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Miscellaneous - 64 BLUE RIDGE ROAD 4/30/2018 (3)
64 BLUERIDGE ROAD 210/065.0 0109-0000.0 L o Date.O �d./�,/r ...... .. Np to TOWN OF NORTH ANDOVER Of ,"1ti0 ., p` PERMIT FOR MECHANICAL INSTALLATION O m f p �,SSAC14 This certifies that . ?r 4 -'�<.r . . .,f✓r. i �?l�. . . . . . . . . has permission for mechanical installation . . . . . f v141�f . . . . . . . . . in the buildings of . . . ...>.r�nc. '2.�. .!C_. . . . . . . . . at . /J0 �,�? �.!q v; . :K: . . North Andover, Mass. Fee.��.'!. . . Lic. 'No.,, !-.k . . . GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date : 9 `3 o"� L/ Permit# Estimated Job Cost: Permit Fee: $_ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License Business Information: Property Owner/Job Location Information: Name: S ) o rel 0 )F(A n c, o u c h Name: 1 7— Street: // 6 g w )^�f Street: �Ly� l�r�,'�kf) y Cit /Town:w , 1►� �C U-1 City/Town:( p &b6f X' Y � Telephone: /9S -2, 3 2 `3 7 Telephone: . Photo I.D. required/Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family Multi-family Condo/Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: Renovation: HVAC V Metal Roofing Kitchen-Exhaust System Chimney/Vents Provide brief description of work to be done: O t t v INSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes No❑ If you have checked Yes,indicat the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box0,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ❑ Master Title ❑ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# E.]Journeyperson-Restricted License Number: Fee$ Check at www.mass.gov/dpl Inspector Signature of Permit Approval t Sheet Metal Commercial Guidelines/Life Safety/Critical Systems Inspection Checklist Yes lino 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 01611`ances,fire rated enclosures and pressure testing required: !. .. . res i-aintb instaltod xOdUte'zequi.red'on eka,t egtiipment and v.'Xr . , Duct penetrations in and fiQors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct nuns installed 6'-0"maximum length Ductwork installed using proper hanger spacing,hanger stock,threaded rod and angle iron Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean-properly sized filters installed(final inspection) Testing and Balancing report complete(final sign-off) od 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 All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating/cooling load calculations , Duct work sized per manual "D"calculations Bath/shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0"maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork/plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean-properly sized filter installed(final inspection) Testing and Balancing report complete(final sign-ofo Load Short Form Job: Date: Sep 22,2014 Attic Unit By: Christopher Bergeron S.G. Torrice Co. 80 Industrial Way,Wilmington,MA 01887 Phone:(800)888-8359 Fax:(978)657-4255 Email:cbergeron@sgtonice.com Project • • For: Mike Gagnon 100 Ogunquit Road, North Andover, MA 01845 Design Information Htg Clg Infiltration Outside db(°F) 2 88 Method Simplified Inside db(°F) 72 75 Construction quality Semi-tight Design TD(°F) 70 13 Fireplaces 1 (Semi-tight) Daily range - L Inside humidity(%) 50 50 Moisture difference(grAb) 54 28 HEATING EQUIPMENT COOLING EQUIPMENT Make American Standard Make American Standard Trade GOLD XI Trade GOLD XI Model AUH1B040A9H21B" Cond 4A7A6018H1 AHRI ref 5722433 Coil 4NXCB025AC3 AHRI ref 5980819 Efficiency 95 AFUE Efficiency 13.0 EER, 16 SEER Heating input 40000 Btuh Sensible cooling 12320 Btuh Heating output 38000 Btuh Latent cooling 5280 Btuh Temperature rise 59 OF Total cooling 17600 Btuh Actual air flow 587 cfm Actual air flow 587 cfm Air flow factor 0.040 cfm/Btuh Air flow factor 0.106 cfm/Btuh Static pressure 0.10 in H2O Static pressure 0.10 in H2O Space thermostat Load sensible heat ratio 0.84 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (fl) (Btuh) (Btuh) (cfm) (cfm) CL.4 9 0 0 0 0 BATH 1 74 991 304 40 32 BEDROOM 2 198 3260 928 130 98 W/D 49 434 739 17 78 CL.5 16 0 0 0 0 LIN. 20 0 0 0 0 CL.6 10 0 0 0 0 W.I.C.2 88 2012 422 81 45 BRIDGE 56 711 174 28 18 HALL 102 397 200 16 21 BEDROOM 3 201 3708 1564 148 166 CL. 6 0 0 0 0 W.I.C. 1 39 97 65 4 7 LIN 5 0 0 0 0 BATH 2 88 1165 284 47 30 BEDROOM 4 175 1899 864 76 92 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. ti + wrightSoft' Ri 9 2014-Sep-22 11:age 1 ht-Su@e®Universal 2015 15.0.02 RSU17410 Page 1 ...Wike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N — J Attic Unit d 1136 14674 5542 587 587 Other equip loads 0 0 Equip.@ 1.00 RSM 5542 Latent cooling 1047 TOTALS I 1136 l 14674 6589 I 587 I 587 Calculation approved Calculations a o ed b ACCA to meet all requirements of Manual J 8th Ed. Pp Y q 2014-Sep-22 11:38:54 wrightSOft' Right-Suite®Universal 201515.0.02RSU17410 Paget ...Wike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N Load Short Form Job:Date: Sep 22,Zona Basement Unit By: Christopher Bergeron S.G. Torrice Co. 80 Industrial Way,Wilmington,MA 01887 Phone:(800)888-8359 Fax:(978)6574255 Email:cbergeron@sgtorrice.com Project • • For: Mike Gagnon 100 O un uit Road North Andover MA 01845 9 q Design Information Htg Clg Infiltration Outside db(°F) 2 88 Method Simplified Inside db(°F) 72 75 Construction quality Semi-tight Design TD(°F) 70 13 Fireplaces 1 (Semi-tight) Daily range - L Inside humidity(%) 50 50 Moisture difference(gr/Ib) 54 28 HEATING EQUIPMENT COOLING EQUIPMENT Make American