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Miscellaneous - 62 COMPASS POINT ROAD 4/30/2018
N �d Date.4flVl..!��.. IlJ1 �' Olt "pp7" TOWN OF NORTH ANDOVER # PERMIT FOR PLUMBING sSACMU5E This certifies that................ ...!... ... '1.................... ..:�... '...................................... has permission to perform.......N��'`�_.........:.` `''"�y-..........,................... .. plumbing in the buildings of.........../...!!2.. 4............................................ ?......... at............4-0?......... ......... .:..�'1 5.........../�f.......... North Andover, Mass. Fee�d.(7..........Lic. No. ..317.1..... ................................................................................. O PLUMBING INSPECTOR Check# 57!5 � MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY I NORTH ANDOVER __ __ - --__L�j MA. DATE 8-17-15 PERMIT# /1 J/2— JOBSITE ADDRESS 162 COMPASS POINT OWNER'S NAME TRUST CONSTRUCTION POWNER ADDRESS: 51 MT JOY DRIVE TEWKSBURY MA 77777]TEL:1_9788513456 TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑� PRINT CLEARLY NEW: RENOVATION: ❑ REPLACEMENT:❑ PLANS SUBMITTED: YES❑ NO❑ i FIXUTRES Z FLOORS Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 2 CROSS CONN DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYS DEDICATED WATER REUSE SYS DISHWASHER DRINKING FOUNTAIN FOOD WASTE GRINDER UNIT FLOOR/AREA DRAIN INTERCEPTOR INTERIOR KITCHEN SINK LAVATORY 1 3 ROOF DRAIN SHOWER STALL 1 SERVICE/MOP SINK TOILET 1 3 URINAL WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES 1 WATER PIPING 1 SPIGOTS 2 INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES 0 NO ❑ If you have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY ❑■ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT i I hereby certify that all of the details and information I have submitted(or entered)regarding this application are an/'ce te to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application i e i with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER NAME: MIKE_BURKE _ _; LICENSE#113127 - SIGNATURE COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORPADDRESS: PO BOX 896 CITY:I PLAISTOW STATE: NH ZIP: I 03865 _ FAX: 16033780040 TEL: 16033780020 _ _. CELL: 19784909385 EMAIL: J.LAURENCIO@POWERHOUSEPLUMBING.COM_ - MASTER❑■ JOURNEYMAN❑ CORPORATION 0# 2482__--___ PARTNERSHIP 0# LLC El# } UGH PLUMBING INSPECTNOTES BELOW FOR OFFICE USE ONLY FINAL INsPECTION NOTES 1' l� Yes No I THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES Date.... ............. OF NORTH,� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION S`QACHU / This certifies that ...................... ........ ".................. 1`.`�..`'e'-....................... has permission for gas installation in the buildings o .........�"P j It'...`..... 5. -�'�— ....................................... at..................`2...... ..:...`'` .1........,. f'......., North Andover, Mass. Fee, . ... Lic. No. .. ��../77. ..................................................................... GAS INSPECTOR Check# 7Q� ` U 1s MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK _ CITY jAqRjHANDOVER MA. DATE _8-17-15 _ � PERMIT# JOBSITE ADDRESS 62 COMPASS POINT OWNER'S NAME TRUST CONSTRUCTION G _ _ OWNER ADDRESS: 51 MT JOY DRIVE TEWKSBURY TEL: 9788513456 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL❑ EDUCATIONAL ❑ RESIDENTIAL❑■ PRINT CLEARLY NEW: RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES❑ NO❑ FIXUTRES Z FLOOR- Bsmt 1 2 3 4 5 6 1 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER r 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 have checked YES,please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWN El AGENT ElSIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted(or entered)regarding this applicatfnill e a accu to to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applicin co ance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER/GASFITTER NAME: _MIKE BURKE I 0LICENSE#_13127 - G COMPANY NAME: POWERHOUSE PLUMBING AND HEATING CORP ADDRESS: PO BOX 896 CITY: PLAISTOW f STATE: NH ZIP: 03865_ FAX: 6033780040 _. TEL: 6033780020 CELL: 9784909385 _i EMAIL: I J.LAURENCIO@POWERHOUSEPLUMBINGAND HEAT MASTER❑■ JOURNEYMAN❑ LP INSTALLER❑ CORPORATION❑■ #=_-'PARTNERSHIP❑#=LLC❑ _ f E ROUGH GAS INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINA INSPEOTION NOTES Yes No A9a- / . THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations w a I Congress Street, Suite 100 .� Boston, MA 02114-2017 f www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): POWERHOUSE PLUMBING CORP Address: PO BOX 896 City/State/Zip: PLAISTOW, NH 03865 Phone#:6033780020 Are you an employer? Check the appropriate box: Type of project(required): 1.