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Miscellaneous - 659 WAVERLY ROAD 4/30/2018
L- - m M 10503 Date .1,--,--1- n..11............ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that A,....)Ck.QA A ........... L. -O... ...... ...... .... ... ...... .. .. . ..... ........ has permission to perform ..... ................................................... plumbing in the buildings of......i--.1¢. . ................................................................ at ......(P ...... .............................. North Andover, Mass. Fee--�3 ...... Lic. No. S&�o .... .... Ht. ...................... ********* ...... PLUMBING INSPECTOR Check # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK ' CITY�+� IMA DATE ( PERMIT# JOBSITEADDRESS QA ``�'(�� OWNER'S NAME POWNER ADDRESS TEL ��� FAX -- TYPE OR OCCUPANCYTYPE COMMERCIAL EDUCATIONAL © RESIDENTIAL PRINT 6k CLEARLY NEW: RENOVATION& REPLACEMENT: 01 PLANS SUBMITTED: YES ® N0Pk FIXTURES'l FLOOR- BSM BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GASIOILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER _ DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK LAVATORY ROOF DRAIN I— .S„ �OWER STALL SERVICE/ MOP SINK ?OILET WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER OTHER 10 1 11 1 12 1 13 1 14 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES .-..; NO I i IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY Q OTHER TYPE OF INDEMNITY D BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massalut,etts Grerairl-wi s, and Tai my ig, ure on this permit application waives this requirement. CHECK ONE ONLY: OWNER( AGENT SIGNATURE OF OWNER OR AGENT In— I hereby certify that all of the details and information I have sub itt d 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 bei complian a �yith all P inept provision of the (Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 1 t \ 1\ PLUMBER'S NAME &�f3W �(�(� \` —LICENSE # - SIGNATURE hul - JP CORPORATION FJ #=PARTNERSHIPP#LLC COMPANY NAME ADDRESS (Qs g U CITY STATE ��' ZIP� (� TEL A - FAX� CELL 1 EMAIL ----------- - -- -- o o z F- w M tij w q Date .. . e1. 0.......... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that.......! MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY��- e S . MA DATE PERMIT # 1 JOBSITE ADDRESS _ �y f'_5 OWNER -S NAME _ W GOWNER ADDRESS TELO FAX TYPE OR P��T O OCCUPANCYTYPE COMMERCIAL EDUCATIONAL 0 RESIDENTIAL ," CLEARLY NEW: RENOVATIONS REPLACEMENT: ® PLANS SUBMITTED: YES [] NO - APPLIANCES Z FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 1 11 12 13 14 BOILER --- __T_.TJ L --,.,._.._ L I _ - - - 1... I BOOSTER ( T� - . CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR _ _ _n_I FURNACE GENERATOR.- GRILLE INFRARED HEATER LABORATORY COCKS .i MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT �I TEST UNIT HEATER ,UNVENTED ROOM HEATER NATER HEATER�- OTHER ._........ ............._ --� v v --- INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES NO 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY 0 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 Massa c s tts Genero Laws, and th t my si nature on this permit application waives this requirement. CHECK ONE ONLY: OWNEAGENT O SIGNAT RE 0 OW ER OR GENT 1 hereby certify that all of the details and information I ha ubmitted or entered regarding this application are true and accurate to the best of my knowledge and that all plumbing work and installations performed und6r the permit issued for this application will be in Mance wi all Partinprovision of the Massachusetts State Plumbing Code and Chapter 142 off ttheGeneral Laws. PLUMBER-GASFITTER NAMEV_ V�c�s, V�� LICENSE # Ci S ATURE MP� MGF EjI JP 0 JGF 0 LPGI 0 CORPORATION ©# =PARTNERSHIP 0# ___ � LLC # COMPANY NAME: )�� _� ADDRESS CITY 2 S®8 STATE to ZIP TEL FAX �_ CELLEMAIL ^ _ H OF z U W aIlk w 0 r a z Oz N❑ W � W O [Oi a � a � •w a W 5 ocoa � w w � w c a o a a a U J a a a c w x w F— LL H O z 0 H U W a v� C�7 C'7 • Rei r 220 Date �11wlv...... TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION This certifies that'.. ; has permission for mechanical installation .�, 7. et9— ............ . in the buildings of .��/`}..P�' !�t . ............... at .......... North Andover, plass. Fee...s . Lic. No..,/,-' 11 .. . %C -• � • GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer J r M Commonwealth of Massachusetts Sheet Metal Permit Date: (' Permit # Estimated Job Cost: (1000 Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License # Applicant License # S Business Information: Property Owner / Job Location Information: Name: So CI ��` S r r e �s Name: Q Street: �0 x / Street: c'9 Gl%CA (� (Z r `� 6RI) City/Town: VI City/Town: �) � d 0 V I C Telephone: ')& � -60y- Photo 6 0 y" -?�'� Telephone: 7 ��-S 3 6 Photo I.D. required / Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family LZ 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: V Renovation: HVAC 1 / Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: Y'\ C � n A. k) r 1.1 IV- A Ot (1 Su,)n 11 CS�ZCt VL _ H INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy 2"" Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under -the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Date By Title City/Town Permit # Fee $ Inspector Signature of Permit Approval Progress Inspections Comments final Inspection Comments Type of License: ❑ Master ❑ Master -Restricted ❑Journeyperson ElJourneyperson-Restricted EJ Signature of Licensee License Number: Check at www.mass.gov/dpi 6 Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist Yes No N/A, Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper cleal`ances, fire rated enclosures and pressure testing required: SF> ;ai, Tc's'I uints installed =xrh6td required 'oil equipment and ell Ji. t . Y Duct penetrations in fi e'rdQ shall-, and floors sealed Metal roofing systems installed watertight using proper materials and fasteners Flexible duct nuns installed 6'-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean - properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -ofd Sheet Metal Residential Guidelines / Inspection Checklist Yes 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 -of) COMMONWEALTROF MASSACHUSETTS �j IMHUSETT. -ft-Pfl-§ddE-NiE 16928323 EXP 0 B' S E CLAS§ REST x, &00 m a "SARITA 2ACARIA 72 SCHOOL STREET 21 REVERE, ll-OrMw 02151,!:, EMS Heat Loss/Heat Gain Calculation Twa@mp SARITA'S SERVICES IftWOWS OLGA MOLOS hqpmm Zack ftmm 7816083854 659 Waverly Rd N. Andover MA, 7819855430 `CbO 06-12-2013 This HVAC load calculation has been performed using sound engineering principles as prescribed by Manual J seventh and eighth abridged editions and ASHRAE Fundamentals. Duct sizing has been performed as prescribed by Manual D. 1. Design Conditions Indoor Outdoor Temp. Diff. Front of home is facing: Winter 70 0 70 East Summer 75 90 15 2. How would you describe the summer humidity in your area? Average 30 3. How tight is the house? Average -under 1500 Sq. Ft. Winter air change / hr: 1 Summer air change / hr: 0.5 4. Fireplace evaluation : Number: None Tightness: No fireplace 0 5. Number of occupants: 5 6. Overhang characteristics (optional) East West S/SE/SW Distance of overhang from 5 top of window Lengjh of overhang 1.5 Tab 0 7. Solar gain through glass Unshaded 11 Shaded Facia Total arca - S .Ft. ]IType of g1w NfShaded 30 Double NE/NW -- Select -- South 28 Double SE/SW -- Select -- East 50 Double West 26 Double S G t -- Select -- Total North and Shaded 1950 Total Solar Gain Must for tinted or reflective window coating HTM Linear ft Unshaded 11 Shaded BTUI 24 Below OH 30 0 0 40 28 0 1120 0 0 0 75 50 0 3750 75 26 0 1950 0 30 720 7540 No 1 7540 8. Ducts/Pipes ocation: Duct system in enclosed crawl space Attic Teml!.7 Insulation - Leaks -- Select -- R-6 1 sealed [Ductgain: 0.05 Ouct loss: 10.123 Tab 1 IL Area 1 696 9. Load Calculation Elements of Load Insulation l R -value 11 Areallin.ft. U valine Heat Loss Meat Gain Gross Wall .. 1428 Glass solar gain 7540 lass 1 Double 134 0.56 5253 lass 2 Double 0.56 0 �kyfizht -- Select -- 0 0 oars JInsulated or Storm 42 0.4 1176 252 Net walls R-11 1252 0.08 7011 1502 Bilin s R-19 696 0.055 2680 1723 oors No Insulation 696 0.31 7552 0 en floors 7No Insulation 0.31 0 0 lab floors No Insulation 0.8 0 0 olume of your building or zone cu Ft. 8352 10718 1148 eopie 1500 fiances 1200 ub:Total ; - `34390 14865 uct LosslGain 4226 748 ensible Load 38615 15613 Went Load 2570 OTAL flTUH 38615 18183 Summary BTUH Tons Total heating load 38615 Total cooling load 18183 1.5 Tab 2 Basement Calculation Elements of Load Insulation / R -value I Areaffl at.ft. U -value Heat Loss Heat Gain Palls -'above gnde Wass Double 0 0.56 0 _North Double 24 0 South ---- Sclect p East Double 75 0 West Double 75 0 oors Insulated or Storm 0.4 0 0 Net walls above R-11 0 0.08 0 0 alls (below graded R-11 0.07 0 0 Bilin s No Insulation 0.6 0 0 oors 0.024 0 0 nfdtrationCu.Ft. 0 0 Number of eo le 300 0 pplianees - Enter total BTUH -> 10 ensible Load: =0 0 stent Load: 0 OTAL BTUH 0 0 otal whole house load includin basement: 38615 18183 Tab 3 Heat Loss 38615 Heat Gain 18183 Summer Design Temp. 90 Winter Design Temp. 0 System #1 (less efficient) Method Air Conditioning Natural gas Total System #2 (more efficient) Method Air Conditionin Heating Heat pump r Total Payback and ROI ost of new or more efficient system ost of less eient system Mates or credits Net or additional investment jVearlv savin Payback ears eturn on investment OI Energy Cost Analysis Heating degree days Cooling degree days Summer Design Temp. Diff. 15 Winter Design Temp. Diff. 70 Oncy Fuel Cost 13 95 a cost of system M.- 11 Fuel Cost tina cost of W $0 No Payback Infinite Tab 4 #2: Price $0 $0 $0 $0 $0 $0 Total Heat Loss Total Heat Gain FOO—MBIame IC-ross wall North windows NE/NW windows outh windows NE/SW windows ast windows est windows t oors Net walls eilin Vwor-cmwl �Ioor-open loorslab nfiltration eo le fiances eat loss ensible Heat Gain �oormg CFM eatin CFM Room by Room 37019 System CFM (cooling) 1000 15254 System CFM (heating) 1000 {itchen Living bedroom 1 bedroom 2 bathroom attic attic room bedroom bedroom 200 224 184 200 40 200 200 10 10 10 3 10 40 3 21 21 163 153 78 91 156 192 10 10 8 10 164 180 32 190 190 66 78 20 156 156 132 156 40 37 71 20 20 8 10 10 1 1 1 1 1 1200 7157 11411 5173 5618 1674 2993 2993 3336 4934 1555 1922 777 1449 1281 219 323 102 126 51 95 84 193 308 140 152 45 81 81 Tab 5 Air Ducts Sizing Total measured length of ducts 25 Use heating CFM Total equivalent length of fittings 2 Flex ducts used Available static pressure for duct .10 Friction rate 0.37 CFM Il No. outlets ��Outlet CFM 1 Duct diam.