<. : TEL j FAX�. _,._._.._....� u.._ TYPE OR OCCUPANCY TYPE COMMERCIAL[j EDUCATIONAL [] RESIDENTIAL,, ' PRINT CLEARLY NEW:[] RENOVATION:[[ REPLACEMENT: PLANS SUBMITTED: YES[] NO FIXTURES-1 FLOOR--+ BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ..._ _! I .._ _...1 ! __.. _. CROSS CONNECTION DEVICE I ._.._.__.._.. ......_.....:I DEOICATED SPECIAL WASTE SYSTEM ._i _.._....1 ..:. _-! _.--' ._..._._._I .._-_..._1 .._ i ! ! ..--.__ I _....-.-..J .....---1 I ._........... DEDICATED GAS/OIUSAND SYSTEM F----1..._......_! ...-:...-._J DEDICATED GREASE SYSTEM _ .............I DEDICATED GRAY WATER SYSTEM _� w- ......_.+ I ' DEDICATED WATER RECYCLE SYSTEM - - ...! ; .-.........I -_- - ) ._._.__.... ..._. DISHWASHER DRINKING FOUNTAIN 1 ._..._.._I ._....._..I ..__...._` _....... _.i ....-_.._.J _... JF77j I............. .......J 7..._1 ......_-... FOOD DISPOSER _ — -I ; 1 .. I I FLOOR/AREA DRAIN _ INTERCEPTOR INTERIOR _ KITCHEN SINK _ - LAVATORY i ._.-._.__) . ._.-.l - i ...._._.. . .. ...... 1 ; .... -..._I .--..-...J .._-_....1 � ROOF DRAIN 1 ._. _.._I i ..---_.._J ..._ -...J ..___._.I ...........J====== _ SHOWER STALL — 771 ...-___! ..___ _ ....._ J ., , _ ._......! SERVICE t MOP SINK — TOILET - L= -._. ..--I ---._}-._._...._1 I I ..,_.___l _..__._..._I ..._._.....I .._....._I .... JURINAL .-....._.f ..__......-I ._.._..._..! —__ _ _ WASHING MACHINE CONNECTION — -_ __ I ! . _.._! WATER HEATER ALL TYPES -- -- __ _-- _-_--- . _--- - WATER PIPING I OTHER .. ! , - - -- �.� .._._. _ ..... .. --- I I --' .. _ _ - - I -....i . ..__I JE...._.! . ` INSURANCE COVERAGE: I have a current liability insurance policy or Its substantial equivalent which meets the requirements of MGL Ch.142, YES CI NO ( ] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE 13Y CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY D OTHER TYPE OF INDEMNITY Lj- BOND E] OWNER'S INSURANCE WAIVER:I atm aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER �] AGENT [] SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding thls application are true and accurate the best of my knowledge and that all plumbing work and Installations performed under the permit Issued for this application will be In complla a vil al eminent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws,JA .� PLUMBER'S NAME ���.!ILICENSE# '�✓ SIGNATURE MP[] JPS CORPORATION[_ ##[ PARTNERSHIP[ I#[ � .�LLC COMPANY NAME _._. ADDRESS (Q !I CITY �✓►�-�3f/�, TATE ZIP `�-- TEL ' FAX -.i CELLEMAIL The Commomalkh o,fffassa0useMs O,fflee10fiives gaflons 600 Washfgft,Sifeet Boson,.cam 0. 111 '4V'0 xkex,q't ompengation bsurance. 'cbWt:��xi c erc /�o cox / Ie� r� c �ns1'iim7ae Hama(Businessi0xgazuaationlfn(Iz`!dual}: Ut .Axayouarzemployer?CheektlzO,approgriatebox: Typo ofproject(re1 eco),' i.a S am a employer with____ _� 4. d S ata a general contractor and S 6. New c611stxr e-UGA employees( and(ax at time)T have nodthe sub-contracts . �remodeling 2.Q S arca.a sale Pxopxzetar or paxtne>~ Hemcl on the atEached sheet:= OMP an_d`Stavena.employees These suTx-contxactoxsha�'e 8. �Demolition working forme in any'capacity. workers'corm.insurance. g, �(Bur�ding addition PTO workers'comp.insraxance 5• El We axe a coxpoxation and its .10.�(Fdectricalxepairs or additions xequirecl.] officers have exercised their light of exemption tion or MOL 1,. [PJMbingxepa9xs ox additions 3.El I am a homeowarex doing all work g mysels.Ufowgrkexs'comp. c.152,§1(4),andwahaVano 12.PRaofxepafirs znsurax�c�ze ed. i employees.LNoworkexs' 1311©diet comp.insurancaxequixerl.] A applicantilsac cheeksbox ZmusEalsQ Tlauitheseetionbelowshowing-6ieirworkerecomprnsation.polieyluformation. I omeovnersvr$o sabmiftbi5atfidayitindzcating ley "re doing Faworvandthenhireoutsideconfzactorsmus�sn6mi ane�afddapitindicatingsizch. x�oniractars'diatchookthisbox.mustattachedasadditionalsheetSE0WbgthenameofthesuT}-couixactorsandt okworkers'comp.poRoyiafomiagon. Xt� taxiexn foy6pfBairgproVIdlngtf7oYAers-'COMpcefo -4 CHT Belowbyliey lie majob,�ife in,f ox�matio�2 . hSmauce CompanyNar> a- D P ay ore ins. %c.#: Expiration Date: © ,�l lob Site.A.ddress: CitylState%Zip:�/Z ����'� Aftaeh,acopy aMewoxitera,compensation,ToReydeclaxatimpage exPixatz00,state), yailure to securer covexage as recce eduuder Section 25.A.ofmaL c.152 of a Imo xrp to$1,500.00 andlor fine-year ampxisoptaenE,as well as civilpenalties in the faxxa of a STOP�i ORIS ORDER an d a fin e ofupto$250.00aday againstt'havl0lator. EeadvisodthataCopy ofthisstatern.entmaybefoxwardedtothe Oftxceflf• hVesggations of the DSA.for iiasuxattce covexage 7e13tivation. t�oXieebycei lie ai cape 7tieofBerjr!ytrial#riei�2fonaiox��rovicl oYertYueantico� , awe, Date:Si l 'hone#: offfeW arse oily, Do not vflfe in AIN area,to be colvIete by c14 or tom offzcia7 City'or Tom-u: Eexxaztl icezzse 1'smingAuthority OrP-10 oxie : x,)Boar(,of wealth 7.B�ziSdingJ�e artment 3.CitylT. oym Clerk 4.Eleetxical Inspector ��'lnrrabi�rgSus�ector Fi.Outer ~ ~ r ' information and Instructions Massachuseits General Laws chapter l52 