❑E I am a employer with 6 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. X New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HARTFORD UNDERWRITERS INSURANCE COMP Policy#or Self-ins. Lic. #:04WECIT2480 Expiration Date:7-28-15 Job Site Address: 62 COMPASS POINT City/State/Zip: N ANDOVER Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00a agai t he violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of DIA or nsurance coverage verification. I do hereby c ti un ert e ' s and penalties of perjury that the information provided above is true and correct. Si ature: Date:8-17-15 Phone#: 60 3780 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#: q 3 . -_- D)I!iof ! • : . � --- , ®I a (.�� `pie'•-.',�� Mpq. .6111--1 k � 0 0 Datll. ,fOR7M TOWN OF NORTH ANDOVER o PERMIT FOR MECHANICAL INSTALLATION f D � s •„�D�.•r�gh SACH U5Et This certifies that .\,�... . . . . 1 .�. . �. .!'��.- °. . . . . • • . . has permission for mechanical installation in the buildings of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at .�. -. . l ., �^+ . . �D// , North Andover, Mass. Fee . . . Lic. No. moi!' _. . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit bate:,, Permit 4 4D Estimated Job Cost: $ j b r?0 ,t-'7/9' Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License it 196 Applicant License Business Information: Property Owner/Job Location Information: Name: J&J Beating. & Air Conditioning Name: l ILi wN Street: 17 Arlington St., Street: Po "/t City/Town: Dracut, MA 01826 City/Town: North Andover, MA 01845 Telephone: .97.8-454-8197 Telephone: 2 7 5_4 Photo I.D. required/ Copy of Photo I.D. attached: YES NO stn ff III itlat J-1 / M-1-unrestricted license J-2 /M-27restricted to dwellings 3-stories or less and conunercial up to 10,000 sq. ft. /2-stories or less Residential: Fyouhave E COVERAGE: ent liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ONo❑ checked Yes, indicate the type of coverage by checking the appropriate box below: nsurance policy [ Other type of indemnity ❑ Bond ❑NSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter112ofthe etts 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 boxl],I hereby certify that all of lice details and information I have submitted(or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO P1'01,l•css Inspections Date Comments Filial Inspection Date Comments Type of License: By El Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit it ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.ctovldpl Inspector Signature of Permit Approval I. TIle C0177171017W(?(jjt1j of Massachusetts .................... " 1JDelr)r, I C017-1-ess Street, Suit b e 1()o Boston, AAA 02114-2017 7f)0R1?7C1SS-g0Weua ........... W'Orhcrs' Compensation Instirmice Affidavit: B it i I del's/Ccin ty',l ctors/Electricil 11,S/1,111 Ili bel's. ALlic,"Int Information TO 13E FILED Nvrrii_1711E PERMITTING AUTI-10RITV. Please Print Lc iglu N41111C (Bilsiness/Oi-ganiz-,it'011/111(IiViCiLla)): J & J Heating & Air Conditioning, Inc. Address: 7 Ari igtan street City/State/Zip: Dracut, MA. 018261111011C /.1: 978-454-819-7 Are you:11,employer?Cliecic Ute appropriate box: Y Typ❑ 0'project ("eqnire(l). am a employer with 40 n,PIoYccs(1-1111 and/or prirt-finic),* 'T*YPe of Pro.ject (required): [2 ct7 'Ila�rrc.s.,ocl, 7. New 'Onstl.0 ion capacity. F forme ill 8• 0 2Q I am a sole proprietor or partnership and have no cinployces working 7. E]New coilstl.tjctioll any Capacity.(No workers'coniP,insurance required.] 8. Remodeling 3.Ej I am a homeowner doing all work ill),self.[No workers'comp. insurance required.)1 9. El Demolition 'I.Ell am a homeowner and will lie hiring contractors to conduct all work on my property. I will 10 El Boilding addition cilstirc that all contractors either have workers'compensation insurance or are SOIL! E] Electrical repairs ol-aciclitiolls proprietors with no employees. I I- 5.E]I ani ji general contractor and I have hired the sub-contractors listed on I i tile attached sheet. 12.F]Pl6nibing 1-CPail-s 01-additions These sub-contractors have el"Ployces and have\vookilcrs'comp,insurance.* 13.r-]Roof repairs 6.E]We arca corporation and its on'lccrs 11,1ve exercised their right ol'cxclnp(iol)per MGL c. 14.[]Other152.§1(4).and\vc have no c"'Ployces.[No worker*s'comp.insurance required.] *Any applicant t _,.r'cthat checks box Y I must also 1-111 01.11 the section below showing their workers'compensation Policy information. 0,vr" ,swho submit this affidavit indicating they are doing all work and lliell hire outside contractors inLISI 5111)"'it a new affidavit indicati s c :Contractors that check this box must attached all additional sheet shoving the 11 111; Ll 11 -el"Ploy"s. lf'tllc sub-contractors have employees,they Must provide their \v -'rre Of[lie sub-contractors and state whether or not[hose entities have workers'comp.policy number, (7ll]llit e177biloyer that is propi(jilIg workers Conilmlsalion insill-alicefor illfOrMati011. M,))eJ77P10)1ees. 13e/otois the policj;all(Ijob site Insurance Company Name: A.I. M_ Mutual ]_n. Policy It or Self ins. Lic. /1: WMZ-8006553-2015 Expiration Date: 06/02/16 Job Site Address! Attach .1 copy OptIll, %V61.1(el-S, com Ci ty/St ate/Zip: ficlis"itioll policy declaration page(showing thepolicy 11113111bCr In(.] expil-,1(joll Failure 1.0 secure cOVCra9c as required Under MGL c. 152, §25A is a criminal Violation punishable by a fine 111)to$1,500.00 and/or one yea "ISO"1111CIlt, as well (lay aga" ill llato as Civil penalties in t1lC f0i'll, of a STOP WORK ORDER and a fine of up to$250.00 a e Vio�to'. A copy of Iljj.S Stc1tenjen, may C Vel-ificat io I . -wl-ded ay be fol to the Office Of Investigations of the DIA fOl'insurance I do hereby eer er le 17S olldpellfl lies oj'peljllrj,11101 the i1000770ti(011 prO'Vided abolle is trile(1114 Cori-eel. Si natLll'C: Date: X-7,h/Y. Phone 8 45t-8 -97 Official rise 0171)). Do not write ill this area,10 be C0177j)lejf_1(l 1)),Cily or town official. City Or Town: Permit/License# ----------- Issilin A01ioleity(circle 011c): 1. Board of health 2. 