Standard Make American Standard Trade GOLD ZM Trade GOLD XI Model AUH2B080A9V4VB* Cond 4A7A6042H1 AHRI ref 5722440 Coil 4TXCB042BC3 AHRI ref 5874393 Efficiency 97 AFUE Efficiency 11.5 EER, 14 SEER Heating input 80000 Btuh Sensible cooling 27300 Btuh Heating output 78000 Btuh Latent cooling 11700 Btuh Temperature rise 55 OF Total cooling 39000 Btuh Actual air flow 1300 cfm Actual air flow 1300 cfm Air flow factor 0.024 cfm/Btuh Air flow factor 0.048 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 (ft2) (Btuh) (Btuh) (Cfm) (cfm) DEN/OFFICE 179 3848 2987 92 143 CL.1 7 0 0 0 0 POWDER 59 1621 912 39 44 GREAT ROOM 347 6740 3178 162 152 EATING 149 2111 523 51 25 KITCHEN 367 5068 4009 122 192 STAIRS 64 0 0 0 0 BR. 6 0 0 0 0 HALLWAY 60 0 0 0 0 DINING 241 2880 1563 69 75 FOYER 136 5166 1726 124 83 CL.3 9 0 0 0 0 CL.2 9 0 0 0 0 BEDROOM 1 350 10033 6768 241 324 W.I.C. 54 72 12 2 1 MASTER BATH 108 1186 714 28 34 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2014-Sep-22 11:38:54 wrightsoft Right-Suite®Universal 2015 15.0.02 RSU17410 Page 3 ...XMike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N •B.STAIRS 64 1442 421 35 20 RECREATION AREA 551 12356 3948 297 189 BATH 3 90 1600 388 38 19 Basement Unit d 2848 54124 27148 1300 1300 Other equip loads 0 0 Equip. @ 1.00 RSM 27148 Latent cooling 3860 TOTALS I 2848 I 54124 i 31007 l 1300 I 1300 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2014-Sep-22 11:38:54 wrightsoft` Right-Suite®Universal 201515.0.02RSU17410 Page XA Wike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N Component Constructions Job: Date: Sep 22,2014 Basement Unit By: Christopher Bergeron S.G. Torrice Co. 80 Industrial Way,Wilmington,MA 01887 Phone:(800)888-8359 Fax:(978)6574255 Email:cbergeron@sgtorrice.com Project Information For: Mike Gagnon 100 Ogunquit Road, North Andover, MA 01845 Design Conditions Location: Indoor: Heating Cooling Boston Logan Int'I AP, MA, US Indoor temperature(°F) 72 75 Elevation: 30 ft Design TD(°F) 70 13 Latitude: 420N Relative humidity(%) 50 50 Outdoor: Heating Cooling Moisture difference(gr/Ib) 53.6 27.8 Dry bulb(°F) 2 88 Infiltration: Dailyrange(°F) - 15 ( L ) Method Simplified Mtbulb(°F) - 72 Construction quality Semi-tight Wind speed(mph) 15.0 7.5 Fireplaces 1 (Semi-tight) _Construction descriptions Or Area Ll-value Insul R Htg HTM Loss Cig HTM Gain 4' BtuhAr=-°F T-'F/Bhih Bhbff Btuh Bluhr Btuh Walls 12F-Osw:Frm wall,vni ext,3/8"wood shth,r-21 cav ins,1/2"gypsum n 519 0.065 21.0 4.53 2349 0.99 516 board int fish,2"x6"wood frm,16"o.c.stud a 355 0.065 21.0 4.53 1608 0.99 353 s 434 0.065 21.0 4.53 1966 0.99 432 w 666 0.065 21.0 4.53 3015 0.99 662 all 1973 0.065 21.0 4.53 8939 0.99 1962 14F-0:Blk wall,vnl ext,2"x4"wood int frm, 10"thk,r-11 cav ins,3/8" n 165 0.341 0 23.8 3922 5.93 979 wood shth,1/2"gypsum board int fnsh 15B11-Owc-6:Bg wall,light dry soil,2"x4"wood int frm,concrete wall, n 72 0.056 11.0 4.47 321 0.21 15 r-11 cav ins,10"thk,1/2"gypsum board int fish w 180 0.056 11.0 4.41 796 0.19 35 all 252 0.056 11.0 4.43 1117 0.20 50 Partitions 12C-Osw:Frm wall,stucco ext,r-13 cav ins,2"x4"wood frm,16"o.c. 422 0.091 13.0 6.34 2679 1.06 446 stud Windows 1 OD-f:2 glazing,clr outr,argon gas,insulated fiberglass frm mat,dr n 18 0.420 0 29.3 512 6.75 118 low-e innr,1/2"gap,1/4"thk;50% blinds 45°,light;6.67 ft head ht n 116 0.320 0 22.3 2587 10.1 1168 e 65 0.320 0 22.3 1450 38.1 2476 s 135 0.320 0 22.3 3011 19.1 2580 w 23 0.320 0 22.3 502 38.1 857 all 356 0.320 0 22.6 8062 20.2 7199 2 glazing,cir outr,argon gas,insulated fiberglass frm mat,cir low-e n 25 0.320 0 22.3 558 12.6 316 innr,1/2"gap,1/4"thk:2 glazing,dr outr,argon gas,insulated n 42 0.410 0 28.6 1200 13.8 578 fiberglass frm mat,clr low-e innr,1/2"gap,1/4"thk;6.67 ft head ht w 4 0.320 0 22.3 84 46.3 173 all 71 0.320 0 26.0 1841 15.1 1067 2 glazing,cir outr,argon gas,insulated fiberglass frm mat,dr low-e s 14 0.320 0 22.3 312 10.1 141 innr,1/2"gap, 1/4"thk:2 glazing,cir outr,argon gas,insulated fiberglass frm mat,clr low-e innr,1/2"gap, 1/4"thk;50%blinds 45°, light;4.5 ft overhang(7 ft window ht,2 ft sep.);6.67 ft head ht Doors 11 JO:Door,mtl fbrgl type s 21 0.600 6.3 41.8 878 15.9 334 wri htSOft` 2014-Sep-22 11:age 1 9 Rig 2015 15.0.02 RSU17410 Page 1 ...Unlike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N 11A0:Door,wd he type n 66 0.470 0 32.8 2151 12.5 818 Ceilings 16B-38ad:Attic ceiling,asphalt shingles roof mat,r-38 ceil ins,1/2" 972 0.026 38.0 1.81 1762 1.30 1264 gypsum board int fish C part ceiling,:C part ceiling,carpet fir fnsh,frm fir,6"thkns,1/2" 284 0.224 1.0 15.6 4418 15.6 4437 gypsum board int fish Floors 19C-19cscp:Flr floor,frm fir,6"thkns,carpet fir fish,r-2 ext ins,r-19 1146 0.049 30.0 1.18 1357 0.21 245 cav ins,tight ctwl ovr,r-11 wall insul 20P-30w:Flr floor,frm fir,6"thkns,hrd wd fir fish,r-30 cav ins,gar 293 0.035 30.0 2.44 714 0.35 102 ovr 21A-28c:Bg floor,light dry soil,6.5'depth,carpet fir fnsh 705 0.022 0 1.53 1080 0 0 wri htsoft' 2014-Sep-22 11:age 2 9 Right-Suite®Universa1201515.0.02RSU17410 Paget RCCA ...Wlike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N " Component Constructions Job:Date: Sep 22,2014 Attic Unit 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: Mike Gagnon 100 Ogunquit Road, North Andover, MA 01845 Design Conditions Location: Indoor: Heating Cooling Boston Logan Intl AP, MA, US Indoor temperature(°F) 72 75 Elevation: 30 ft Design TD(°F) 70 13 Latitude: 420N Relative humidity(%) 50 50 Outdoor: Heating Cooling Moisture difference(gr/Ib) 53.6 27.8 Dry bulb(°F) 2 88 