regwes aft employers to N-ovide workers,comPensatqon for Eok employees. .Fuxsuaxit to this stafate,an.eviployee is defuaed as"..,evexypexson i1i tie service of another under any contract o�hire; • e�px'SS or h]*1ed,oxal ox written:' .M enTIO' N defined as"an individual,paxinership,association,coxpoxation o�ot7ier.iegaZ entity,or anytwa oxxnoxe. . oftheoxego7ng engaged in anoint enterprise,and includingthe legalxepxesenta,LIVes of deceased emlQye,.or ttXie receiver•oxfraisfee o�ate znclz�lzdual, as exship,association or opt erlegai entRy,employing employees. �owevexfhe 0wxaexofadwelling7xouseiiavingnotxnaxetltaxt eeapartmentsandwhoxcoldestherein,orthaoccupantof'tA,3 dwelling hoose of another who employs,persons to do maintenance,eonsfnzction oxxepair work on suclx dwelling house ox onthegxounds oxbT lding appurfenmttlterete shaffnotbecause ofsuch employmentbe deemedto be,an employer" MGL chaptex 152,§25C(6)also states that"every state or 101W Heensing agency shall wifhlzold the issuance or renewal of a RcenSO ar pemit to operate a busnzess or to construct h jRftgs ire the commonwealth for aaay applicant who leas not produced•acceptable evidence of compliance wzth the insurance coverage required;' Additionally;MGL chatex 152,§25C(7)stateWeifherthe eommonwealthnor any Of its political subdzviszons sha1Z enter fato any'confract fox fl a performeace ofpublic wOxklmtR acceptable evidenoe of compliance with the insAxartce xecluixeznenfs of this chapfexhave b eextpxesented to the oQntracfuag aufhoxity." AppReanrs l'leaso X11 out the workers'comp ensailon affidavit completely,by ChCCkfug the boxes that apply to your situation and,zi iiecessaty,supply sub-confractor(s)nMe(s),addxess(es)an:dphonenumbex(s)alongwith.their ceMcate(s)of insuranco. Limitedvabay Companies(LLC)orLimitedLiabilityFaxtnexships(LLI')withuo employees otlierthan the members oxpaxtaexs,axenotxeggixeclta caxrywoxl�ers'campensationiasurance. L an 1 0 doeshave eznployees,apolicyisxeq*ed. Beabbedthat,"afdavitmaybesubmittedfotheJ]eparfixtentof Industrial ' Accidents fox conhrmmtion ofinsurance,coverage. Also be sure to Riga and elate the aMdavi: The of tdavit should bexetumedtothe*or town thattheappReationfoxtheperndtorRceuseisbexngnquesfed,xtotthe De aximentof Iixdusfr3alAccidenfs. Shouldyouhave any questionsxegardivgrlle law or yora arexequir ed to obfaiu apToxlsexs' eompensationpolicy,laleasecalltheTaepar€vzentattli�mzmbEr,lisiedbelow: Selfzustrxedcompaniesshouldenteztheir • self insurance license numb ex on the appxopxiate line. ' city or Town Officials I'Zeasebesuxe;haffS�eazfidavitiscompleteandpxinfedlegibly: T$eDeparbuenthasProvided aspaceatthebofOm offheai davittoxyotto M outiizthe,event the Office oflnvestigaoonsJas toconfactyouxegarcllingtheaplilxcan I'leasebesvxefaz"dlixtbepezmzf/licensenumb exwhzchwillbeust. edasareference number, juaddition,anappllcanf tliatmust submitmultiple.permif/license applications IR any given year•,need only submit one affidavit indicating cun'ent PO inz"oxmation(irnecessary)andunder"Yba Sita Address"the applicantshouldwxife"alllocafionsiit (city oz town):'A cgpyoifTieaffdavitthathasbeonofficiallysfainpedoxmarkedbythecityortownmaybepxovidedtothe applicant asprflo(thatavalidafz"tdavit•isonffleox;Utaxepexmiixarlicenses. Anew azfidavitmustbefrlledonzeach year:l�lhexeahomeownexorciti�exaisobtainingalicenseoxpennotrelatedfoanyb,a nessoxcommercialventure (i.e.a dog license orperznitto burn leaves eta)saidpexson.iia N'OTxequixedto cuWplete t - affidavit. The Office ofInvestigations would life to thank you in,advance for your cooperation and should you have any cffIG 'tons, please do nota huetate to give m a call. The Department's address,telephone aiad fax nu7n.bex: Tho CmAmn—c-'axthofM—W- Sodwa- Th(Tubu It R.f]hCTu zaX cc t e t Roaton-,M. 02111 Revised 5 2605 Fax ���a� ij n a ! Sl vt Es Ic In OF9A w � +_ V w s � � � c w s♦ ?r yrs. > > a „< . LJCENEs.dfi�J.t*iGE ,Ei�r'#s�t�►�'�1�iN D TE 'EMAL NUMBER i 4 `.n p - . Date.....,��...h// .�................... OF�10RTIy,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION �8 CMU a This certifies that . L1.. .........` '` .......................................................... has permission for gas in-stall tion .......-2 r." !�................................ in the buildings of...... . . .... .�.. ............... ...................... ...... ........... at ...S i'"................. ...... ...................... ........ North An.....ver..,..Mass. .. .. Fee:i, . V Lic. No,�.',�... G..... .. ..r:: ............................................... G rPECTOR Check# . t , -` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK j CITY 6 w 1! /() C� MA DATE F-g-o'er 'PERMIT# JOBSITE ADDRESS L SSe/r�z� �IOWN ER'SNAM E GOWNER ADDRESS 11 TEL — FAXG TYPE OR OCCUPANCY TYPE COMMERCIAL[J] EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW:[l RENOVATION:El REPLACEMENT: PLANS SUBMITTED: YES NO APPLIANCES Z FLOORS- BSM' 1 2 3 4 5 6 7 8 9 10 11 12 13 1 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER + --- DRYER - FIREPLACE FRYOLATOR FURNACE GENERATOR (. GRILLE INFRARED HEATER _- LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER OOM/SPACE HEATER OOF TOP UNIT _ T_ ! TEST UNIT HEATER UNVENTED ROOM HEATER I WATER HEATER OTHER —-- - —----- I — --� — — - -1 -— INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ��NO El IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 OTHER TYPE INDEMNITY ® 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. CHECK ONE ONLY: OWNER E- AGENT —_Il 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 complia ce with all e ' ent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 063 PLUMBER-GASFITTER NAME _ St LICENSE# I 9 C f SIGNA RE MP 0 MGF 0 JP ® JGF LPGI E1 CORPORATION __}#=PARTNERSHIP®# ____=( LLC®#= COMPANY NAME: ��I t � pADDRESS CITY 'a1 D?/lF° _ STATE L UZIP TEL - (> FAX j�CELL[ EMAIL ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No fl THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES _ The Commonwealth ofMassachusetts - Department of Industrial Accielents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.govIdla Workers'Compensation bsurance Affidavit:Suifders/Contractors/Electricxans/Pliimbers ,A heant bformation Please Print Legibly Name(Businessiorganizationftdividual): ' ` „'` ` M(KA8411C4 4 Address: 02 (: 9M k City/Sfatemp: k)• Ado V am- Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.C'T am a employer with 4. ❑I am a general contractor and I 6. ❑New c6nstruction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner listed on the attached sheet. 7. Remodeling ship aud'have no.employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance, g, []Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised.their 3.❑ X am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§I(4),and we have no UP Roofxepairs insurancerequired.]T employees.[No workers' 1311 Other comp.insurance required.] xAny applicant that checks box#1 must also fill outthe section bel6w showing their workers'compensationpokey information. Tuomeowners who submit this affidavit indicatingthey 2te dying all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that cheekthis box must attached an additional sheet showingthe name of the sub-contractors and their workers'comp.policy infomlation. X am an employer that isproviding workers'compensation insurance for my employees Below is thepolley and job site Nfarmation. Insurance Company Name; o o yt o < IU S cl2 f A-1 C e Policy#or Self ins.Lie..#: Expiration Date: Job Site Address;L-6Z -K S -Pity/State,/Zip: e,c�&`�J 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 ofMGL o.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 STOR WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA-for insurance coverage verification. X do Hereby cer fy u der tl pain d Ities of jury that the information pYovided above is true a d eoYrect. - Simature: Date: S Phone 0: official use oply. .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 of hire,• express orimplied,oral or written:' An employer'xs 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 Iegal representatives of a•deceased employer,or the receiver or irtisfee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than tbree 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 ' cceptable evidence of compliance with theinsurance 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)andphone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation.insurance. If an LLC or LLP does have employees,a policy is required. Be advised That fbis affidavit may be submitted to the Department of Industrial Accidents for continuation 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 Mod 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 andprinted 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 whichwill be used as a reference number. In addition,an applicant that must submitmultiple 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 shouldwrite"alllocations in (city or town):'A copy of the affidavit that has been ofCcially stamped or marked by the city or town may b e provided to the applicant as proof that a valid afizdavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture (i.e.a dog license orpermit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance fox your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and faxnumber: `the Con oz�W0a1 fM_Q saChvWelte - Depa invent OffAdusWal Accidents oface OffAvestzgaam's 6.9G Wasbiugtm creel: BWon,MA 021 If 617-7.27 4900,at 406 ox 1-8,77-MASSAFE _ Revised 5-26-05 FaX 0 617-727-7749 WWW—Mus,ggvIdia. 4 .