13nilding Department 3. City/Town Cie,qc . Other :tech teal Inspector S. Plumbing Inspector Contact Person: Phone fl: ACORQ CERTIFICATE OF LIABILITY INSURANCE FATE 12712015/27/2015 FEddward ER 978.887.4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 'IF. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE outh Main Street HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. box 457 ' Topsfield, MA 01983 INSURERS AFFORDING COVERAGE NAIC 1/ INSURED ]g,] {{eating & Air Conditioning, Inc. ' INSURERA: Great ARIerican Alliance Ins CO --�- 17 Arlington Street INSURER B: Safety Insurance Company 39454 Dracut, MA 01826 INSURERc: A.I.M. Mutual Insurance Co INSURER D: INSURER P. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOA 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR DD' POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER r DATE MM DD YY DATE MM DD YY dMITS: GENERAL LIABILITY PAC6418906-09 06/01/2015 06/01/2016 EACHOCCURRENCE $' 1,000,00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 3OO OO CLAIMS MADE OCCUR MED EXP(Any one person) $ 10 QQ A PERSONAL&AOV INJURY $ 11000,000 GENERAL AGGREGATE 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S 2,000,000 POLICY PRO JECT LOC AUTOMOBILE LIABILITY 2434550 06/01/2015 06/01/2016 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,OO ALL OWNED AUTOS 0 BODILY INJURY $ B X SCHEDULED AUTOS (Por person) X HIRED AUTOS BODILY INJURY X $NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY . AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY UMB6418958-08 06/01/2015 06/01/2016 EACH OCCURRENCE S 2,'000,00_ X A OCCUR u CLAIMS MADE AGGREGATE S 2;000 _0t) a DEDUCTIBLE $ RETENTION S WORKERS COMPENSATION ` WMZ-800-8006553-2015 06/02/2015 06/02/2016 X -70 AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUI'IVErY� E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? u (Mandatory In NIA) E.L.DISEASE-EA EMPLOYEE $ 1 QQQ QQ If yes,describe under SPECIAL PROVISIONSp61ow E.L.DISEASE-POLICY LIMIT S OTHER 1 OOO OO DESCRIPTION OF OPERATION S/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS r r r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMtD TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Evidence Of Insurance AUTHORIZED REPRESENTATIVE Peter Sennott/LAR ACORD 25(2009/01) ©1,989-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD V . OMMONWEAiTl-I OF" MA5`,AC1-IlI SEI*TS SIIEf Y Mi (.11L W0121(1 RS: I SSUES IIII F 0 L L OWI!NI LCLNSC ns A MAS I fl2 11NRI;S1 R I GTI p ;, HEAT I NG F Ac l:R I C ,1 F J III.:A'1.I NG c nc 17 11121 ;1 NGTON S1 MA 0.182.6- 1�.Gfi dt' 28/16. >,. 21 h�39 l9L]�;.0=1�If it°1�'d•1!,&39�f81d).1AaI.LS�T�i11..7 y11'_lgll9� 7;11f:,'l�ll��°li' � • I SAC,14, T:S, DRIVER'S LICENSE QIIYA qa liS•1 Bb END. 4d NUMBER .605-03-201f'..':NONE:.. S99655871 941).E%P 3,'.:.DOB .. _ 05 2Tg016 05 {ySU9- '12 REIT 15 SEX M AY*6"9 IDM NONE , 2 ERIC RJ �. 8 83 LONG DR DRACUT,MA 01826.2048 �j�. � sDDosoa:onR.�ei•°�zoa° i Iq;;;::(yOMMONWALTH O Ml .. ."THUS SHE MCT:XIL WORKER$ : j ISSUCS THE FOLLOWING LICC,NSE ft; AS A B SSS ' [DWARD T AYOTTC:":!' �;5< J J`"HEgTING IR CONDITIONING is I' N,,. t7 ARLINGT'ON STR,C1 Mf UT t)A 01826 144485 ' I it i i i ti r Job: g262 - - wrightsoft` Load Short Form Date: May 22 Compass Point 2015 Entire House By: J&J Heating and Air Conditioning 17 Airington st,Dracut,Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 I E Htg Clg Infiltration Outside db (°F) 12 88 Method Simplified Inside db (°F) 70 75 Construction quality Tight Design TD (°F) 58 13 Fireplaces 1 (Average) Daily range - L Inside humidity (%) 50 50 Moisture difference (gr/Ib) 47 28 HEATING EQUIPMENT COOLING EQUIPMENT Make Goodman Mfg. Make Goodman Mfg. Trade GOODMAN Trade GOODMAN, JANITROL,AMANA DISTI... Model GMH950703BX Cond GSX130361 B* AHRI ref 2002183 Coil CA*F3642*6D* AHRI ref 4869931 Efficiency 95AFUE Efficiency 11.3 EER, 13 SEER Heating input 69000 Btuh Sensible cooling 32000 Btuh Heating output 66000 Btuh Latent cooling 8000 Btuh Temperature rise 45 OF Total cooling 40000 Btuh Actual air flow 1333 cfm Actual air flow 1333 cfm Air flow factor 0.032 cfm/Btuh Air flow factor 0.044 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.88 ROOM NAME Area Htg load Cig load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) Bedroom2 169 3565 2555 113 113 bedroom 3 144 3237 2888 103 128 bathl 80 1293 705 41 31 bath2 90 1440 735 46 33 