Infiltration: Dailyrange(°F) - 15 ( L ) Method Simplified Wetbulb(°F) - 72 Construction quality Semi-tight Wind speed(mph) 15.0 7.5 Fireplaces 1 (Semi-tight) Construction descriptions Or Area 1.1-value Insul R Htg HTM Loss Clg HTM Gain ft' BluhM2--°F f'-°FBtuh BIuhRF Btuh Bluhff Btuh Walls 12F-Osw:Firm wall,vnl ext,3/8"wood shth,r-21 cav ins,1/2"gypsum n 263 0.065 21.0 4.53 1192 0.99 262 board int fish,2"x6"wood frm,16"o.c.stud a 304 0.065 21.0 4.53 1375 0.99 302 s 319 0.065 21.0 4.53 1445 0.99 317 W 48 0.065 21.0 4.53 217 0.99 48 all 934 0.065 21.0 4.53 4229 0.99 928 Partitions (none) Windows 2 glazing,dr outr,argon gas,insulated fiberglass firm mat,dr low-e n 33 0.320 0 22.3 736 10.1 332 innr,1/2"gap,1/4"thk:2 glazing,clr outr,argon gas,insulated a 13 0.320 0 22.3 279 38.1 476 fiberglass firm mat,clr low-e innr,1/2"gap, 1/4"thk;50%blinds 45°, s 25 0.320 0 22.3 558 19.1 478 light;6.67 ft head ht all 71 0.320 0 22.3 1572 18.2 1286 Doors (none) Ceilings 1613-38ad:Attic ceiling,asphalt shingles roof mat,r-38 cell ins,1/2" 1136 0.026 38.0 1.81 2058 1.30 1476 gypsum board int fish Floors (none) 2014-Sep-22 11:38:54 A wrightsoft' Right-Suite®Universal 2015 15.0.02 RSU17410 Page 3 Z& ...Nike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N Summary ProjectSummary Job: Date: Sep 22,2014 Attic Unit 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 Information For: Mike Gagnon 100 Ogunquit Road, North Andover, MA 01845 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: Boston Logan Int'I AP, MA, US Winter Design Conditions Summer Design Conditions Outside db 2 OF Outside db 88 OF Inside db 72 OF Inside db 75 OF Design TD 70 OF Design TD 13 OF Daily range L Relative humidity 50 % Moisture difference 28 gr/lb Heating Summary Sensible Cooling Equipment Load Sizing Structure 11323 Btuh Structure 4491 Btuh Ducts 3351 Btuh Ducts 1051 Btuh Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 14674 Btuh Use manufacturer's data y Rate/swing multiplier 1.00 Infiltration Equipment sensible load 5542 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Semi-tight Fireplaces 1 (Semi-tight) Structure 408 Btuh Ducts 639 Btuh Heating Cooling Central vent(0 cfm) 0 Btuh Area(ftp 1136 1136 Equipment latent load 1047 Btuh Volume(ft) 9086 9086 Air changes/hour 0.30 0.14 Equipment total load 6589 Btuh Equiv.AVF(cfm) 45 22 Req.total capacity at 0.70 SHR 0.7 ton Heating Equipment Summary Cooling Equipment Summary Make American Standard Make American Standard Trade GOLD XI Trade GOLD XI Model AUH1B040A9H21B" Cond 4A7A6018H1 AHRI ref 5722433 Coil 4NXCB025AC3 AHRI ref 5980819 Efficiency 95 AFUE Efficiency 13.0 EER, 16 SEER Heating input 40000 Btuh Sensible cooling 12320 Btuh Heating output 38000 Btuh Latent cooling 5280 Btuh Temperature rise 59 OF Total cooling 17600 Btuh Actual air flow 587 cfm Actual air flow 587 cfm Air flow factor 0.040 cfm/Btuh Air flow factor 0.106 cfm/Btuh Static pressure 0.10 in H2O Static pressure 0.10 in H2O Space thermostat Load sensible heat ratio 0.84 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. y htsolft; 2014-Sep-2211:38:54 g1 wr I+LS.P. Gagnon-1 � Right-SuiteC�Universal 2015 15.0.02 RSU17410 Page 1 ...\Mike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N Pro ect Summary Job: J • Date: Sep 22,2014 Basement Unit By: Christopher Bergeron S.G. Torrice Co. 80 Industrial Way,Wilmington,MA 01887 Phone:(800)888-8359 Fax:(978)657-4255 Email:cbergeron@sgtonice.com •ject Information For: Mike Gagnon 100 Ogunquit Road, North Andover, MA 01845 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: Boston Logan Int'I AP, MA, US Winter Design Conditions Summer Design Conditions Outside db 2 OF Outside db 88 OF Inside db 72 OF Inside db 75 OF Design TD 70 OF Design TD 13 OF Daily range L Relative humidity 50 % Moisture difference 28 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 48352 Btuh Structure 24884 Btuh Ducts 5772 Btuh Ducts 2264 Btuh Central vent(0 cfm) 0 Btuh Central vent(0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 54124 Btuh Use manufacturer's data y Rate/swing multiplier 1.00 Infiltration Equipment sensible load 27148 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Semi-tight Fireplaces 1 (Semi-tight) Structure 2075 Btuh Ducts 1785 Btuh Heating Cooling Central vent(0 cfm) 0 Btuh Area(ftp 2848 2848 Equipment latent load 3860 Btuh Volume(ftp 27225 27225 Air changes/hour 0.26 0.13 Equipment total load 31007 Btuh Equiv.AVF(cfm) 119 57 Req.total capacity at 0.70 SHR 3.2 ton Heating Equipment Summary Cooling Equipment Summary Make American Standard Make American Standard Trade GOLD ZM Trade GOLD XI Model AUH2B080A9V4VB" Cond 4A7A6042H1 AHRI ref 5722440 Coil 4TXCB042BC3 AHRI ref 5874393 Efficiency 97 AFUE Efficiency 11.5 EER, 14 SEER Heating input 80000 Btuh Sensible cooling 27300 Btuh Heating output 78000 Btuh Latent cooling 11700 Btuh Temperature rise 55 OF Total cooling 39000 Btuh Actual air flow 1300 cfm Actual air flow 1300 cfm Air flow factor 0.024 cfm/Btuh Air flow factor 0.048 cfm/Btuh Static pressure 0.10 in H2O Static pressure 0.10 in H2O Space thermostat Load sensible heat ratio 0.88 A A to meet all Calculations approved by CC requirements of Manual J 8th Ed. iSI.0 + wri htSOft' 2014-Sep-22 2 9 Right-Suite®Universa1201515.0.02RSU17410 Paget \Mike Gagnon-100 Ogunquit Rd,North Andover.rup Calc=MJ8 Front Door faces: N N First Floor EATING KITCHEN GREAT ROOM ST IR: POWDER T� A BR. W.I.C. MASTER BATT- CL.1 HALLWAY II DEN/OFFICE DINING BEDROOM 1 FOYER CL.2 CL.3 Job#: S.G. Torrice Co. Scale: 1 : 100 