•-- � BUILDING PERMIT .,• ,� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: '� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION: 61 Essex Street PROPERTY OWNER:Steven N. &Anna L. Gesing MAP NO: 103 PARCEL: 5 ZONING DISTRICT: R 1 Historic District yen Machine ShopVillage e n TYPE OF IMPROVEMENT PROPOSED USE Q New Building ❑One family ❑Addition ❑Two or more family ❑ Industrial Alteration No.of units: Commercial 0 Others: ❑ Repair, replacement 0 Assessory Bldg. SHED ❑ Others ❑Demolition F1 Other Q Septic 0 Well ❑Floodplain Rl Wetlands Q Watershed District ❑Water/Sewer Attachments&: Professional Service Providers: Watershed Special Permit: Waiver-Attached Notice of Decision:Dated August 11, 2014,granting a Waiver of the Watershed Protection District Special Permit to allow the location and construction of our 24'x 14'shed on our referenced lot. Shed Plot Plan and Wetland Survey-Attached Plot Plan Engineer: Bill McLeod/Peter D.Goodwin—Andover Consultants;One East River Drive, Methuen MA 01844 Copy of Bill for Purchase of Shed from Reeds Ferry Small Buildings Inc.and Summarized Estimate of Other Install Costs Time and Materials costs for Cement Pad will be provided once billing is received.Anticipate total Install T&M=$2800 Electrician:Chuck Fay;Fay Construction, Lawrence MA; License#29617 Ph: (978)828-7835 Plumber. William DeSantis License#10768 Cement Pad Install: Kevin Fitzgibbons; Kevco Enterprises;North Andover, MA;Ph:(978)265-4782 Reeds Ferry Shed-Contractor:MA Contractor Registration#and Construction Supervisor License-Attached Reeds Ferry Shed-Contractor:Certificate otbability Insurance-Attached (Identification-Please Type or Print Clearly) OWNER: Name: Steven N. & Anna L.Gesine Phone: HM - (978) 655-5660/CELL—(617) 633-1968 Address: 61 Essex Street, North Andover, MA 01810 CONTRACTOR Name: Reeds Ferry Small Buildings Inc. Phone: (603) 883-1362 Address: 3 Tracy Lane Hudson, NH 03051 Supervisor's Construction License: Michael Carleton-CS-095889 Exp. Date: 05/12/2016 Home Improvement License: Reg.#- 119903 Exp. Date:09/17/2015 ARCHITECT/ENGINEER: Peter D. Goodwin:Andover Consultants Inc. Phone:978-687-3828 Address: One East River Drive, Methuen MA 01844 Reg. No.48133 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:$19,295.35 FEE: $ 23z .L Check No.: Receipt No.:= NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner W'� Signature of Contractor T Plans Submitted Q Plans Waived Q Certified Plot Plan Q Stamped Plans Q TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well Q Tobacco Sales ❑ Food Packaging/Sales Private (septic tank, etc.) Q Permanent Dumpster on Site ❑ ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED CANNING&DEVELOPMENT W ❑ _�� COMMENTS a"'/-d DATE REJECTED DA APPROVED CONSERVATION ❑ �� COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ � \ COMMENTS G `�'� G _ (� �U�LL k r- 15 �Iyl t Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT-Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS PER ZONING N50'20'10"E ;S AL A- p2K 55' _z JgLL S � AL / \ PROPOSED 14'X24' SHED D.H. A26E LOT 4A (FND.) I X21 25E 323,643 S.F. �v � L J oleall � R a Qwo / O M cr m N / Z rn a8. N 6g, 51„W 138.27' ' 53 4/ �• D.H.(FND.) S53 35'02pIN s. 136.48, 1 D.H.(FND.) S54]-2K8Z57"W — 104.00' — 91.45' S49 28'07"W --' - D.H.(FND.) S52'15'39"yy N/F D.H.(FND.) (CENT J. & ANNETTE M. VISCONTI JOHN C. & ELEALEANOR SIMPSON � NORTH TOWN OF NORTH ANDOVER of, .. ,^,4O a ` PERMIT FOR MECHANICAL INSTALLATION h F 9 ., 0.k .k ,SSACHU5Et This certifies that ,2. LCl . . . :1 �, .-7. . .� . �-! -J . . • has permission for mechanical installation ` .CiA; f.1L 3. in the buildings of .:31 C'!% . . fir: S :: . . . . . . . . . . . • • • • at . . . • . • • ., North Andover, Mass. Fee.,,),YQ." Lic. No..`.�4)(.. . . . . . . . . . . .� GAS INSPECTOR lQ WHITE:`Applicant CANARY: Building Dept. PINK:Treasurer o Commonwealth of Massachusetts Sheet Metal Permit Date : / Permit# Estimated Job Cost: 4n Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# I Applicant License# !�kUy Business Information: Property Owner/Job Location Information: Name: Re 1 D me C CO e r Name: 9-e oe Street: C�o� ISS (24 Street: (of E SSc X City/Town: City/Town: AW Telephone: 1 —(D a I ID O�'� Telephone: C (� ") �� C) Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family V Multi-family Condo/Townhouses Commercial: Office 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 Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: (1. - o rZ,Al It ,.J o r 1 , u a A INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy P 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. G / 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 T Final Inspection Date Comments Type of License: By [Master Title ❑ Master-Restricted CitylTown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted � D License Number: Fee$ ❑ Check at www.mass.gov/dpi Inspector Signature of Permit Approval q Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire/smoke dampers with access doors properly installed- actuator checked for proper operation(May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke/atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed(where required)and operation verified(May also be verified by fire department during fire alarm testing) Grease/kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper clea`ances,fire rated enclosures and