W.I.C 50 1543 316 49 14 Master bed 180 3889 3538 123 157 Bedroom 4 120 1617 1690 51 75 Hall 42 522 105 17 5 kitchen 300 8420 6007 267 267 1/2 bath 60 1494 1154 47 51 wash 60 2461 1355 78 60 dinning 156 4758 3411 151 151 living room 195 5589 4186 177 186 entry 104 2240 1381 71 61 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. rF wri htsOft9 2015-Dec-14 06:40:41 �./_�� g Right-Suite®Universal 2015 15.0.12 RSU05790 Page 1 ACCA ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N Entire House d 1750 42068 30027 1333 1333 Other equip loads 5195 4096 Equip. @ 0.93 RSM 31597 Latent cooling 4846 TOTALS 1750 47263 36444 1333 1333 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 1 wri htsoft° 2015-Dec-14 06:40:41 ^." Right-Suite®Universal 2015 15.0.12 RSU05790 Page 2 ACCP ...Desktop\M-J-Copy\crabtree kerrylynn Iot40.rup Calc=MJ8 Front Door faces: N Building Anali ss Job: g2 62 Compass Point inrrightsoft� y Date: May 22 2015 Entire House By: J&J Heating and Air Conditioning 17 Alrington st,Dracut,Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 751 i Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Dally range �°F) - 15 ( L ) Method Simplified Wet bulb (°F - 72 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) "KI, o . Component Btuh/ft2 Btuh % of load Walls 3.7 7167 15.2 wd Glazing 17.3 3398 7.2 ;. ,,,. Doors 16.7 818 1.7 ®� Ceilings 14.7 12827 27.1 Floors 6.4 5585 11.8 Infiltration 4.8 10404 22.0 Ducts 1868 4.0 Piping 0 0 ` Humidification 5195 11.0 ` Ventilation 0 0 Adjustments 0 Total 47263 100.0 Component Btuh/ft2 Btuh % of load Walls 1.0 1904 5.6 Glazing 42.0 8259 24.2 Doors 7.7 377 1.1 Ceilings 12.7 11134 32.6 Floors 1.4 1222 3.6 R'�` Infiltration 1.0 2102 6.2 Ducts 579 1.7 Ventilation 0 0 � � � . , Internal gains 4450 13.0 Blower 4096 12.0 Adjustments 0 Total 34122 100.0 Latent Cooling Load = 4846 Btuh Overall U-value= 0.174 Btuh/ft2-°F Data entries checked. 2015-Dec-14 06:40:41 wrightsoftm Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 1 ACCN ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N Component Constructions Job: g2 62 Compass Point iwrightsaft� Date: May 22 2015 Entire House By: J&J Heating and Air Conditioning 17 Alrington st,Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com a h For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 `� ;. �" e • e Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ftz°F ft�°F/Btuh BtuhM Btu Btuh/ft2 Btu Walls 12F-Osw: Frm wall,vnl ext, 1/2"wood shth,r-21 cav ins,1/2" n 450 0.065 21.0 3.74 1665 0.99 448 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud e 505 0.065 21.0 3.74 1891 0.99 502 s 438 0.065 21.0 3.74 1640 0.99 436 w 521 0.065 21.0 3.74 1952 0.99 518 all 1914 0.065 21.0 3.74 7167 0.99 1904 Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 e 36 0.300 0 17.3 622 28.2 1015 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; e 40 0.300 0 17.3 691 52.7 2108 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft s 12 0.300 0 17.3 207 27.4 329 head ht w 49 0.300 0 17.3 841 28.2 1373 W 60 0.300 0 17.3 1037 52.7 3162 all 197 0.300 0 17.3 3398 40.6 7986 Doors 11 P0:Door,mtl pur core type e 49 0.290 10.5 16.7 818 7.68 377 Ceilings C part ceiling,:C part ceiling,hrd wd fir fnsh,frm flr,10"thkns,1/2" 875 0.255 1.0 14.7 12827 12.7 11134 gypsum board intfnsh Floors 19A-Obswp:Part floor,hrd wd flr fnsh,frm flr,10"thkns 875 0.295 0 6.38 5585 1.40 1222 wri htsoftm 2015-Dec-14 06:40:41 ..� g Right-Suite®Universal 2015 15.0.12 RSU05790 Page 1 RCCA ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N Component Constructions Job: g2 62 Compass Point inrrightsoft`� Date: May 22 2015 Bedroom2 By: J&J Heating and Air Conditioning 17 Airington st,Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com o e For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 in imigillm =W=112, iglij Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft� Btu h/ft2-°F ft2-°F/Btuh Btuh/ft2 Btu Btuh/112 Btu Walls 12F-Osw: Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" n 117 0.065 21.0 3.74 438 0.99 116 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud e 93 0.065 21.0 3.74 348 0.99 92 all 210 0.065 21.0 3.74 786 0.99 209 Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 e 24 0.300 0 17.3 415 52.7 1265 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap,1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings (none) Floors 19A-Obswp:Part floor,hrd wd flr fnsh,frm fir,10"thkns 169 0.295 0 6.38 1079 1.40 236 2015-Dec-14 06:40:41 wrightsoft" Right-Suite®Universal 2015 15.0.12 RSU05790 Page 2 ACCA ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N Component Constructions Job: 8262 Compass Point ill/CIQhtSOft� p Date: May 22 2015 bedroom 3 By: J&J Heating and Air Conditioning 17 Alrington st, Dracut,Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com � o For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft� Btuh/ftz-°F ft2-°F/Btuh Btuh/ft2 Btu Btuh/ft2 Btu Walls 12F-Osw:Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" n 108 0.065 21.0 3.74 404 0.99 107 