Performed by Christopher Bergeron for: Page 1 Mike Gagnon 80 Industrial Way Y Rig ht-Suite®Universal 2015 100 Ogunquit Road North Andover,MA Wilmington,MA 01887 15.0.02 RSU17410 Phone:(800)888-8359 Fax:(978)657-4255 2014-Sep-22 11:39:04 cbergeron@sgtorrice.com 0 Ogunquit Rd,North Andover.rup 1 N Second Floor BATH BEDROOM 2 UPPER GREAT ROOK CL.j U. STAIR' CL.5' W/D • ' LIN. W.I.C. i BRIDGE HALL CL. W.I.C. i LIN BEDROOM 4 BEDROOM 3 UPPER FOYER BATH 2 CL. Job#: S.G. Torrice Co. Scale: 1 : 100 Performed by Christopher Bergeron for: Page 2 Mike Gagnon 80 Industrial Way y Rig ht-Suite®Universal 2015 700 Ogunquit Road North Andover,MA Wilmington,MA 01887 15.0.02 RSU17410 Phone:(800)888-8359 Fax:(978)657-4255 2014-Sep-22 11:39:04 cbergeron@sgtorrice.com 0 Ogunquit Rd,North Andover.rup N Basement RECREATION AREA i B. STAIRS BATH 3 GARAGE STORAGE Job#: S.G. Torrice Co. Scale: 1 : 100 Performed by Christopher Bergeron for: Page 3 Mike Gagnon 80 Industrial Way Rig ht-Su ite®Univ ersa12015 100 Ogunquit Road Wilmin ton,MA 01887 9 15.0.02 RSU 17410 North Andover,MA 01845 Phone:(800)888-8359 Fax:(978)657-4255 2014-Sep-22 11:39:05 cbergeron@sgtordce.com 0 Ogunquit Rd,North Andover.rup N First Floor �162 dm 1 R96 dm EATING KITCHEN R96 m 369 dm I GREAT ROOM ST . RS ��MER �2 dm BR. W.I.C. MASTER BATH dm CL.i • HAL WWN dm7 9 359 dm DEN/OFFICE DINING BEDROOM i 62 cfm FOYER 4 162 dm ELY" ®. CL.3 1 4 dm Job#: S.G. Torrice Co. Scale: 1 : 105 Performed by Christopher Bergeron for: Page 1 Mike Gagnon 80 Industrial Way Right-Suite®Universal 2015 100 Ogunquit Road Wilmington,MA 01887 15.0.02 RSU17410 North Andover,MA 01845 Phone:(800)888-8359 Fax:(978)657-4255 2014-Sep-23 08:56:04 cbergeron@sgtomce.com 0 Ogunquit Rd,North Andover.rup N � Basement 7" Usl 148 dr i 6x8 148 dm 7 RECREATION AREA ` 7" I 6 370 cfmg SIAI S 6" Ef — I ,5 DA 310 S of 38 cfm X5" I 4 6A kA6E 4" 1�18 L=9 16x8 22x8 8 116x8 8x8 x8 1 1 X " 10x8 10 I I10 © 7 I) 24x8 _ _ _ _ 10" I 7" 6„ 10x8 7„ 7„ STORAGE Job#: S.G. Torrice Co. Scale: 1 : 105 Performed by Christopher Bergeron for: Page 3 Mike Gagnon 80 Industrial Way Right-Suite(H)Universal 2015 100 Ogunquit Road Wilmington,MA 01887 15.0.02 RSU17410 North Andover,MA 01845 Phone:(800)888-8359 Fax:(978)657-4255 2014-Sep-23 08:56:04 cbergeron@sgtordce.com 0 Ogunquit Rd,North Andover.rup - ONWEALTH OF MAS p► HI SEn • ����:COMM• � • • • SHEET . QWDRKERS I C.EN5E :.... .:..:::i .. ISSUESTHE' FbLLNRE$TRICTED ` S, q< p,STER U r EN I C J... D I F DDM i 1. x.88GOW 7 TON 28/1.6..,<;.,;: .<;' 223 365 -- . . DOMEN-1 OP ID: ML DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/30/2014 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). CONTACT PRODUCER Phone:781-455-6664 NAME, Brown& Brown of MA,LLC DBA Fax:781-453-0204 PHONE FAX Richard W.Endlar Ins.Agency c o Ext A/C No): 858 Washington St.Ste#200 ADDRESS: Dedham,MA 02026-6099 Howard A.Savitt INSURER(S)AFFORDING COVERAGE NAIC 4 INSURER A:Arbella Ins. Group 17000 INSURED Domenic DiFranco INSURER B: 11 Dowing Rd. Wilmington, MA 01887 INSURER C: INSURER 0: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTypE OF INSURANCE TR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 8500047105 05/19/2014 05/19/2015 PREMISES Ea occurrence $ 50,00 CLAIMS-MADE Fx-]OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aocident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Peraoddeni) $ HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS (per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION I WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LJMITSi ER ANY PROPRIETOR/PARTNER/EXECUTNEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) L.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) RE: 100 Ogunquit Rd. , North Andover CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. Laura AUTHORIZED REPRESENTATIVE ©1988-201 D ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD h h.�). Date... . ............... 3?; aoL TOWN OF NORTH ANDOVER p PERMIT FOR WIRING 00 $s�CHU 1 � Thiscertifies that ... .................................... ........................................................................ has permission to perform ... e......... .....`'.Y...........I.........:..... ............ awiring in the building of.....-4 ........... .......,N"!;OR ................`�1, .............................................. A....�.......... l� u ....................1 ... ELECTRIC Check#2q c5S— N r nly -a\- Common wealth of Massachusetts Official Use O Permit No. Department artment of Fire Services Occupancy and Fee Checked a • BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07j geaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C),5 12.00 (PLEASE PRINT IN NK OR TYPE ALL INFORMATION) Date: City or Town oh. NORTH ANDOVER To the s ector of Miresl By this application the undersigned gives notice of his or her in ntion to perform the electrical work described below. Location(Street&Number) & 51 cJ RI dol'7 Owner or Tenant 5 N t Telephone No. f e- 2 7 Owner's Address d Is this permit in conjunction with a building permit? Yes No [I (Check Appropriate Box) Purpose of Building C� ea!� t '�S (,0 Utility Authorization No. - Existing ServiceW Amps 1,20 /a,?SVVolts Overhead❑ Undgrd 0 No.of Meters f' New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: G✓ e ��-� c -�L o 4 Completion of thefollowing table may be waived by the Insnector nfWira.c, No.of Recessed Luminaires 13 No.of Cell:Susp.