pressure testing required. Seip?;?ii es,;:ainta installf cl Wli .i `r quired'orr egtiipment and d?i,tv.3i. Duct penetrations in fire'ratQ-vral1.3 and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct rums 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-oft) c Sheet Metal Residential Guidelines/Inspection Checklist Yes No 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 V All sheet metal work being performed with proper joumeyperson-to- / apprentice ratios V Equipment sized per heating/cooling load calculations V 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" V Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers M Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining VNew/clean -properly sized filter installed (final inspection) Testing and Balancing report complete(final sign-off) COMMONWEALTH OF MASSACHUSETTS SHEET METALWORKERS ASA MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO:. .,,�JO'* C REID 1500 SALEM ST NORTH ANDOVER MA 01845-491 . 15806 11/28/14 28008. EXPIRATION DATE SERIAL I LICENSE • Fold,Then Detach Along All Perforations Fold,Then Detach Along All Perforations OMMONwrik" A OF-W.'SSAdHUS SHEET METAL°`W0RKERS ISSUES .THE FOLLOW11. f.ICENSt AS A `8USI N S5;,... JQHK: C REI D r I31i I D MECH- h. ItA:L COMP 27 CHAR:LE$ ST 5'_ NI RTH ANDOYER MA8184,5 51 �.. 6/29/16 ':. 183319 REIDMEC-01 KRISTINL Ai._.LJ ■..! r ATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/15/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Connie Parent NAME: Elliot Whittier Insurance Services,LLC PHONE 75 Sylvan Street Suite 8202 /CD EXc:(978)977-4884 No);(978)977-0850 AIL Danvers,MA 01923 ADDRESS:cparent@elliotwhittier.com INSURER(S)AFFORDING COVERAGE NAIC# _. INSURER A:Excelsior Insurance Co 11045 INSURED INSURER B:Peerless Insurance CO 24198 Reid Mechanical INSURER C: 27 Charles St#3 INSURER D North Andover,MA 01845-1664 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF._ -POLICY EXP LTR• TYPE OF INSURANCE INSO POLICY NUMBER MMIDDIYYri MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000 000 CLAIMS-MADE occuR CBP8457320 05/23/2014 05/23/2015 -DAMAGETGRENTEb - ,- --- X_. j P.......... .-- MED EXP(Any one person) i$ 5,000 PERSONAL&ADV INJURY $ 1,000,000 FGE 'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC - — ---- PRODUCTS-COMP/OPAGG $ 2,000,000 ..... OTHER: $ AUTOMOBILE LIABILITY ; i I COMBINED SINGLE LIMIT $ 1,000,000 _._.. G(Ea accident) A JANY AUTO BA8443664 05/23/2014 05/23/2015 j BODILY INJURY(Per person) $ ALL SCHEDULED AUTOPROPERTY INJURY(Per accident) $ OWNED AUTOS I X I ' � I XNON-OWNED HIREDAUTOS X AUTOS $ i iPer acadentZ_ ______ UMBRELLA L t..._. 1 B X EXCESS LgBIAB X CLAIMS-MADEI EACH OCCURRENCE $ 2,000,000 OCCUR CU8456428 05/23/2014 05/23/2015 AGGREGATE $ 2,000,0_0.0 . !, DED X I RETENTION$ 10,000 $ •WORKERS COMPENSATION I X PER OTH AND EMPLOYERS'LIABILITY STATUTE LIN B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N j WC8458524 05/23/2014 05/23/2015 I E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? �i N I A .. .....- (Mandatory in NH) I I E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under ---- ----- --- -- - -- DESCRIPTION of OPERATIONS below ! E.L.DISEASE-POLICY LIMIT $ 500,000 i I I j I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) HVAC Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Town of North Andover i 1600 Osgood Street •; North Andover MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD t Load Short Form Job: Date: Aug 27,2014 Entire House By: Christopher Bergeron S.G. Torrice Co. 80 Industrial Way,Wilmington,MA 01887 Phone:(800)888-8359 Fax:(978)657-4255 Email:cbergeron@sgtorrice.com • Information For: Reid Mechanical 61 Essex Street, North Andover, MA Design Information Htg Clg Infiltration Outside db(°F) -1 88 Method Simplified Inside db(°F) 72 75 Construction quality Average Design TD(°F' 73 13 Fireplaces 1 (Average) Daily range - M Inside humidity(%) 50 50 Moisture difference (gr/Ib) 55 31 HEATING EQUIPMENT COOLING EQUIPMENT Make American Standard Make American Standard Trade GOLD ZM Trade ALLEGIANCE 13 Model AUH2D120A9V5VB* Cond 4A7A3060D1 AHRI ref 5722443 Coil 4TXCD064BC3 AHRI ref 3781760 Efficiency 96.7 AFUE Efficiency 11.0 EER, 13 SEER Heating input 120000 Btuh Sensible cooling 40600 Btuh Heating output 116000 Btuh Latent cooling 17400 Btuh Temperature rise 50 *F Total cooling 58000 Btuh Actual air flow 2121 cfm Actual air flow 1933 cfm Air flow factor 0.026 cfm/Btuh Air flow factor 0.047 cfm/Btuh Static pressure 0.10 in H2O Static pressure 0.10 in H2O Space thermostat Load sensible heat ratio 0.88 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ftz) (Btuh) (Btuh) (cfm) (cfm) OFFICE 218 4048 1510 106 70 DEN 261 3307 1426 87 67 UTILITY 100 1783 344 47 16 FUTURE PLAYROOM 516 4767 1890 125 88 STORAGE 822 9340 688 245 32 BASEMENT/HALL 374 2348 80 61 4 MASTER BEDROOM 223 6921 4386 181 205 BEDROOM 2 184 5578 2066 146 96 C L.2 25 453 119 12 6 LIN. 10 45 24 1 1 C L.1 A 22 643 147 17 7 CL.1 B 22 100 53 3 