� Air veL Su trunk /branch First section offAHiT 1000 11.8 1321 1st reduction /b 0 2nd reduction /branch 0 3rd reduction / branch 0 4th reduction / branch 0 Sth reduction / branch 0 Return trunk /branch First section off AIU 1000 11.8 1321 1st reduction/ branch 0 2nd reduction /branch 0 3rd reduction / branch 0 4th reduction /<branch 0 5th reduction /branch 0 Room runs Kitchen 193 1 193 6.3 885.9 Living room 308 1 308 7.5 992.4 bedroom 1 140 1 140 5.6 819.4 bedroom 2 152 1 152 5.8 835.9 bathroom 45 1 45 3.6 621.9 attic bedroom 81 1 81 4.6 717.4 attic bedroom 81 1 81 4.6 717.4 Tab 6 Equipment selection as per Manual S (Design temp.: j Outdoor Indoor Winter 0 70 Summer90 75 ID des' RH 50%,63F WB Altitude Predominantly Cool climate Manufacturer's Equipment Specification Equipment Manufacturer Mod IMH outu Furnace PAYNE PG95SAS4808OB60000 Boiler Heat pump / PAYNE PA13NA036000 AC Evaorator PAYNE PNPVP3617ALA Air handler OTAL CAPACITY with altitude correction 60000 elected ui ment size OVERSIZED Available static pressure for duct lower ext, staticpress. coil pressure drop filter pressure dro r 'ter pressure drop grille pressure drop other vailable SP for duct 01 Total Sensible Latent 0 0 0 0 OK UNDERSIZED UNDERSUND Heating CFM Cooling Ext. static pressure of blower 1200 0 Supplemental heat needed for heat pump capacity 47F ca aci 17F ca aci ODDT TUH supplemental heat kiw—supplemental heat Tab 7 OP ID: LR '4 EV CERTIFICATE OF LIABILITY INSURANCE AT06/1 DD/YYYY) r06/18/13 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(ies) 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 endorsements). PRODUCER Phone: 781-593-9393 Soderberg Insurance ServicesFax: 781-599-7338 200 Broadway Lynnfield, MA 01940 NAMEACT Zacarias Sarita PHONE 781-608-3854 FAX A/c No Ext : AIC No): E-MAIL ADDRESS: PRODUCER CUSTOMER ID #: SARIZAI INSURER(S) AFFORDING COVERAGE NAIC # GENERAL LIABILITY INSURED Zack Sarita d/b/a INSURER A: Nautilus Insurance Sarita's Heating 21 Essex Street Revere, MA 02151 INSURER B: MA Workers Comp Assig Risk INSURER C: CNA Sure EACH OCCURRENCE $ 1,000,000 A INSURER D: INSURER E: INSURER F: 05/05/13 COVERAGES CERTIFICATE NUMBER: REVISION NLIMBER: 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 LTR TYPE OF INSURANCE ADD UBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx� OCCUR NN245409 05/05/13 05/05/14 PREM E(RENTED PREMISESS Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? ❑Y N / A AWC702685420131 05/04/13 05/04/14 STATU- OTH- X T RY LIMITSE E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100;`t00 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS below 1� C CNA Surety F. 61348554 —1 05/04/12 05/04/15 Street Bond 40 0 0 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) fax to 978 688 9542 CERTIFICATE HOLDER rANrr-1 I ATlnKl ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall AUTHORIZED REPRESSENTATIVEQ ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD I I �. � . �� (- 7, Date. ...... ..................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING be VQ,�� This certifies that'. has pennission to perforn, ....... wiringin the building of ........... e ..... .............................................................................. at North Andover, M .................................................... ...................................... gA7 `7 We -33� . .............. Lic. No.Ltq64 ................ . .. ......... . ... ..... . LECTRICAL SPE Check # 76 \-I -32 (,o 11665 �L\ Commonwealth of Massachusetts 0 al Use ly Department of Fire Services PermitNo. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS I[Rev. 1/07] I (leave blank) APPLICATION FOR PERMIT T04�RFORM* ELECTRICAL WORK All work to be performed in accordance with the'Massachusefts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PHNT IATNK OR TYPEALL XFORAM TION) Date: City or Town of: NORTH ANDOVER By this application the undersig ives notice of his or her filb oo Location (Street & Number) �f yly j _ &Gq Wav, Owner or Tenant (A- 6Z M 0, 1 6.�, I Owner's Address — To the Inspector of Wires: to perform the electrical work described below. Is this Permit in conjunctionwith a building permit? YesE . �A/A?7 . -1— M. Purpose of Building L. . kr 11. 44. 1114 1X!% %(A4&11 FY Vtlf]K Telephone No. No Llyr (Check Appropriate Box) Utility Authorization No. Existing Service Amps volts OverheadE] Undgrd D New —Service Amps Volts OverheadEl Undgrd P Number of Feeders and Ampacity Location an Nature of Proposed Electrical Work: O�A � [C\Ah4Q % No. of Meters No. of Meters 4e 07— %. fwz. i CnMillPtimi nffbo f,7,7� — A� L- A_ T___-;__ 1 No. of Recessed Luminaires -1 -__._._, No. of Ceil.-Susp. (Paddle) Fans ..... - �j No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above r-1 In- Swimming Pool rrnd . L_j 2rnd. No—.—OTEm—ergency Lighting BatteKy Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS JN'o. 6f Zones No. of Switches No. Of G2S 13 urners Detection EiDd Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: I AMber ............ I Tons I ........................ .1 KW ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local 0 Municippl F] Other Connection No. of Dryers No. of Water Heaters KW Heating Appliances KW No. of No. of signs Ballasts Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent rOTHER, Attach additional detail ifdesired, or as required by the Inspector of 97res. Estimated Value o�Eleptrical Work: 006 (When required by municipal policy.) Work to Start: (,P/ 1-7113 - Inspections to be requested in accordance with YIEC Rule 10, and upon completion. INSURANCE COWP�&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 equivalunt. The�, undersigned certifies that such cov ge is in force, and has exhibited proof of same to the permit issuing office. GUECK ONE: INSURANCE J7 tND El OTBER 0 (Specify:) 5-1 VL I certify, under iWains and walties ofperjury, that the information on this application is true and com plete FIRM NAME: LIC. NO. - Cc:) q Licensee: Signatur LIC.N0.:f15)6 14 (Ifapplicable, enter lexempt "in the licpsf number line) Address: t I Wyl"Ayt -,YT F Bus. Tel. No.:b1_7__C4A_161 2;::� Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, securit� 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 coveragenormally required by lawo.=a e below, I hereby waive this requirement, I am the (check one)EI owner 0 owner's agent. Owner/Agent I Signature -7 Telephone No.?v/—,6-TY 6v P_PRMI2:,FEE,.,- $ P56"'i 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the 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 pennit shall be issued to the person, finn 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 A 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. 