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud w 84 0.065 21.0 3.74 314 0.99 84 all 192 0.065 21.0 3.74 719 0.99 191 Partitions (none) Windows 2 glazing,clr outr,air gas,vni frm mat,clr innr, 1/4"gap,1/4"thk:2 w 24 0.300 0 17.3 415 52.7 1265 glazing,cir outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings (none) Floors 19A-Obswp:Part floor,hrd wd fir fnsh,frm fir,10"thkns 144 0.295 0 6.38 919 1.40 201 2015-Dec-14 06:40:41 ,ti wrightsoft" Right-Suite®Universal 2015 15.0.12 RSU05790 Page 3 .SCK ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft- Component Constructions Job: g2 62 Compass Point 9 Date: May 22 2015 bath 1 By: J&J Heating and Air Conditioning 17 Alrington st, Dracut,Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 BtuhM°F ftz-°F/Btuh Btuh/ft2 Btu Btuh/ftz Btu Walls 12F-Osw:Frm wall,vni ext,1/2"wood shth,r-21 cav ins,1/2" e 64 0.065 21.0 3.74 240 0.99 64 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 e 8 0.300 0 17.3 138 52.7 422 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings (none) Floors 19A-Obswp: Part floor,hrd wd flr fnsh,frm flr, 10"thkns 80 0.295 0 6.38 511 1.40 112 wrightsofta Right-Suite®Universal 2015 15.0.12 RSU05790 2015-Dec-14 06:40:41Page 4 /CO, ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft Component Constructions Job: g2 62 Compass Point 9 bath2 Byte: May 22 2015 J&J Heating and Air Conditioning 17 Alrington st,Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 :vim {yID "- • o . .' �. Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss CIg HTM Gain ft2 Btuh/ftz-°F ft�-°F/Btuh Btuh/ft2 Btu Btuh/112 Btu Walls 12F-Osw: Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" e 73 0.065 21.0 3.74 273 0.99 73 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,cir innr,1/4"gap,1/4"thk:2 e 8 0.300 0 17.3 138 52.7 422 glazing,clr outr,air gas,vnl frm mat,cir innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings (none) Floors 19A-Obswp:Part floor,hrd wd flr fnsh,frm flr,10"thkns 90 0.295 0 6.38 574 1.40 126 .w 2015-Dec-14 06:40:41 Wrl htsoft Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 5 !}SCA ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft Component Constructions Job: g2 62 Compass Point 9 w, ^ DDate: May 22 2015 a� By: J&J Heating and Air Conditioning 17 Airington st,Dracut,Ma 01826 Phone:978 4548197 Email:eric@jjheatae.com Web:jjheatae.com e � For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft� Btuh/ft2-°F ft2-°F/Btuh Btuh/ft2 Btu Btu h/ft2 Btu Walls 12F-Osw:Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" e 45 0.065 21.0 3.74 168 0.99 45 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud s 90 0.065 21.0 3.74 337 0.99 90 all 135 0.065 21.0 3.74 505 0.99 134 Partitions (none) Windows (none) Doors (none) Ceilings (none) Floors 19A-Obswp: Part floor,hrd wd flr fnsh,frm fir,10"thkns 50 0.295 0 6.38 319 1.40 70 2015-Dec-14 06:40:41 wrightsoft" Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 6 RCCA ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft; Component Constructions Job: g2 62 Compass Point 9 Date: May 22 2015 Master bed By: J&J Heating and Air Conditioning 17 Alrington st, Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:iiheatac.com �`- ' „ e 4 q ® e For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-0F ft2-°F/Btuh Btuh/ftz Btu Btuh/ft2 Btu Walls 12F-Osw: Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" s 123 0.065 21.0 3.74 461 0.99 122 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud w 84 0.065 21.0 3.74 314 0.99 84 all 207 0.065 21.0 3.74 775 0.99 206 Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 s 12 0.300 0 17.3 207 27.4 329 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft W 24 0.300 0 17.3 415 52.7 1265 head ht all 36 0.300 0 17.3 622 44.3 1594 Doors (none) Ceilings (none) Floors 19A-Obswp:Part floor,hrd wd flr fnsh,frm flr,10"thkns 180 0.295 0 6.38 1149 1.40 251 2015-Dec-14 06:40:41 wrightsoft" Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 7 ACCP. ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft Component Constructions Job: g2 62 Compass Point g Date: May 22 2015 Bedroom 4 By: J&J Heating and Air Conditioning 17 Airington st, Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com p i, For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ft2-°F/Btuh Btuh/ft2 Btu Btu hA2 Btu Walls 12F-Osw:Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" w 60 0.065 21.0 3.74 225 0.99 60 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 w 12 0.300 0 17.3 207 52.7 632 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings (none) Floors 19A-Obswp:Part floor,hrd wd fir fnsh,frm fir, 10"thkns 120 0.295 0 6.38 766 1.40 168 2015-Dec-14 06:40:41 wrightsoft' Right-Suite®Universal 2015 15.0.12 RSU05790 Page 8 ACCP. ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft- Component Constructions Job: g2 62 Compass Point 9 Hall Byte: May 22 2015 J&J Heating and Air Conditioning 17 Airington st, Dracut, Ma 01826 Phone:978 4548197 Email:eric@jiheatac.Lom Web:jjheatac.com ..,, ;..>� ��i��atl, Gas, ... .� ;. >,.,.