2 M.BATH 85 1725 1142 45 53 FAMILY 229 4711 5152 123 240 LIVING 388 7952 7448 208 347 DINING 217 5898 4126 154 192 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2014-Sep-12 12:17:02 wrightSaft` Rig ht-Su ite®Universal 2015 15.0.02 RSU17410 Page 1 A ...andard\Reid Mech-61 Essex St,North Andovecrup Calc=MJ8 Front Door faces: N CL.3 10 385 83 10 4 C L.4 9 40 21 1 1 BEDROOM 3 194 5032 2027 132 95 BATHROOM 80 2146 1399 56 65 C L.5 14 62 33 2 2 C L.6 14 402 92 11 4 FOYER 84 3087 1658 81 77 HALLWAY 162 732 388 19 18 LAUNDRY 23 985 208 26 10 C L.7 17 75 40 2 2 MUD 41 3494 868 91 40 C L.8 13 435 72 11 3 KITCHEN 227 4504 3947 118 184 Entire House d 4580 80997 41440 2121 1933 Other equip loads 0 0 Equip. @ 1.00 RSM 41440 Latent cooling 5823 TOTALS i 4580 I 80997 1 47263 I 2121 I 1933 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2014-Sep-12 12:17:02 wrightSOft Right-Suite®universal 2015 15.0.02 RSU17410 Page t ...an dard\Reid Mech-61 Essex St,North Andover.rup Calc=MJ8 Front Door faces: N 1 Component Constructions Job: Date: Aug 27,2014 Entire House By: Christopher Bergeron S.G. Torrice Co. 80 Industrial Way,Wilmington,MA 01887 Phone:(800)888-8359 Fax:(978)657-4255 Email:cbergeron@sgtordce.com Project • • For: Reid Mechanical 61 Essex Street, North Andover, MA Location: Indoor: Heating Cooling Lawrence Muni, MA, US Indoor temperature (TF) 72 75 Elevation: 151 ft Design TD (°F) 73 13 Latitude: 430N Relative humidity(%) 50 50 Outdoor: Heating Cooling Moisture difference(gr/Ib) 54.6 31.2 Dry bulb(°F) -1 88 Infiltration: Dailyrange(°F) - 18 ( M ) Method Simplified Wetbulb(T) - 73 Construction quality Average Wind speed (mph) 15.0 7.5 Fireplaces 1 (Average) Construction descriptions Or Area Ll-value Insul R Htg HTM Loss Clg HTM Gain ft' BtuhIW-°F ft'-°F/Btuh Btuh/ft' Btuh Btuh/ft' Btuh Walls 126-0sw:Frm wall,vnl ext,3/8"wood shth,r-11 cav ins,1/2"gypsum n 78 0.097 11.0 7.04 552 2.21 173 board int fnsh,2"x4"wood frm,16"o.c.stud a 519 0.097 11.0 7.04 3652 2.21 1144 s 311 0.097 11.0 7.04 2190 2.21 686 w 420 0.097 11.0 7.04 2961 2.21 928 all 1328 0.097 11.0 7.04 9354 2.21 2931 15A13-Oocw-6:Bg wall,light dry soil,empty core,2"x4"wood int frm, n 324 0.055 0 4.82 1562 0.28 92 concrete block wall,r-13 cav ins,10"thk,1/2"gypsum board int fnsh a 660 0.055 0 4.77 3151 0.27 177 s 314 0.055 0 4.75 1493 0.26 82 w 270 0.055 0 4.82 1301 0.28 77 all 1569 0.055 0 4.79 7508 0.27 427 13DB-Oocws:Blk wall,vnl ext,2"x4"wood int firm,10"thk,r-17 cav w 352 0.079 0 5.74 2017 0.84 296 ins,3/8"wood shth,1/2"gypsum board int fnsh Partitions 12C-Osw:Firm wall,stucco ext,r-13 cav ins,2"x4"wood frm,16"o.c. 214 0.091 13.0 6.61 1414 0.93 200 ` stud Windows 4A4-2ov:2 glazing,cir outr,air gas,insulated vinyl frm mat,clr low-e In 12 0.470 0 34.1 398 11.5 134 innr,1/4"gap,1/8"thk; 50% blinds 45°,light;6.67 ft head ht a 116 0.470 0 34.1 3973 37.1 4319 S 13 0.470 0 34.1 444 19.9 259 w 95 0.470 0 34.1 3227 37.1 3508 w 160 0.470 0 34.1 5460 37.1 5934 all 396 0.470 0 34.1 13502 35.8 14153 4A4-2ov:2 glazing,clr outr,air gas,insulated vinyl frm mat,clr low-e a 15 0.470 0 34.1 500 48.2 707 innr,1/4"gap,1/8"thk;6.67 ft head ht s 10 0.470 0 34.1 334 25.9 253 w 33 0.470 0 34.1 1137 48.2 1607 all 58 0.470 0 34.1 1971 44.4 2567 Doors 11 JO:Door,mill fbrgl type a 40 0.600 6.3 43.6 1742 15.1 604 w 20 0.600 6.3 43.6 871 15.1 302 n 20 0.600 6.3 43.6 871 15.1 302 all 80 0.600 6.3 43.6 3485 15.1 1207 2014-Sep-12 12:17:02 WTiightSC ' Right-Suite®Universal 2015 15.0.02 RSU17410 Page 1 ...andard\Reid Mech-61 Essex St,North Andover.rup Calc=MJ8 Front Door faces: N Ceilings 166-19ad:Attic ceiling,asphalt shingles roof mat,r-19 ceil ins,1/2" 2290 0.049 19.0 3.56 8146 2.38 5459 gypsum board int fnsh Floors 21A-28t:Bg floor,light dry soil,6.5'depth,carp 80%fir fnsh 2290 0.022 0 1.60 3658 0 0 2014-Sep-12 12:17:02 wrightSOft' Right-Suite®Universal 2015 15.0.02 RSU17410 Page 2 ACCh andard\Reid Mech-61 Essex St,North Andover.rup Calc=MJ8 Front Door faces: N Pro ect Summa Job: J � Date: Aug 27,2074 Entire House By: Christopher Bergeron S.G. Torrice Co. 80 Industrial Way,Wilmington,MA 01887 Phone:(800)888-8359 Fax:(978)657-4255 Email:cbergeron@sgtorrice.com Project • • For: Reid Mechanical 61 Essex Street, North Andover, MA Notes: 1) Distributor is not responsible for the accuracy of the load calculation if inaccurate/incomplete construction information is provided by the dealer. 