0 Rule 8 — Permit/Date Closed: Note: Reapply for new permit 0 0 Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required 0 Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass Failed Re- Inspection Required 0 Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed Re- Inspection Required 0 Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Fail Re- Inspection Required 0 Inspectors Comments: N f Inspectors Signature: Date: FINAL INSPECTION: Pass Failed Re- Inspection Required El lnsp�ectorsCoM�nnts: 7- 4 V Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com The Commonwealth ofMassachusetts Department of Industriq[Acc!6�ts Office of Investigations 600 Washington Street Boston, MA 02111 Vww,.mass.gov1d1a Workers' Compensation Insurance Affidavit: Builders/ContractorsfFle,ctricians/Plumbers Name (Bi Address: City/State/Zip: !A (2��cAm , N Ohone#: Are you an employer? Check the appropriate box: - Type of project (required): 1. El I am a employer with 4. El I am a general contractor and 1 6. E] New construction oyeas (fiffl and/or part-time).* 2. am a solo �roprietor or partner- have hired the sub-coiltractors listed on the attached sheet. 7. E] Remodeling ship and'have, no employees These sub -contractors have 8. El Demolition working for me in any capacity. workers' comp. insurance. 9. E] Building addition [No workers' comp. insurance 5. El We are a corporation and its IO.Vlectrical required.] officers have exercised their repairs or additions 3, El I am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.Q Roof'repairs insurance required.] t employees. [No workers' 1311 other comp. insurance required.] �Any applicant that checks box#1 must also. -Lill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they tire doing all workand then hire outsido contractors must submit anew affidavit indicating such. tContractors that checkthis box must affached an additional sheet showingthoname of the sub -contractors and their workers' comp. policy inforination. lam an em ployer that isproviding workers' compensation insuranceformy employees. Below is thepolley andjob site information. Insurance Company Name:. Policy 9 or S elf -ins. Lie. 0: ExpiratioaDate: JOB Site Address-, pity/StatefZip: N.AJover-MA 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 STORWORK 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 h ereby cer4oiqN Ler fite p a MWfn dp effarties ofp erju ry th at th e inform ation pro vided ab o ve is tru e an d correct. Ofjlclal use only. Do not write in this area, to he completed by city or town of ficial. City or Town: PermitUcense 9 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Uumbing Inspector 6. Other Contact)?erson: , Phone information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...ever express or implied, oral or written." y person in the service of another under any contract ofhire, An employerlis defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint 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 deerjaed to be an employer.D1 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 compliancewith the insurance coverage requ,.1red." Additionally, MGL chapter 15 2*, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 ceitificate(s) of insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If anLLC orLLP does have employees, a policy is. required. ]Be 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 retumcdto the city or town that thic application forthepermit 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. Pleas ' e be sure to fill in the perinit/lice'llso number which will be used as a reference, number. In addition, an applicant that must submit multiple permit/licerise applications "in any given year, need only submit one affidavit indicating current policy infonnation (ifnecessaty) 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 ii on file for fature permits or licenses. A now affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or*pjermit not related to any business or commercial -venture (i.e. a dog license or p-* ormit 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 Com- monwalth of M Depadmeat of ladusidal Accidents OfAce offavestigations. 600 Washingtw Street Boston, MA 021 It TQL # 617-727-4900 ext 406or 1-877-MASSAFF, Revised 5-26-05 Fax# 617-727-7749 Division of Professional Licensure: License Search A The Official Website of the Office of Consumer Affairs and Business Regulation (OCABR) 4 Division of Professional Licensure Mass.Gov Home State Agencies A -Z Topics Home Division of Professional Licensure lieck A Professional License By the Division of Professional Licensure LICENSEE Name: DERYN L. TENCH MATTAPAN, MA NEW SEARCH Licensing Board: ELECTRICIANS License Type: JOURNEYMAN ELECTRICIAN TYPE CLASS: E License Number: 52014 Status: CURRENT Expiration Date: 7/31/2013 Issue Date: 4/112004 Exam Date: 3/3112004 School: JATC This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. The page above has been generated by the Division of Professional Licensure web server on Friday, June 21, 2013 at 8:30:55 AM. 0 2007-2011 Commonwealth of Massachusetts Page I of I Mass.Gov ONLINE SERVICES Check a License Locate a Licensed Professional Onhne Address Change Contact the Agency More... REFERENCES & RELATED INFO Disclaimer Regarding Website License Searches Enforcement Process Glossary Glossary of License Status Cocles More... Site Policies Contact Us http://Iicense.reg.state.ma.us/public/PubLicenseQ.asp?board—code=EL&type class= E&li... 6/21/2013 .................. This certifies that .... has permission for gas in a lat ..... le-& ............... in the buildings of ...... ("�Tf - W. a-0,44 - -W. ; at . .0. men Fee ... Lie. No... Check# 8753 ............ North Andover, Mass. GASIUSPk�TOR Jtn 24 13 01:12p p.3 C ppUCATIOR FOR -A PERMIT TO. PERFORM GAS.FITTIN.G WORK. viot Ace Al'"111SETTS UNIFORM T# ATE PERMI CITY JOBSITE ADDRESS OWNEWS NAME 'Elf FAX OWNER -ADDRESS TYPE OR EDUCATIONAL RESIDEN-nALEY' OCCUPANCY TYPE COMMERCIALD1. PRINT CUARLY.: . OVATION: REPLACEMENT: FAa'-' PLANS. SUBMITTED: YES No El REN 4 �q T io APPI]ANCES I FLOO 11111, =2 1 3 1 6 BOOSTER CONVERSION BURNER COOK SLOVE - - - DIRECT VENT HEATER DRYER - . _: FIREPLACE .FRYOLATOR FURNACE GENERATOR GRILLE *. ..§�MAInrr%uCATCD� .*. INSURANCE COVERAGE I have a current liabilit . V n�urance. policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES ONO [I I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE. BY CHECIUNG T�E APPROPRIATE Box BELOW LIABILITY INSURANCE POUCy. OTHER TYPE INDEMNITY [:1 BOND OWNER'S INSURANCE WAIVER: I am aware that the licensee does -not have the Insurance coverage . required by Ch aliter 142 of the Massachusetts General Laws, and that my signature on this pemtt application waives this requirement. CHECK ONE ONLY. OWNER 0 AGENT [I SleNATURE 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 knawledge and that all plumbing work and Installations performed under the permit issued for this application will be in compilence wIth all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Lem. PLUMBER-GASFITTER NAME ord SIGNATURE MP MGF El RE G LLC JGFO LP 10' CORPORATION04F JPARTNERSHIPEI#[�_ Lz�� T.- -5 i 16c 7 'JADDRESS COMPANY NAME STATE ZIP TEL _00 CITY LA/a,11 I FAX1114P-13.1" -71-1 LF_��,.',EMAILI ... .... ..... M Jun 24 13 01:12p a COMMONWEALTH OF MASSACHUSETTS OLUMBERS AND GASFITTERS L.CENSED AS A MASTER PLUMBER ISSUES THE ABOVE LICENSE TO: .CLIFI'ORD H GILES 113R tGND ST GEORGEIGWN MA 01833-1014 8701 05/01/14 164450 COMiMONWEALT,40E-iVIASSACHUSETtS: PLUMBERS AND LICENSED As A JOURNEYMAN PLUMBEP> ISSUES THE ABOVE LICENSE TO: CLIFFORD H GILES .13R POND ST .GEORGETOWN MA 01833-1014 14095 05/01/14 164449 p.2 JUN -24-2013 12:48 Sennott Insurance 978 837 2404 P.01 UrNLC %016.1 % 9 'wr - - — — - — __ - 1 -1 -r/ —, 979.887.4900 — FAX 979.997.2404 F.,Sennott Insurance Agency, Inc. �th Main Street 0. Box 4S7 psfield, MA 01983 RED The P-Fu—mbi nfCo. F0 Box 1607 Wakefield, MA 01880 TH-18-CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A: Comerce Insurance Co. INSURER�- _A11ri;i*r1_�_aF1n'ancial Benefit INSURER C: VERAGES AE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THF INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 4Y REQUIREMENT, TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH THIS CERTIFICATE MAY BE ISSUED OR AY PERTAIN. THE INSURANCE AFFORDED BY THE� POLICIES DESCRISED HEREIN IS SUBJECTTO ALL THE Tr%RM$, EXCLUSIONS AND CONDITIONS OF SUCH DLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN R50UCED BY PAID CLAIMS. . .. .. .... bC*Y EXP Pazy"E"FFECTIVE LIMITS TYPE OF INSURANCE POLICY NUMBER DATE IMM/001YYYYj DATC(MM/DDNYYY� E -6 -ft -n $ . 1 000 00C GENERAL LIABILITY BCHNKR 11/01/2012 91/01/2013 F-ACHOCCURRENrE �1- 11 -0A9AZM'AERTC07--- - COMMERCIAL GENERAL LIABILITY jjj�g urrenw) 10 00( CLAIM$ MADE 1�1 OCCUR MED EXP (Any one person) S,()O( PERSONAL INJURY 1,000,00( I GENERAL A043REGATE 2 P 000 1 00( I PROE)UCTS-COMF/OPAGG 1$ 2,000,00( GEN L AGGREGA I E LIMI I rLICO F -En: 7 POLICY F] JPpi [7 LOC AUTOMOBILE LIAVILIrV ANYAUTO ALL OWNED AUTOS X SCHEDULED AUTOS 141RED AUTOS NOP4-OWNEDAUTOS GARAGE LIABILITY I ANY AUTO FXCESS I UMBRELLA LIABILITY OCCUR F ICLAIMS MADE DEDUCTIBLE RETENTION S WORKERS COMPENSATION AND EmpLOYIERS'LLAWLITY YIN ANY PROP RIETOR/PARTNER/EXQvv OFFICERIMEMBER EXCLUDED? (Mandatory In NN) fixes describe under S EbIAL PROVISIONS below OTHER SCRIPTION Of i VOMCLES / AWN9928706-01 11M2012 11/01/2013 COMBINED SINGLE LIMIT (Fa accideni) BODILY INJURY $ (Per person) SODILY INJURY S (Per accident) PROPERTY DAMAGE S (Per eccidont) AUTO ONLY - EA ACCIDENjr S OTHERTHAN EAACC S AUTO ONLY: AGO S CP416878-11 11/17/2012 11/17/2013 EACHOCCURRENCE $ AGGREGATE ADDEO BY PROVISIONS E.L. EACH ACC)DENT I E.L. DISEASE - EA EMPLOYEE $ El DISEASE -POLICY LIMIT 3 1,000 --RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESGRISEEI POUCIES BE CANCPLLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYSWRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT, BUT FAILURE TO DO 30 $HALL Town of North Andover IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURERi 118 AGENTS OR 120 Main Street REPRESENTATivEs. North Andovar, MA 01845 AUTHORIZED REPRESPNTATIVE Peter Sennott 1) FAX: 978.689.9S42 0 1988-2009 ACORD CORPORATION. All rights The ACORD name and logo are registered marks of ACORD JUN -24-2013 12:48 Sennott Insurance 978 887 2404 P.02 k t ; J IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(jes) must be ondorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain Policies May require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer($), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD25 TOTAL P.02 n 24 13 01:11p A 711., fl.(). FIAXY, '1607 NIA 01880 -800-C)M-001 H. Giles P1`eSid(-2n," P. I Phone: 781-2�16-0010 978-352-3898 Facsimile Transinissioli F)"Orn: S ------------ - Please see that this trdiisi)i1s*Sion i's i I ven ro the 01": Pt S P -le_- e�Aj Reference:- 1 /* _,g r 6L, N u m b o . f p*ages including this cover. sheet: I'le(le f No to:. If all Pages ore not Pk?c(� I . v e d' 'pleus(-? noflf.v at once, Thank You. Me ssag 6.� e. Reply requested Reply not neceSS017V I UHN'll is UGII:k.14;r wal ..t- I.V :;P1W'M.M1 pIT(i1)(;TO1 I Oc. lb Date:1.7-� .................. 