�. t �� • • • For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area 11.1-value Insul R Htg HTM Loss Clg HTM Gain ft� Btuh/ft2-0F ft2-°F/Btuh Btuh/ft2 Stuh Btuh/ft2 Btu Walls 12F-Osw: Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" w 27 0.065 21.0 3.74 101 0.99 27 gypsum board int fnsh,2"x6"wood frm, 16"o.c.stud Partitions (none) Windows (none) Doors (none) Ceilings (none) Floors 19A-Obswp: Part floor,hrd wd fir fnsh,frm fir,10"thkns 42 0.295 0 6.38 268 1.40 59 t WPI I1tSt?ft" 2015-Dec-1406:40:41 9 Right-Suite®Universal 2015 15.0.12 RSU05790 Page 9 .CCK ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft Component Constructions Job: g2 62 Compass Point 9 Date: May 22 2015 kitchen By: J&J Heating and Air Conditioning 17 Alrington st,Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 - ";c' 'y�. r�;7" ;. w;ar z, "' J why; • • • • Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb ( F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft� Btuh/ft2-°F ft2-°F/Btuh Btuh/ftz Btu Btuh/H� Btu Walls 12F-Osw:Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" n 108 0.065 21.0 3.74 404 0.99 107 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud e 164 0.065 21.0 3.74 614 0.99 163 all 272 0.065 21.0 3.74 1018 0.99 271 Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 e 12 0.300 0 17.3 207 28.2 338 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors 11 P0:Door,mtl pur core type e 49 0.290 10.5 16.7 818 7.68 377 Ceilings C part ceiling,:C part ceiling,hrd wd flr fnsh,frm flr,10"thkns,1/2" 300 0.255 1.0 14.7 4398 12.7 3818 gypsum board int fnsh Floors (none) wri htsoft 2015-Dec-14 06:40:41 1- g Right-Suite®Universal 2015 15.0.12 RSU05790 Page 10 ACCK ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N i wri htsoft Component Constructions Job: g2 62 Compass Point 9 1/2 bath Bate: May 222015 By: J&J Heating and Air Conditioning 17 Alrington st, Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com 0 ORNMIR For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-1F ft2-1F/6tuh Btuh/ft2 Btu Btu h/ft2 Btu Walls 12F-Osw:Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" e 33 0.065 21.0 3.74 124 0.99 33 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 e 12 0.300 0 17.3 207 28.2 338 glazing,clr outr,air gas,vnl frm mat,cir innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings C part ceiling,:C part ceiling,hrd wd flr fnsh,frm flr,10"thkns,1/2" 60 0.255 1.0 14.7 880 12.7 764 gypsum board int fnsh Floors (none) 2015-Dec-14 06:40:41 wrightsoft' Right-Suite®Universal 2015 15.0.12 RSU05790 Page 11 ACCK ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N Component Constructions Job: g262 Compass Point wrightsoft� Date: May 22 2015 wash By: J&J Heating and Air Conditioning 17 Alrington st,Dracut,Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com 777: ..7"�.a;; ¢ s, ,' e 0 0 .. !• For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 • �� o Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ftp-°F ft2-°F/Btuh Btu h/V Btu Btuh/ft2 Btu Walls 12F-Osw:Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" e 33 0.065 21.0 3.74 124 0.99 33 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud s 108 0.065 21.0 3.74 404 0.99 107 all 141 0.065 21.0 3.74 528 0.99 140 Partitions (none) Windows 2 glazing,cir outr,air gas,vni frm mat,clr innr,1/4"gap,1/4"thk:2 e 12 0.300 0 17.3 207 28.2 338 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings C part ceiling,:C part ceiling,hrd wd flr fnsh,frm flr,10"thkns, 1/2" 60 0.255 1.0 14.7 880 12.7 764 gypsum board int fnsh Floors (none) i 1 wri htsoftg 2015-Dec-14 06:40:41 ,.� g Right-Suite(R)Universal 2015 15.0.12 RSU05790 Page 12 ACOA ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft Component Constructions Job: g2 62 Compass Point Q Date: May 22 2015 dinning By: J&J Heating and Air Conditioning 17 Airington st,Dracut, Ma 01826 Phone:978 4548197 Email:eric@jiheatac.com Web:jjheatac.com For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 LZILT�11 SEE= Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/P-°F ft�-°F/Btuh Btuh/ft2 Btu BtuhM Btu Walls 12F-Osw:Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" n 117 0.065 21.0 3.74 438 0.99 116 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud w 83 0.065 21.0 3.74 312 0.99 83 all 200 0.065 21.0 3.74 750 0.99 199 Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap,1/4"thk:2 w 25 0.300 0 17.3 426 28.2 696 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings C part ceiling,:C part ceiling,hrd wd flr fnsh,frm fir,10"thkns, 1/2" 156 0.255 1.0 14.7 2287 12.7 1985 gypsum board int fnsh Floors (none) I 2015-Dec-14 06:40:41 wrightsoft' Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 13 ACCA ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJS Front Door faces: N wri htsoft- Component Constructions Job: g2 62 Compass Point Date: May 22 2015 living room By: J&J Heating and Air Conditioning 17 Alrington st,Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com -s.: For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 601 