2) It is the sole responsibility of the dealer to ensure that the duct system is adequately sized for the airflow capacity of the specified equipment. Design Information Weather: Lawrence Muni, MA, US Winter Design Conditions Summer Design Conditions Outside db -1 °F Outside db 88 °F Inside db 72 °F Inside db 75 °F Design TD 73 °F Design TD 13 °F Daily range M Relative humidity 50 % Moisture difference 31 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 63574 Btuh Structure 36108 Btuh Ducts 17423 Btuh Ducts 5332 Btuh Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 80997 Btuh Use manufacturer's data y Rate/swing multiplier 1.00 Infiltration Equipment sensible load 41440 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 1 (Average) Structure 2156 Btuh Ducts 3667 Btuh Heating Cooling Central vent(0 cfm) 0 Btuh Area(ft2) 4580 4580 Equipment latent load 5823 Btuh Volume(fF) 29491 29491 Air changes/hour 0.32 0.15 Equipment total load 47263 Btuh Equiv.AVF(cfm) 158 74 Req.total capacity at 0.70 SHR 4.9 ton Heating Equipment Summary Cooling Equipment Summary Make American Standard Make American Standard Trade GOLD ZM Trade ALLEGIANCE 13 Model AUH2D120A9V5VB* Cond 4A7A3060D1 AHRI ref 5722443 Coil 4TXCD064BC3 AHRI ref 3781760 Efficiency 96.7 AFUE Efficiency 11.0 EER, 13 SEER Heating input 120000 Btuh Sensible cooling 40600 Btuh Heating output 116000 Btuh Latent cooling 17400 Btuh Temperature rise 50 °F Total cooling 58000 Btuh Actual air flow 2121 cfm Actual air flow 1933 cfm Air flow factor 0.026 cfm/Btuh Air flow factor 0.047 cfm/Btuh Static pressure 0.10 in H2O Static pressure 0.10 in H2O Space thermostat Load sensible heat ratio 0.88 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. � htsOft' 2014-Sep-1212:17:03 , Right-Suite®Universal 2015 15.0.02 RSU17410 Page 1 andard\Reid Mech-61 Essex St,North Andover.rup Calc=MJ8 Front Door faces: N N First Floor 'CL.3 M.BATH MASTER BEDROOM FAMILY LIVING DINING CL.4 GARAGE CL.7 A B N. HALLWAY %.8 CL.2 FOYER KITCHEN I— .6 M DRY BEDROOM 2 BEDROOM 3 BATHROOM Job#: S.G. Torrice Co. Scale: 1 : 165 Performed by Christopher Bergeron for: Page 1 Reid Mechanical 80 Industrial Way Right-Suite®Universal 2015 61 Essex Street Wilmington,MA 01887 15.0.02 RSU17410 North Andover,MA Phone:(800)888-8359 Fax:(978)657-4255 2014-Sep-12 12:17:18 cbergeron@sgtorrice.com ...h-61 Essex St,North Andover.rup N Basement OFFICE DEN STORAGE BASEMENT/HALL FUTURE PLAYROOM UTILITY Job#: S.G. Torrice Co. Scale: 1 : 165 Performed by Christopher Bergeron for: Page 2 Reid Mechanical 80 Industrial Way RightSuite®Universal 2015 61 Essex Street Wilmington,MA 01887 15.0.02 RSU17410 North Andover,MA Phone:(800)888-8359 Fax:(978)657-4255 2014-Sep-12 12:17:18 cbergeron@sgtorrice.com ...h-61 Essex St,North Andover.rup Date...../../ —...z.....b ............... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION HU i This certifies that .... ,.`.�11..... lJ .' .1.................................... .................... ,!-as permission for gas installation ... a in the buildings of..... '.. '.` ........................................................................ al....�1... - `�.p.x...... y¢-". '.................. North Andover, Mass. Fee.' {A`.--...... Lic. No. ..1.0 tog...... M ........................................................... (� GAS INSPECTOR Check# I\Zb �7����'�� -` �MAMINCHIUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ��! � U�L.._��( MA DATE ' t PERMIT# JOBSITE ADDRESS _ _X OWNER'S NAME GOWNER ADDRESS „ / n •rx TELFAX � j® TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT ( RESIDENTIAL CLEARLY NEW:RENOVATION:El REPLACEMENT:El PLANS SUBMITTED: YES NO ' APPLIANCES 7 FLOORS-- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER - -_ .. __.. I I I 1::j BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER -J . —s_ �— _ _. - . .. �- LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER _ ROOF TOP UNIT TEST UNIT HEATER I �— UN ELATED ROOM HEATERS I WATER HEATER 1 N O HER INSURANCE COVERAGE I 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 COVERAG CHECKING THE APPROPRIATE BOX BELOW �IQ3 LIABILITY INSURANCE POLICY OTHER T YPE INDEMNITY BOND �] S OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the d Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER © AGENT [.I,J �1 SIGNATURE OF OWNER OR AGENT N hereby certify that all of the details and information I have submitted or entered regarding this application are true and accur to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with a Pe ' e t provision c/the N Massachusetts State Plumbing Code and Chapter 14 of the eneral Laws. �{ PLUM BER-GASFITTER NAME L LICENSE#/D7 SIGNATURE MP 0 MGF 01 JP El JGF LPGIE1 CORPORATION Q#=PARTNERSHIP®# LLC E]# COMPANY NAME:T�.1 = ,� ��ADDRESS �, D CITY ' _ -J STATE[alzlp Gam?6 7]TELG FAX - CELLEMAIL - _- ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL/INSPECTION T TES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES 'A V c The Commonwealth of Massachusetts " Department oflndustrialAccidents 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/Orgmization/lndividual):? �_ V Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Typo of project(required): L❑ gam a employer with 4. ❑ I am a general contractor and I 6. ❑New construction loyees(full and/or part-time).` have hiredthe sub-contractors2. I a sole proprietor or partner- listed on the attached sheet.t ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance, g• ❑Building addition [No workers'comp.insurance 5. ElWe 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 I L❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§ (4 1 ,and we have no ) 12.Q Roofrepairs insurance .re uiredemployees.