(Paddle)FG I1,� ` No.of Luminaire Outlets No.of Hot Tubs ��ll e I D /�`�"'�•- No.of Luminaires -2 Swimming Pool Above No.of Receptacle Outlets !d No.of Oil Burners No.of SwitchesNo.of Gas Burners , i No.of Ranges No.of Air Cond. Tots �e Ton; No.of Waste Disposers Heat Pump I Number Tons Totals: ....................... No.of Dishwashers Space/Area Heating KW Ulf No.of Dryers Heating Appliances K Ul f No.of Water KW No.of No.of 1 Heaters Signs - Ballasts P No.Hydromassage Bathtubs No.of Motors Total H OTHER: Attach additional detail if desired,or as required by the Inspector of Mres. Estimated Value of lectrical Work: O!J V D (When required by municipal policy.) Work to Start: 7 I Ll Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE GE. 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 covere is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,tinder thepa' ndpena�ties ofperjury, the information on this application is true and complete. s a FIRM NAME: JU LIC.NO.: 3Cc D L� Licensee: A iv CLe S Signature C IC.NO.:f&,0 3 L^ f applicable,ente "exem t" 'n the ' erase er line.) Bus.Tel.No.: z 3� (I pP p D v Address: � Alt.Tel.No.:1� *Per M.G.L c. 147,s.57- ,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAVER: 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 d 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. 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 R Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 Re-Inspection Required($.) ❑ ; Inspectors Comments: Inspectors Signature: Date: FINAL INSP CTION: Pass K Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. ....... weinhold@townofinerrimae.com Commonwealth of Massachusetts Official Use Only of Fire ServicesPermit No. o Department Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts ElectricaVCode C),�C 12.00 (PLEASE PRINTINNK OR TYPE ALL.INFORMATION) Date: 1141City or Town of: NORTH ANDOVER To ther of 67resl. By this application the undersigned gives notice of his or her m ntion to perform the electrical work described below. Location(Street&Number) (� �1 V ie(* dol`T Owner or Tenant _5 N R t" Telephone No. L 2 Owner's Address al—ac Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building C <,�• P�d� t S Utility Authorization No. Existing ServiceW Amps 1.20 lo?WVolts Overhead❑ Undgrd❑/' No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: G) e Completion of the following table may be waived by the Inspector of Wires. No.of Recessed LuminairesNo.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires -2 Swimming Pool Above ❑ In- El o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets !Q No.of Oil Burners FIRE ALARMS No. of Zones No.of SwitchesNo.of Gas Burners No.of Detection and f Initiating Devices Tot No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons K No.of Self-Contained .................................................... Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent P 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 Wires. Estimated Valueof lectrical Work: O d 4) !� D (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE GE. 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 co?ve5pge is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE 0 BOND ❑ OTHER ❑ (Specify:) I certify,cinder the pa' s and penallies ofeT* �the information on this application is true and complete. � FIRM NAME: 141.4 lu 7 LIC.NO.: 3Co D L� Licensee: CIAX le-NISignature IC.NO.: &,P 3 L^ (If applicable,ente "exempt" 'n the i en e, line.) p Bus.Tel.NO.-� z Address: � Al J4 Alt.Tel.No.: � *Per M.G.L c. 147,s.57- ,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c.143,§3L,the C 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,ary 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. Permits shallbelimited 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 0 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 F?1 Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass F?1 Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSP CHON: Pass K Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. ......lweinhold@townofmerrimac.com ry The Commonwealth of Massachusetts Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): / C_ Address: D City/State/Zip: f D w/1 S t&I (>`y6 Phone#: �- d Z ' 3 k:�. . Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers'comp.insurance. g, El Building addition [No workers'comp.insurance 5. ElWe are a corporation and its 1011 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]i employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box Of must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they hire doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lie.#: Expiration Date: 7db Site Address: City/State/Zip: AtEach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of 'Investigations of the DTA for insurance coverage verification. IT do hereby certo under Aepains anldpenalties ofperjury that the information pro vlldedabove is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to he 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 - - - Contact Person: Phone#: 4 i Information and Instruction*8 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 been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. De advised that this affidavit maybe 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 permithicense 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(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. 