4; 0 TOWN OF NORTH ANDOVER "WA PERMIT FOR GAS INSTALLATION This certifies that . J. ............... has permission for gas installation--. in the buildings of ... at ...... ............ North Andover, Mass. Fee ......... Lic. No ........... ... . . . . . . . . . . GAS INSPECTOR Check 35,77 4ASSACHUSETTS UINUORM APPLJCATON FOR PERMIT TO DO GAS FrrMG �o or print) iNuKfH ANDOVER, MASSACHUSETTS Building Locations 10!5c% Date �91,- Permit 20-27 Amount S -<1 � Pri n i or We) Check one: Certificate Installing Company Name Andover Md. & Mg. Co., Inc. 1Z Corp. 2199 .Address 20 Agean Dr., Unit -10 F� Partner. us�jness Telephone Name of LiccrIsed Plumber or Gas Fitter -- George 11 aRnsp r-1 Firm/Co. INSURANCE COVERAGE Check onw. 1 have a current liability Insurance policy or it's substantial equivalent. Yes FX Noo 1 fvou have checked ves, please indicate the ty pe coverage by checking the appropriate box. Li�.,blllnl insurance policy Other type olf indemnity r7 Bond 0-ner�s Insurance Waiver-. I am aware that the licensee does not have the Insur-ance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: S ignarure of Owner or Owner's Agent Owner El Agent 0�11erebv c.-riifv that all of the details and information I have submitted (or entered) in above application are tr I ue and accurate to the ocst ot'my knowledge and that all plumbing work and installations performed under Permit Issued for this ap plication will be in compilance with all pertinent provisions of the -.\,Iassachusetts State Gas CoWand Chapter 142 of t General Laws. By: Tirle Cryjowrl I*-�PPROVED(OFFICIi IISE ONLY) Ilignature of Plumber Gas Fitter ff"'Masfer r7 Joumeyman !red Plumber Or Gas Fitter 9983 License Numoer Owner's Name 6;;W 4 New Renovadon Replacement Plans Submitted � Pri n i or We) Check one: Certificate Installing Company Name Andover Md. & Mg. Co., Inc. 1Z Corp. 2199 .Address 20 Agean Dr., Unit -10 F� Partner. us�jness Telephone Name of LiccrIsed Plumber or Gas Fitter -- George 11 aRnsp r-1 Firm/Co. INSURANCE COVERAGE Check onw. 1 have a current liability Insurance policy or it's substantial equivalent. Yes FX Noo 1 fvou have checked ves, please indicate the ty pe coverage by checking the appropriate box. Li�.,blllnl insurance policy Other type olf indemnity r7 Bond 0-ner�s Insurance Waiver-. I am aware that the licensee does not have the Insur-ance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: S ignarure of Owner or Owner's Agent Owner El Agent 0�11erebv c.-riifv that all of the details and information I have submitted (or entered) in above application are tr I ue and accurate to the ocst ot'my knowledge and that all plumbing work and installations performed under Permit Issued for this ap plication will be in compilance with all pertinent provisions of the -.\,Iassachusetts State Gas CoWand Chapter 142 of t General Laws. By: Tirle Cryjowrl I*-�PPROVED(OFFICIi IISE ONLY) Ilignature of Plumber Gas Fitter ff"'Masfer r7 Joumeyman !red Plumber Or Gas Fitter 9983 License Numoer 4 .n Z cn ?i z C tn Z W S. W z :.c z W z �c S u : 8 -8.-� SENI ENT B A S E -M E N T I sf F L 0 0 R 2 N D F L 0 0 R 3 R D F L 0 0 R -4 T If F L 0 0 R Tr if F 1. 0 0 R 6T It F L 0 0 R 7T if F L 0 0 R .4 T If F 1. 0 0 R - ----- � Pri n i or We) Check one: Certificate Installing Company Name Andover Md. & Mg. Co., Inc. 1Z Corp. 2199 .Address 20 Agean Dr., Unit -10 F� Partner. us�jness Telephone Name of LiccrIsed Plumber or Gas Fitter -- George 11 aRnsp r-1 Firm/Co. INSURANCE COVERAGE Check onw. 1 have a current liability Insurance policy or it's substantial equivalent. Yes FX Noo 1 fvou have checked ves, please indicate the ty pe coverage by checking the appropriate box. Li�.,blllnl insurance policy Other type olf indemnity r7 Bond 0-ner�s Insurance Waiver-. I am aware that the licensee does not have the Insur-ance coverage required by Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement. Check one: S ignarure of Owner or Owner's Agent Owner El Agent 0�11erebv c.-riifv that all of the details and information I have submitted (or entered) in above application are tr I ue and accurate to the ocst ot'my knowledge and that all plumbing work and installations performed under Permit Issued for this ap plication will be in compilance with all pertinent provisions of the -.\,Iassachusetts State Gas CoWand Chapter 142 of t General Laws. By: Tirle Cryjowrl I*-�PPROVED(OFFICIi IISE ONLY) Ilignature of Plumber Gas Fitter ff"'Masfer r7 Joumeyman !red Plumber Or Gas Fitter 9983 License Numoer I � N2 4-7 5 '01 i", �'j j Date �'Z. 7. C-�- . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ........... ........ ................. has permission to perform ...... Z_ .............................. plumbing in the buildings of .......... .......... at .......... .............. North Andover, Mass. ...... Lic. /* PLUMBI N'61NSP'ECT 0 R Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMMING (Type or print) NORTH ANDOVEF, MASSACHUSETTS Date Budding 4 K� Owners Name 6Nar le-'�, \�ernMp,,-+e Permit #�'5 Amount 1?6-- e of Occupancy It I Plans Submitt Yes New RenovationE] Replacement 31 "', FIXTURES (Print or type) Check �9e: Certificate Installing Company Name Andovor Plhn- 9 HTa Cln- Tnr-- acorp. 2122 Address 20 Aegea . n Dr. Unit -10 Partner. Methuen, MA 01844 Business Telephone Firm/Co. Name ofLicensedphimber: Georg'L aRose insurance Coverage- Indicate theXpe of insurance coverage by checking the appropriate box Liability insurance policy [a Other type of indemnity El Bond Insurance Waiver I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three *insurance Tip—OF %, Owner [:] Agent 11 I hereby certify that all of the details and information I have submitted (or ente . red) in above application are true and accurate to the best of my knowledge and that all plumbing work and insu&fions performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State P11umWdR Code and 9!