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Tiht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area 11.11-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ftz-°F ft2-°FBtuh Btu h/112 Btu Btuh/ft2 Btu Walls 12F-Osw: Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" s 117 0.065 21.0 3.74 438 0.99 116 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud W 111 0.065 21.0 3.74 416 0.99 110 all 228 0.065 21.0 3.74 854 0.99 227 Partitions (none) Windows 2 glazing,clr outr,air gas,vnl frm mat,clr innr,1/4"gap,1/4"thk:2 w 24 0.300 0 17.3 415 28.2 677 glazing,clr outr,air gas,vnl frm mat,clr innr, 1/4"gap, 1/4"thk; 50%outdoor insect screen;foreground=green grass(0.23);6.67 ft head ht Doors (none) Ceilings C part ceiling,:C part ceiling,hrd wd fir fnsh,frm fir,10"thkns,1/2" 195 0.255 1.0 14.7 2859 12.7 2481 gypsum board int fnsh Floors (none) i 2015-Dec-14 06:40:41 wrightSOW Right-Suite®Universal 2015 15.0.12 RSU05790 Page 14 ACCA ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N wri htsoft Component Constructions Job: g2 62 Compass Point 9 Date: May 22 2015 en tt y By: J&J Heating and Air Conditioning 17 Alrington st, Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com c`r e x .gyp , ` For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature (°F) 70 75 Elevation: 30 ft Design TD (°F) 58 13 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 46.5 27.8 Dry bulb (°F) 12 88 Infiltration: Daily range (°F) - 15 ( L ) Method Simplified Wet bulb (°F) - 72 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Average) Construction descriptions Or Area U-value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ftz°F ft2-°F/Btuh Btuh/112 Btu Btuh/112 Btu Walls 12F-Osw: Frm wall,vnl ext,1/2"wood shth,r-21 cav ins,1/2" w 72 0.065 21.0 3.74 270 0.99 72 gypsum board int fnsh,2"x6"wood frm,16"o.c.stud Partitions (none) Windows (none) Doors (none) Ceilings C part ceiling,:C part ceiling,hrd wd flr fnsh,frm flr,10"thkns,1/2" 104 0.255 1.0 14.7 1525 12.7 1323 gypsum board int fnsh Floors (none) " 2015-Dec-14 06:40:41 .z 9' wrightsoft" Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 15 ACCK ...Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N - Wrl �1tS0ft-9 Project Summary Job: g2 62 Compass Point Date: May 22 2015 Entire House By: J&J Heating and Air Conditioning 17 Alrington st, Dracut, Ma 01826 Phone:978 4548197 Email:eric@jjheatac.com Web:jjheatac.com For: Trust Construction 51 Mount Joy Drive, Tewksbury, Ma 01876 Notes: .., ,rr s • Weather: Boston Logan Int'I AP, MA, US Winter Design Conditions Summer Design Conditions Outside db 12 OF Outside db 88 OF Inside db 70 OF Inside db 75 OF Design TD 58 OF Design TD 13 OF Daily range L Relative humidity 50 % Moisture difference 28 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 40200 Btuh Structure 29447 Btuh Ducts 1868 Btuh Ducts 579 Btuh Central vent (0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 5195 Btuh Blower 4096 Btuh Piping 0 Btuh Equipment load 47263 Btuh Use manufacturer's data n Rate/swing multiplier 0.93 Infiltration Equipment sensible load 31597 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Tight Fireplaces 1 (Average) Structure 3863 Btuh Ducts 984 Btuh Heating Cooling Central vent (0 cfm) 0 Btuh Area (ft2) 1750 1750 Equipment latent load 4846 Btuh Volume (ft3) 15750 15750 Air changes/hour 0.26 0.09 Equipment total load 36444 Btuh Equiv.AVF (cfm) 164 152 Req. total capacity at 0.80 SHR 3.3 ton Heating Equipment Summary Cooling Equipment Summary Make Goodman Mfg. Make Goodman Mfg. Trade GOODMAN Trade GOODMAN, JANITROL,AMANA DISTI... Model GMH950703BX Cond GSX130361 B* AHRI ref 2002183 Coil CA*F3642*6D* AHRI ref 4869931 Efficiency 95AFUE Efficiency 11.3 EER, 13 SEER Heating input 69000 Btuh Sensible cooling 32000 Btuh Heating output 66000 Btuh Latent cooling 8000 Btuh Temperature rise 45 OF Total cooling 40000 Btuh Actual air flow 1333 cfm Actual air flow 1333 cfm Air flow factor 0.032 cfm/Btuh Air flow factor 0.044 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.88 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. rF 2015-Dec-14 06:40:41 wrightsoft� Right-Suite@ Universal 2015 15.0.12 RSU05790 Page 1 ICCN ..Desktop\M-J-Copy\crabtree kerrylynn lot40.rup Calc=MJ8 Front Door faces: N Date l... ...4!1............ TOWN OF NORTH ANDOVER PERMIT FOR WIRING S3ACHU This certifies that0 .................... has permission to pe .. ..... ........ ..................................................... wiring in the building of......&"R e.-I....0.)...........L.—Ie.......................... ... . .. ......... . ..................... ... ........ ....... at (0Z.... .........0.4............................North Andover,Mass. Fee.4 U, A.........Lic.No-1A..1.;E. .................................................................................... ELECTRICAL INSPECTOR Check# Official Use 0n1 � Commonwealth of Massachusetts O - Department of Fire Services Permit No. �oZ �- �' Occupancy and Fee Checked " BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] • � (leave blank • t • APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 R 12. (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intenti to perform the electrical work described below. Location(Street&Number) _� Cr� Q Owner or Tenant !1(U S.r Telephone No. )T -3�d- S 331 Owner's Address Is this permit in conjunction with building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Llr, Nutility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps 110 / DbVolts Overhead❑ Undgrd EQ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.o mergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No,of Zones No.of Switches No.of Gas Burners No.of Detection and Initiating Devices No.of Ranges No.of Air Cond. I Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: •••••••••• Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances Key Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wtres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and enalti of perjury ��t"hat the inform2FP1 on this application is true and complete. . U FIRM NAME: _ �� U� (,' LIC.NO.: Licensee: M,t--6 Signature LIC.NO.: i 1 (If applicable,enter "exempt"in the license nu ber line.) �,f� Bus.Tel.No.• 1 - Address: 2 / � � d- wk�M�(V� (lt` / I SS Alt.Tel.No.: 1-13�� *Per M.G.L c. 147,s.57-61,security work requires Department o 'ublic Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. , ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the t permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, §32,an ' electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. r Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass F?] Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass[N Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH ECTION: Pass 0 V Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: —L I— /S FINAL INSPEC ION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: 61 DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com V s . The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 _ Boston,MA.02114-2017 +^ F www.massgov/dia work Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TEE PERMITTING AUTHORITY. Please Print Le 'bl A ''licantTnformation COS �p Name(Business/OrgariizatiorAndividual): Address: City/State/Zip: ;... -. . Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with emP (full full and/or parttime).* 7. ❑New donstract[on yees 2.F]T am a sole proprietor or partnership and have no employees working for me in 8. []Remo delijig any capacity.[No workers'comp.insurance required.] 9. Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10(]Building addition <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole i proprietors with no employees. 12.Q Plitnzbing repairs or additions 5.❑I am a general contracto'and I have hired the sub-contractors listed on the attached sheet. 13%O Rb6f repairs These sub-contractors have employees and have workers'comp.insurance? 14.Q Other 6.❑We area corporatiori and its.officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no e_mploydes.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: i homeowners who shooks,this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. Insurance Company Name: 1 ExpirationDate: r Policy#or Self-ins.Lic.#: r �p I City/State/Zip: 01 �01 Job Site Address: °� z Attach a copy of the wolckers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a0.00 criminalSP iWOiRKpO DER and a fine of up to $2by a fidb up to 00.00 a imprisonment,as well as civil penalties in the form insurance and/or one-year imp e forwarded to the Office of Investigations of the DIA for in violator.A co of this statement may b day against the viol 1?Y coverage verification. Ido hereby certify under ilaepains and penalties of perjury that the information provided above is true and correct. Date: Signature: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.other Phone#: Contact Person: F Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their enipl6yees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hiik express or implied,oral or written." An employer is d'efuied 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 ppan 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 b6 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 r`equtred." Additionally,MGL chapter 152,§25C(1)states"Neither the commonwealth nor any of its political subdivisions shall enter intp any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of thus chapter have been presented to the contracting authority." Applicants Pleasb 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 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 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"fob 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 0-e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MA.SSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia s , _ 0MMONWEALTH OF MASSACHUSETTS Ism • - • • + BOARb t>1+ E�Ei.TRICi�NS 1 SSUS THE F0LLOWi 'G'L I CENSE W .f j AS' A REf .tOURNEYMAN LLECTR I��I AN M,ICH'A€L A FARING 23 H ORCHART3 AVE `st �~ (v A4 PHI LL. Mk 01830-435 f 12955 ol7�t �>6 °65600