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: Tho Coxr_�wliwwealtb ofMo88achusetts Dcpazt out offadustrial,Accidonta Office of uVestigatlou 600 WashiVoa Sheet Boston,MA 02111 Tel,#61.7-727-4900 ext 406 or 1-877-MASSAFF Revised 5-26-05 Fax#617-727-7749 W.1YlAC..q onv�Aia COMMONWEALTH OF MM$S HUSETTS �oAM bF ELCTRI C 1 AN ISSUES 144. FOLLOWING LICENSE AS A 1I 'JOURN),YMAN LCtiR I{int ALAW< T CAREY W 90 ASH S '. v TO IISH�ND: 1�A 014697 41`0 6o E o I /I + 7760 sl � 1-�Date . . I . . . . • TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION 1 This certifies �. . .` ?p . . NP.� Pas permission for gas installation . . .a. . . . . . . . . . . . . . . . . . . . . . . . . -4n the buildings of--.4. (AAT):Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . .l.S?`"i . .Z.Vi -q - .Z. 4 � �. . . , North Andover, Mass. Fee . . . . Lic. No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR Check# �o� 8803 t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY ' ft—'11 MA DATE-/�-L? PERMIT# JOBSITE ADDRESS Jr ��4��_ OWNER'S NAME A c:fr4 1-/ti I1 k 7 � GI OWNER ADDRESS TELL!z.,l,; ,7/z-216 FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL PRINT RESIfiENTIAle1� CLEARLY LAI RENOVATION:[, REPLACEMENT: PLANS SUBMITTED: YES® N00 APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 !l 10 11 12 1 13 14 C BOILER �R BOOSTER I CONVERSION BURNER s COOK STOVE I DIRECT VENT HEATER DRYER f :! FIREPLACE FRYOLATOR FURNACE GENERATOR b� GRILLE it INFRARED HEATER �r LABORATORY COCKS T MAKEUP AIR UNIT OVEN I POOL HEATER ROOM ISPACE HEATER I f ROOF TOP UNIT 1 1 TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of RflGL.Ch.142 YES NO ® ggJJ IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW r LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY BOND OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage retnr4d by ChapPr 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER F-1AGENTF-1d SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true anc ccurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian a ith all Pertinent rovision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMB ER-GASFITTER NAME' c,e- a LICENSE#�'" S64TURE MP MGF I � r—� (� � � f------ —'� � JP , JGF LP I G� ,..w..� ,,,,� � GI CORPORATION�# PARTNE HIP�4�;#=LLC[I#� COMPANY NAME: LJ/A: C/- c '!ADDRESS! ,a t✓ ��i �_ h� CITY Gtr. tr r STATE I// ZIP( f/ T TEL�: � �� FAX :'CELLI !EMAIL ��10 ���/'/moi r The Commonwealth of Massachuselys Department of Industrial Accidents � ��•� Office ofInvestig anions 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/F ft-tricians/plumbers Avolicant Information Tease Print Name(Business/Organization/Individual): Townsend on Company, Inc. Address: 27 Cherry Street PO Bog 90 City/State/Zip: Danvers, MA 01923 Phone#: 978-777-07.00: Are you an employer?Check the appropriate box: 1.® I am a employer with 60 4. [] I am a general contr7sheet. Typ�of project(required): employees(full and/or part-time).* have hired the sub-c6. I`�ew constxucxion 2.❑ lam a sole proprietor or partner- listed on the attache7. [ Remodeling ship and have no employees These sub-contractorsave working for me in any capacity. employees and have workers' g' emolition [No workers'comp. insurance comp.insurance.+ 9. Building addition 3.❑ required] 5. We are a corporation and its 10. Flectrical repairs or additions I am a homeowner doing all work officers have exercised their myself. [No workers'comp. right of exemption per MGL l 1'[�Plumbing repairs or additions insurance required.]t c. 152,§1(4),and we have no 12.0 Roof repairs employees. (No workers' 13.[{Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'co enationof t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mus '- ,tion afr&vft jn g� tContractors that check this box must attached an additional sheet showing the risme of the sub-coahactors and state w or not those ea i a l employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensatnon Insurance for my employees Be1ew is the information. policy and j�s s Insurance Company Name: h l (/, aH� G_—Se_,' Policy#or Self-ins.Lic_#: UV (5- Expiration Date:_ G Job Site Address: c,e City/State/Zip:__. Attach a copy of the workers'compensation policy declaration show" the olie Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the' of cri�tnmal tratlon date). f penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well.as civil penalties in the form of a StOO 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 forsvacded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der the pains and aloes of perjury that the information provided above'is true and correct Si ature: Phone#: Official use only. Do not write in this area,to be completed by c' u3'or town aricnal City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector moi,Plumbing Inspector 6.Other Contact Person: Phone#: -�TOWNSEND � ��'vQ/ �-"�PITRIEY 601y�3 Townsend Oil Company, Incorporated 02 IP 0003197595 JUL 182013 Post Office Box 90, Danvers, MA 01923 MAILED FROM ZIP CODE 01 923 ?`,jl:�`I ii �C�i;�ii Il�j��11��I�,\\•- 11�\IIS \'%\i�� l \�—i �'s%�.•% Q "r ' moN V-\\\�� ���!��j�j =i 64 S-2 4202:Q ,rr��'�'rJ�'1��1'►Ir�lll'I����f''r��i��'ll,ir!'r1r'�f"i�r�e�iri� COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS- Illi LICENSED AS AN LP GAS INSTALLER ISSUES THE ABOVE LICENSE TO`. JOSEPH, T GURRY III 3 JOHN ST APT 9 METHUEN MA 01844-5051 885 05/01/14 183465 EXPIRATIONLICENSE NO., DATE SERIAL NO. Date.. ........... 1............ TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING BSACM�l5� This certifies that .....A..... W...........0....0.......A.....P....14."... ...................................................... has permission to perform ......h............ `? ....... ..... ..... wiring in the building of...„. .G I Z at ....... ......� � .... . .. !.... ...................................North Andover�Ma - i MFee....(-.b........Lic.No. ;! ...... 0..)ii ....C. ... ......... tel, AL IN6PE6DR Check# } Commonwealth of Massachusetts Official Use Only i Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK 1 .All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINT 1N HK OR TYPE-4LL) FORMATION) Date: 3 — z7— 26/13 City or Town of: NORTH ANDOVER To the Inspector of Wires: „1 By this application the undersigned gives notice of his or her intention t perform the electrical work described below. Location(Street&Number) l y c��'_ R/ 4fe go Owner or Tenant W Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service O Amps 'M Volts Overhead❑ Undgrd No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: e/yl en I' Lely ode — Y� Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminairs !� No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of LuminairesSwimming Pool Above ❑ In- Elo.o mergency Lighting rnd. rnd. Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No. of Zones No.of Gas Burners No.of Detection and No.of Switches ��� Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices g Tons No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local❑ Municipal El Other p g Connection No.of Dryers Heating Appliances KW SecNoto Dev cl s or E uivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent U ' No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: "1 � I J "� d e-�o Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value ofElectrical Work: 3 S ,� (When required by municipal policy.) Work to Start: ,.26 / Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE VE G : 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,tinder the i s and penaltie perjury,that thef�rniation on this application is true and complete. �� FIRM NAME: . LIC.NO.: 6 0 3147 Licensee: /���}-/� j C L ��Signatur LIC.NO.: 6-o' 3 (If applicab e,enter "exem ' in icense er line.) Bus.Tel.No.:lel 6/ 3 Address: TDu'O'l St� /t't Alt.Tel.No.. -7S' *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. v Owner/Agent PERMIT FEE. $ /l 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 i permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed (7 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 .� r 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. 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 M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: r Pass M Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH ECTION: Pass 0/11, Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: 3 FINAL INSP N: Pass 7 Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: �G� s /y ,�z /� Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): r� Address:�� / S J i�� c/ `✓j City/State/Zip: Q Phone#: G, Ll' �� Z^�� 3� Are you an employer?Check the appropriate box: Type of project(required): . 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 21EXam a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]f 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. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sienature: Date Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: U Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.mass.gov/dia • a Z 'old, I n d, .Tuo r Detach Alonq All Perforations COMMONWEALTH OF MASSAUSETTS CH ELECTRICIANS AS AREG JOURNEYMAN ELECTRICIAN ISSUES THE ABOVE LICENSE TO: I 4LAN T.:CAREY .5 0 ASH.,. ST �..I N TOWNSHFND MA 01469 1410 ,GO [ OZ/3l/13 ggr131 ,`y4 rforahons •'''� 600�d r . r . ' CO Folq then Detach Along All . I NTRO[# l.,f j'� ` - P?tlorapon``If Uc t l(J / 389 DjLj. - ease is 1MPp NT i". Suite n Of prO lost o.de RTA �y if Your p ro Boston 1 y81oA 0 ce L. S4r notify yo OfCorrect name 2j18. e, 100p soar �. Res°cal qpp cation e o ar�areshown i8 c0Q W as�in9t n She: as acne enSO lS subtion. Alwas to lnSu ean9ed notify or assi tided It is lect to t, Ys refr t proAer rn -Your bo person o pod���nape ernat e .Prot,-Ision o�hfice ailingU f°e rd Y of p•!vd of n' r ws eS required b/aYe and h a icen�bOd o�a ryk Your aid �d. �S ODate .�fl.�� � � . O F 14. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that . . E���� . . . . .L . . , . . . . . , 'has permission to perform plumbing in the buildings of . . . . . . . . . . . . . . . . . . . . . at . . . ��� . . � . . . . . . . . . North Andover, Mass. . . . . . . . . . . . . . . I . . . . . . PLUMBING INSPECTOR Check#�. J -� ' MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY r' MA DATES PERMIT# JOBSITE ADDRESS f0 OWNER'S NAME ✓1 � P OWNERADDRESS O E jE 0D ! TELE_ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL PRINT CLEARLY NEW: ® RENOVATION:d REPLACEMENT:Ell PLANS SUBMITTED: YES®I Not( FIXTURES 7FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM i ._-_. ( ! � _....____1 -.. _.. I DEDICATED GREASE SYSTEM _-.----__1 __i f -._._...._1 ._____1 ____l DEDICATED GRAY WATER SYSTEM i DEDICATED WATER RECYCLE SYSTEM DISHWASHER ( -_.._-... __! ..___ I DRINKING FOUNTAINf FOOD DISPOSER FLOOR/AREA DRAIN f _.._.._— ( 1 I _....__..1 INTERCEPTOR(INTERIOR) KITCHEN SINK �__E _..___.! .._--__� _-.._.. 1 .___..._..[ ___-_-1 .._.___( _-._-_.._� .__._._.._I __._�_( _.__._-➢ ___.._l _._.__� LAVATORY ROOF DRAIN SHOWER STALL SERVICE/MOP SINK _.f TOILET URINAL _1 ._...--i _-- _i i __.._...E _._._..� _. ..._1 __. ` ..----J[ WASHING MACHINE CONNECTION E-77== ! WATER HEATER ALL TYPES C - I WATER PIPING ! .