�",2 of tile General Laws. "Own R.OVED wna uSE ONLY Type of'Plumbing License qqs� I — License Number Master 1311�10urneyman A if Location 6& A Ue r- I No. Date LQ,5-lo 7586 SGilding Inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ MU Building/Frame Permit Fee /-A) $ Foundation Permit Fee $ Other Permit Fee $ TOTAL I—If ) $ Check# 7586 SGilding Inspector TON" OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING WELDING PERMT NUMBER: DATE ISSUED: 7 7 SIGNATURE: Building Commissioner/Inspector of Buildings Date SECTION 1- SITE INFORMATION 1.1 Propetty Address: uLaUA a4t.- 1.2 Assessors Map and Parcel Number: 01 ;0 0601 Map Number Parcel Numb�r 1.3 Zoning Information: Zoning Dia;ic—t Proposed Use 1.4 Property Dimensions: Lot Area (sf) Fr-tage (ft) 1.6 BUILDING SETBACKS (ft) Front Yard Side Yard Rear Yard Re�red Provide Required Provided Req*red Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public 0 Private 0 Zone Outside Flood Zone 0 1.8 Sewerage Disposal System: Municipal 0 On Site Disposal System 0 SECTION 2 - PROPERTY OWNERSHEP/AUTHORIZED AGENT F 2.1 Owner of Record 174f jC 14t? 6x,-&5'7 woueil N, Name (Print Address for Service j 73 Signiif6rie- Aelephone 2.2 Owner of Record: Name Print Address for Service: Sij',at,re Telephone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Cqnstruction Supervis Licensed "struction Supervisor: Add Z�d� W-47-72 Signature V Telephone Not Applicable 0 2- 2 License Number Expiration'Da 3.2 R * t red Home Improvement Contractor 7 qal 9z, Not Applicable 0 I Compapy Wme Registration Number Expirationif Dad �A�ei 1 Signatu Telephone M M X z 0 0 z M 0 M z Q I SECTION 4 - WORKERS COMPENSATION (MG.L. C 152 6 25c(6) I Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes ....... 0 No ....... 0 SECTION 5 Description o Proposed Work (check applicable) New Construction 0 Existing Building 0 Repair(s) 0 P erations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: A4 SECTION 6 - ESTIM[ATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed by permit applicant 0 WFICLAL USEVTqLy]1--']1'1" 1. Building - (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction o' O"rn C/o,( 3- Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection -6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIEES FOR BUILDING PERNUT 1, as O%vner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1, CLI,44J _,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief Print Na�" Signature of Owner/Aient Date -M NO. OF STORIES SIZE BASENIENT OR SLAB -SIZE OF FLOOR TINIBERS I ST 2 ND 3 RD SPAN DRAENSIONS OF SILLS DDAENSIONS OF POSTS DINIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVMY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE AJ. Walsh & Sons Inc. 55 111casaw S(r(,c( Norlit Andovu, MA 01945 Mass. J,jCJ-',NSE` # 022690 Xhiss. RI-fdSTRATION # 103359 RESIDENTIAL CONTRACTING AGREEMENT Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home Improvement contractors and subcontractors engaged In home Improvement contracting, unless specifically exempt from registration by provisions orchapter 142a orthe general laws, must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. Designated Registrant's Name: Registradon Number: Salesjxrson's Name: s d This agreement i ma 0 7 between (COWMACT of ka�l 73 (ADDkiiss) (RIONP NUMBER) hereinafter called "Contractor" and (OW of 4t a /WZ NER) (ADDRESS) I I hereinafter called "Owner". 0410NE NUMBER) DETAILED DESCRIPTION OF WORK TO BE PERFORMED Slich work consists of the following: DETAILED DESCRIPTION OF MATERIALS TO BE USED MaLerials,toV,se r�rmingpe above #scribed work consisi of the fol �Jinpe, 11. PRICE Contractor agrees to do all work described in Section I for the total price of S III. PAYMENT Payment will be made as follows: 92 MEFq!=N@ 133 1/31 % (S — ) upon signing Contract, upon complc6on of upon complcbon of S and the remaining 130 upon verification of the work by Owner and Contractor as having been satisfactorily completed, which verification shall take Place PTOMPLIY after completion. Notice: No agreement For home Improvement contracting work shall require a down pay7nent (advance deposit) of more than one-third or the total contract price or the total amount of all deposiLs or payments which the contractor must make, in advance, to order and/or otherwi%e obtain delivery of special order materials and equipment, whichever amount is ereate . IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the A th third day following the signing of this Agreement, unless specified here in writing. Contractor wW begin the �Ork �MOR(date). Barring delay caused by circurnstances beyond Contractor's control, the work V ,w _on �oa will be completed by 1 j"D (date). "Me Owner hereby acknowiedges and agrees that the scheduling dates are approximate and that such dclays that are not avoidable by the Contractor shall not be considered as violafions of this Agrcement. V. NO ACCELERATIONOF PAYME'STS B(A LSCkOWING ALLOWED TlIcContractoymeynot raluire payments to be ni-vic Ifiadvaiii.001' HIC LiffICSSImLified InSet lion 111(paymenI)above for the reason that hc docms himself or the payments to be Insecure. If. however. he deems hinit,elf u) tx- insecure, he may require. L, a prerequisite to continuing the work described herein. that Ufa hLianceof the paymeno. unfirr t1iiAcontrat i ihafaic iii 1hr, ofilr(jl(if theOwner. %hall lx- placed in it jointi-scro%* account that requires flic signature of both the Contractor and the Owner for withdrawal. 