[No workers' required.] 13.❑Other /� S comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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 1s providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name% Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MCL 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. IdoherebvcertiryuntlerilzeAiinspdpenaId ofperjury that the information provided above is true and correct, Signature: Date: Phone#: S 3 _ �-3P 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.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - C'nntarf Persnn: Phone#: f a 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 ofits 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 beenpresented 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 LL C or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents fox confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill.in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations iu (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. Anew 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 Coo om.aaltf ofM-ossa h-V -tts Department oflndust&d.Accidents • (1f�ee Q£Inyesti�at�iou� • 600 WasMVon.Sheet BostonMA02111 Teel,#617-727-4900 oxt 406 or 1-87MASSAFB Revised 5-26-05 Bax#617-727-7749 f z� ISSUES THE ABOVE.LICENSE Tp: -� • 57 N E L.&O f-4 S 1 -1 0,768 (!5/i).1,11 rF ?..7;; t r t ,t,,,.,, q��.1. -l..Vh GENERATOR APPLICATION DATE: �� ' I �� 910/ 3 LOCATION: 61 F —54r?,e� OWNERS NAME: GENERATOR kw NO INSTALLATION OR GROUND DISTURBANCE BEFORE APPROVALS* CONTRACTOR: .,� PHONE NUMBER: ELECTRICAL GAS RESIDENTIAL COMMERCIAL TEMPORARY LOCATION OF GENERATOR: *ZONING DISTRICT:Tz � *PLANNING APPROVAL QF IN WATERSHED) i *CONSERVATION APPROVAL � i3 - v�/� 3 4 ti North Andover MIMAP November 14, 2013 5 R2 Boxford Water-Erot iddn � l eadowview Road: A\R - a %I vsse c - 'llow ,0 - I Rail Line ';a Wetlands Zoning Interstates Exempt Lands Busine s 1 Di rict Interstate :.:Busine s 2 Distnct Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, —Major Roads O Busine s 3 Dishlct Meters Data Sources:The data for this map was produced by Merrimack ®Busine s 4 District NORTH Valley Planning Commission(MVPC)using data provided by the Town of Roads Y Gene" Business District Or t° �, North Andover.Additional data provided by the Executive Office of O Planne Commercial Dev "' res O Environmental Affairs/MassGIS.The information depicted on this ma is C,Easements ? �� O P y Cortido Development Disl 3 _ L for planning purposes only.It may not be adequate for legal boundary Q MVPC Boundary f 1 Cortido Development Dist O A definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER C3 Municipal Boundary IO Cortido Development Dist 1' A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Zoning Overlay Industn I 1 District Y - ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY ` Indusia 12 Distract 0 Adult Entertainment • i ^ * OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT ❑Ind sin 3 Distract °o • ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF 0 Downtown Overlay District O Indusln S District ��' ^" ' '' Historic District Reside ce 1 Districty.(y THIS INFORMATION ®Water Protection Reside ce 2 Disrict SSACMUs�t ❑Parcels � Raside ce 3 DisMct Hydrographic Features dece 4 Dianct Streams 1"=515 ft de ca:Distract ede ce 6 Disrict ,��age esidential District r North Andover MIMAP November 14, 2013 'Al'. ,. x Boxford 4 AIN t O"> M;:p_A k N" IN O T a tii .IN"L. r 1lC+f a Interstates Interstate —Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Roads Meters Data Sources:The data for this map was produced by Merrimack NORTH Valley Planning Commission(MVPC)using data provided by the Town of r EasementsCf 4t`i North Andover.Additional data provided by the Executive Office of C3 MVPC Boundary ,r rt r�'� Environmental Affairs/MassGIS.The information depicted on this map is Parcels 3' G for planning purposes only.It may not be adequate for legal boundary O9 definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING t i THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY t s ^ • OF THESE DATA,THE TOWN OF NORTH ANDOVER DOES NOT +F o� w i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF A's THIS INFORMATION SSACNUS� 1"=515ft w�° ^ ' D N PE RATH LIVING DINING WALK IN WALKIN CAIINA LL.-�____� LL�__, 1. DN HALL FOYE KITCHEN CLOSET 9A x P6 T - u== moalrx,by pwiercinivs New (013) First F1001, - ~ ' � F� cl.Oslk,I JU S,MIRAGE I UlALIA Y OFFICIE 14T IT8 14'8 x 15' 2.0'9 x 38'3 UP 9'x 46' FLIVURE PLAYROOM '19'x 21r3 q These plans are for murketing purposes only and to Essox St.Nor Ili UTILITY provide general Information about 6 -e 9,Y,10,6 Andover,MA. Floor plans and dimensions c.0 approximate. prepEirar)ior Peggy Patin aside of Prudential Howe&Doherty in Andover,MA. Plans created by Dimensions New England(976) 794-3993.x.vvm.dii*neiisiaiishoinc,,I)-,)90.(;c)") Lo�Aver Lcwel