--_ I -_ _-! _ ._.._ ! ! __._ f ._ I ._-.. I _-- ! f _ . _f I t OTHER y _.___-f _-]I 1 I 17=11F__.-1 I ___ _ 1 _ i INSURANCE COVERAGE: have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES[-1 NO —1 IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW —Y ' LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY D1 BOND [7] OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the 1 Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT E SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian wit�rtinent rovisio of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME _�11� __ A LICENSE# 6 SIGNATU E MP .-I JP CORPORATION .. I#=PARTNERSHIP Q# LLC ok I Tq0,, r COMPANY NAME vj �G1�- �/ ^; ADDRESS CITY __......+STATE /!7./,4. 1 ZIP LQ� TEL FAX - I CELL _._.' EMAIL __..- ...-..._... - ROUGH PLUMBING INSPECTION NOTES BELOW FOR OFFICE USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES L4J nz The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations UIP. 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegjbL Name (Business/Organization/Individual):_ �/�� Address: /6 CA�o✓Ia �� A- City/State/Zip: /i4 Sb(Jr� M'k QIV� Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 1 7• Rf Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp. insurance 5. [1 We are a corporation and its 9. Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. kContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. T am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ?olicy#or Self-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip: kttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 'ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine if up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. i ature: Date: 3—;27 - /�} l� hone#: 9 S J ! 7 9 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#: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia Date . . �2-I TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that . . . • • . • • • . . • . . . . . . . has permission for gas installation . a- . .F�'�" . . . . . . . . . . . I, in the buildings of. .�. ,. . . . . . . . . . . . . . . . . • • • • . . • • • . s at . . . . . • ��-• •��• ��. • . ti.�.�Q� . . , North Andover, Mass. Fee . ---. . Lic. No. .Z(a(A3 . . . . . . . . . . . . . . . . . . . GASINSPECTOR Check# 8638 lA ` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK 4 CITY 0 MA DATE r 2II PERMIT# b ' JOBSITE ADDRESS U (� � �� OWNER'S NAME V OWNER ADDRESS _�a .,. a Lt, TEL _ FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW:[j RENOVATION:d REPLACEMENT:El PLANS SUBMITTED: YES 0 N0r--J1 APPLIANCES 7 FLOORS BSM 1 2 3 4 5 6 1 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE A J1,-- ( DIRECT VENT HEATER I DRYER FIREPLACE FRYOLATOR FURNACE - GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM I SPACE HEATER _ _— I L .._ _ _ I ROOF TOP UNIT s — _ _. . TEST UNIT HEATER UNVENTED ROOM HEATER I ►� ( I l _ _ �- WATER HEATER -dT-HER - _ I 1 -_ F— 1 —I -1 ! INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES JE-]NO -[] IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYC]_I OTHER TYPE INDEMNITY BOND F-11 _ 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 © AGENTjI SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia with all Pertinent pr vision f the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME 1 R-----,,--- _ __ LICENSE# SIGNATURt MP EJ1 MGF JP 5d JGF 0 LPGI�_( CORPORATION Q#=PARTNERSHIP®#=LLC el#[-EIV�YW COMPANY NAME: -C ��' -..�a1IADDRESS CITY _ S�j�J✓_ _.._ _�� _ STATE�ZIPp TEL FAX CELL -EMAIL - ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT# PLAN REVIEW NOTES �Q-d 1 ( The Commonwealth of Massachusetts Department of IndustrialAccidints 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 Lei=ibly Name(Business/Organization/Individual): A t�) `1 d/n` Address: Clh t4 rlv �e (-A City/State/Zip: /FAJ F S 6 uf� ✓n 1A Phone#: -2-,5 1% 92--- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. Pyeli construction ployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet.I �• Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. E]Building addition workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[:1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]f 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. I Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. J /�' Z� Signature: l//s / Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - Contact Person: Phone#: _ f Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office ofInyestigatiions 600 Washington.Street Boston.,MA 02111 Teel,#617-727-4900 at 406 or 1-877,TMASSAFE Revised 5-26-05 Fax##617-727-7749 www-mass.govfdia COMMONWEALTH OF MASSACHUSETTS PLUMBERS AND GASFITTERS , LICENSED AS A JOURNEYMAN PLUMBER tl . 15`SUESTHE ABOVE LICENSE TO i A `t DAVID L. TAYLOR " 16 , CHARLOTTE RD . i ! TEWK'S BURY MA ti1876-32D2 . 26643 05/.01/14 - 183719 ` Fold,Then Detach Along All Perforations � I A t ' CONTROL# H392304 IMPORTANT _.._.BOARD J If this license is lost or -destroyed; notify yc PL Division of Professional Licensure, 1000 Suite 71 0,Boston,MA 02118-6100. t i If your name or address shown is changed,' TYPE of correct name or address to insure propE f Renewal Application. Always refer to your _ j This license is subject to.the is' of t as amended.It is a personal pr , nd rrl or assigned to any other person. Keep hiss „- person or posted as required by law. Hill 110121U.. I 183719 ' 1 lD.1't.10 SECURITY€El t !` Fold,Then Detach Along All Perforatic I x I ;z Y., ,