1-1 V1. INSURANCE Contractorwill be responsible to Owner or any third part y forariv property damage or bfjoh ly injurycausedby himself, his employees or his subcontractors in the performance of. or as a result of, the work under this A&Tccmcnt. Contractor agrees to carry insurance to cover such damage or injury. VII. SUBCONTRACTING Contractor agrees that. notwiffistanduig any apreement for ni a icrIals andlor labor between Contractor and a third pan y. Contractor is resporLsibic to Owner for comple6on of all work described in a 6mcly and workinarilike manncr. Vill. CONSTRUCTION-REILATED PERMITS 71he following construcLion-TClated permits will N- necessary in order to corrfl)leic the %colic (if work included in this Agreement: The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction -Tel ated permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory. permit granting or inspectional agencies. atithoritics or individuals. -Notice: It the homeowner obtains hL% own construction -related permits for the work described under this agreement, the homeowner is hereby advised that In the event of 2 dispute, judgment and nonpayment or the contractor, the homeowner will not be entitled to make & claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. IX. MODIFICATION This Agreement. including thcprovisionsrclating topricc (Section 11) and paymcnischcdule (Section 111) cannot be changed except by a written St3LcMcnL signed by both Contractor and Owner. However. Cancellation by Owner is allowed in accordance with the Notice of Cancellation (annexed). X. WARRANTIES The CoIILraCt0f WarTaIIIS dial. UIC Work I kirnished hetcunder sliall be I I cc fy oin defects in maici jah. and workmajL%hil) for a period of following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials. or damage caused by the Contractor. Iiis subcontractors, employees or ageots. Is di%(A)velcd widlin one year after coiniple6on of any job, including cleanup. the Contractor shall. at his own experise. fomhwith remedy. repair, cnrtf-(-t replace, or caille W he remedied, repairect or replaced. such damage or such defect in materials or workmanship. Ilic fotcrotrip warranties Shall pirvive any insp#-(-twr. Tv-rfomrfed in covnei-flor with the Pgpped-urv-,r wo-k. All warranties for equipment supplied by the Contractor undcr this Agreement shall be. those given by the manufacturers of such equipment. which shall ( ot Irf t.11, It if 1;111 tilact III cf.%' Wai I amic-;, the Owiier may lis: icoltilred to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentaLion, wluch failure voids the manufacturer's wan anty, shall riot create anV TCSponsibility for the Cuntractor to warranty such cquipmcnL '17hiswarranty gives the owner specific legal rights. and owner may also have other rights whIch vary from sLatc to state. Under Massachusetts law, sales of goods carry in implied wananty of mcrchantability and fitriesS fOT a lzarticular purp(isc. X1. COMPLETENESS OF AGREEMENT FOR LXECUTION The Owmer is hereby advised that he should not sign this Agreement unless and until all blank- sections have been filled in or marked as void. dcletedor not applicable, ja� until all exhibits and related of referenced documents iha[ are incorlitiraied herein arc attached hereto. XII. COPY OF AGREEMENT TO BE GIVEN TO OWNER '11iis Agreement is govcmed by die Laws of Niassachuscas. It inust be c.,.ccuted in duplicatc. and an original signed copy hcrcof given to dicOwncr at ilic time of cxecinion. No work under the Agreeint-tit shall begin prior to the signing of die Agreement and transmittal to the owner of a copy thereof. RIGHTS TO CANCEL Theowner may cancel thisagreement ifit has beensigned bytheownerata placeother titan an address of the contractor which may be his main office or branch thereof, provided that the owner notifies the contractor in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See attached Notice of Cancellation. HOMEOWNER: DO NOT SIGNTHIS CONTRACT IF THERE ARE ANY BLANK SPACES. -1— A:d4 &A4 644-^� AA"- U :nM — -_7 OwrierA signatille Date Signed �i a-�2�mgk Contractor's Signaturc4 Date Signed I I - (,G 2 r.M "2 CL me cc 0 CF .2 C2 c=L E 0 'o mc =0 0 C.2 8, cc rm- 51 TL Cc 0 ca CJ 0 mo cm ra 0 CL "co, 0 CL Saw 0 ui .0 ca UJ E 5.6 cal C.3 &- U A 0 CM CL ca CD C, CLM I.- = 02 an :110 Cf) z 0 C/) P-4 fi ;o l .11.1 u 0 42 "�3 CD CD CD z CL. 0 C40 cm C 0 .� CD .LA 4D E CD CD LIL— = CD a) 0 Cm CD cc 0 C:L m cm< C40 S.0 cc 2) 10 CL 0 CD C.0 Z ts CD CL C40 S cc "a ca LLI Q LLI W ix w w 19 w LLI U) Cd 0 u x rl xr, x z 0 CL me cc 0 CF .2 C2 c=L E 0 'o mc =0 0 C.2 8, cc rm- 51 TL Cc 0 ca CJ 0 mo cm ra 0 CL "co, 0 CL Saw 0 ui .0 ca UJ E 5.6 cal C.3 &- U A 0 CM CL ca CD C, CLM I.- = 02 an :110 Cf) z 0 C/) P-4 fi ;o l .11.1 u 0 42 "�3 CD CD CD z CL. 0 C40 cm C 0 .� CD .LA 4D E CD CD LIL— = CD a) 0 Cm CD cc 0 C:L m cm< C40 S.0 cc 2) 10 CL 0 CD C.0 Z ts CD CL C40 S cc "a ca LLI Q LLI W ix w w 19 w LLI U) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the 'law", 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 j oint 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 section 25 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, 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. F777,77777,�- Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns. 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. The affidavits may be returned to the Department by mail or FAX.unless other arrangements have been made. The O.ffice of Investigations would like to thank you in advance for you 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,7h Floor Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406 North Andover Building Department Tel: 978-688-9545. DEBRIS DISPOSAL FORM In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by IVIGL c 11, S 150 A. The debris will be disposed of in: (Location of Facility) SignatuA, of Permit AW11'Cant LO � Z, Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector