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HomeMy WebLinkAboutMiscellaneous - 71 REGENCY PLACE 4/30/2018Date: July 14, 2016 20918 This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20918 OF NOHTH Ory 2 �OTOWN p p O PERMIT FOR WIRING t � �9SSACHUSE�� This certifies that James P Mutter has permission to perform FINISH BASEMENT wiring in the buildings of GERARD WELCH at 71 REGENCY PLACE, North Andover, Mass. Lic. No. 38914 Page 1 of 1 https:Hnorthandoverma.viewpointcloud.com/ 7/14/2016 Ai Date .1 1 1.15 .................. TOWN OF NORTH ANDOVER RMIT FOR WIRING This certifies thatIle P .................�-PS.......! ..................... ............................ has permission to perform "'T e,......... ,,,,,,, `P.,,,!`'Q„ -.„ 1^ — .. .........J.. wiring in the building of.....r1g?° r� /.rr.:...l�/Z P. -d,,,,,,,,,,,,,,,,,,,,,, at......../..../...Q�.�...�'.........../..../��--- ....................... . North Andover, Mass. Fee......`.."...... Lic. No.k....................................................................................... ELECTRICAL INSPECTOR Check # G D Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07j (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT INMK OR TI'PE ALL INFORMATION) Date: 9 / Q , / City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her inte�Qion to perform the electrical work described below. Location (Street & Number) Owner or Tenant Owner's Address Is this permit in conjunction with a Purpose of Building - Existing Service Amps New Service 101,9 0 Amps Number of Feeders and Ampacity /6volts Location and Nature of Proposed Electrical Work: ; `%t6 -g,7 / No LJ (Check Appropriate Box) Utility Authorization No. oR -d-J. Y % /3 Overhead ❑ Overhead ❑ Undgrd ❑ No. of Meters Undgrd [B'O" No. of Meters Comvletion ofthe following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans s Total Trsformers KVA Tran No. of Luminaire Outlets No, of Hot Tubs Generators KVA No. of LuminairesSwimming Pool Above ❑ In- Elo. rnd. rnd. o cy Lighting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges g No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW p g Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Systems:* SecuritNo. o or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent Hydromassage Bathtubs No. of Motors Total HP Telecommunications iqnNo. No. of Devices or E u valent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start:�)'r-/D ..i g� Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, ander thepains and penaltij..�ofperjury that the information on this application is true and complete. FIRM NAME:. �/tM Cs .JJ %YI oe-LIC. NO.: Licensee: 4 Signature COAAM LIC. NO.: E-3 (If applicable, enter "expiuotl in the licensen �m ne.}, Bus. Tel. No.- q!y k` Address: C / r"Ct (+�,e 114,1144 r, X4 ® 7 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Departmeno ublic Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $. Signature Telephone No. _ ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the 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 Ins a on Pass M LZ Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signatur on Date: 4`�/ / ( j✓ SERVICE SPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: S-/ . PARTIAL ROUGH INSPECTION: Pass n Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of IndustrialAceldents M I Congress Street, Suite 100 Boston, MA. 02114-2017 s www.mass.gov/dia wo3:kers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plum ers. TO BE FILED 'WITH THE PERMTTING AUTHORI7'X- Name (Business/Oiganization/Individual): Address: 0�k k !(eta r� City/State/Zip: Gv `I/1 "ill d C�'EPhone #: `7 7 Are you an employer? 'Checlk the appropriate box: 1.QT a employer with employees (full and/or part-time).* 2. I am a sole proprietor or partnership and have no employees working for me in ' comp. insurance required.] any capacity. [No workers 3.0 I am a homeowner doing all work myself, (No workers' comp. insurance required.] t <1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑I am a general contractor and 1 have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance) 6. Q We are a corporation and its, officers have exercised their right of exemption per MGL c. 152 §l(4) and we have uo employees. [No workers' comp. insurance required.] gCge) -2-!5— Type of project ()required). 7. ❑ N&W'constra'dtlon 8. R.emodeliing 9. ❑ Demolition 10 [] Building addition ILE] Electrical repairs or additions 12. [] plumbing repairs or additions 13T] Roof repairs 14.n Other *Any applicant that check's box #i must also fill out the section below showing their workers' compensation policy information. Homeowners who submit•this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached'an additional sheet showing the name of the sub -contractors and state whether or not those entities have ees, they must provide their workers' comp. policy number. employees. if the sub -contractors have employ X am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. Expiration Date,. City/State/Zip: Job Site Address: ompensation policy declaration page (showing the policy number and expiration date). Attach a copy of the workers' c e. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 Failure to secure coverage as required under MGL and/or one-year imprisonment, as well as civilpenalties O Investigations of the DIA. for insuran 0 a day against the violator. A copy of this statement may be forwarded to the Office coverage verification. X do hereby cert' under tlae pain d penalt'es of perjury that the information provided above is true and correct. 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): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone Contact Person: Information and Instrnctions 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 enferpri'se, 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 b6 deemed to be an employer." MGL chapter 1.52, §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 certificates) of insurance. Limited -Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial -Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-87741ASSAFE Fax # 617-727-7749 Revised 02-23-15 wwwmass.gov/dia J % 3 Date .. 1/... 1. fir . . TOWN OF NORTH ANDOVER t PERMIT FOR MECHANICAL INSTALLATION p • �S ACMUSttt tJ t This certifies that' . . �' e rA................. . has permission for mechanical installation .......... ems.. ,,....... . in the buildings of r'.4 f . ..' ...... ... . at .). 1 .... gg�°n. �-..1�� � L --.., North AA/ndover, Mass. Fees .�� .. Lic. No.. ��' ? _� . /. .......... f' :. ` ......... . GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer S Commonwealth of Massachusetts Sheet Metal Permit Date: I I 11 I S� Permit # Estimated Job Cost: $--"30, 00 y Permit Fee: $ Plans Submitted: YES q� NO Plans Reviewed: YES NO Business License # 6 1 Applicant License #i 31 Business Information: Property Owner /i Job Location Information: Name: Cts �' i 5 (, o c` P Pj% F(ah K S it` Name: of o I �•� Pro a& r t� 5 Street: s s 5 W o b Street: rC t o City/Town: —i w k 5 b k r City/Town: or V11 V -C i( Telephone:69 �S 1 �SS Y 9 3 Telephone: Photo I.D. required/ Copy of Photo I.D. attached: YES NO StaflWtW J- - unrestricted license J-2 / M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. / 2 -stories or less Residential: 1-2 family /- Multi -family Commercial: Office Retail Institutional - Condo / Townhouses Other Industrial Educational Other Square Footage: under 10,000 sq. ft. ✓ over 10,000 sq. ft. Number of Stories:. Sheet metal work to be completed: New Work: Renovation: HVAC 1� Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: OL 1k�z �1 ^- of YL ► +W 0 i"k � ti-st V,� Z kms, INSURANCE COVERAGE: 1 have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes p' No ❑ H you have checked -Yes, indicate the type of coverage by checking the appropriate box below: A liability Insurance policy [!� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this boxb./l 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 Duct inspection required prior to Insulation installation: YES NO Progress Inspections Comments Final Inspection Comments Type of License: By ❑ Master Title ❑ Master -Restricted City/Town oumeyperson Signature of Licensee Permit X Fee $ ❑Joumeyperson-Restricted License Number. _ -� 3 I Check at www.mass.gov/dal Inspector Signature of Permit Approval s 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 journeyperson-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 V'— Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct ✓ Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) Load Short Form Job: Date: May 06, 2015 (Rest of House) By: HEATING SERVICE Franks Heating Service 555 Woburn St, Tewksbury, MA 01876 Phone: 978-851-4403 Fax: 978-851-0398 For: lot 7 regency ridge north andover ma Htg Clg Infiltration Outside db (°F) 1 88 Method Simplified Inside db (°F) 70 75 Construction quality Average Design TD (°F) 69 13 Fireplaces 1 (Average) Daily range - M Inside humidity (%) 30 50 Moisture difference (gr/Ib) 28 28 HEATING EQUIPMENT Make American Standard Trade GOLD ZM Model AUH2B060A9V3VB* AHRI ref 5722438 Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 97AFUE Area (ft2) 60000 Btuh 58000 Btuh 57 OF 933 cfm 0.022 cfm/Btuh 0 in H2O COOLING EQUIPMENT Make American Standard Trade GOLD SI Cond 4A7A3030G1 Area (ft2) Htg load (Btuh) Coil 4TXCB031 BC3 Htg AVF (cfm) Clg AVF (cfm) AHRI ref 5636141 144 5013 Efficiency 11.5 EER, 13.5 SEER 89 Sensible cooling 22400 Btuh Latent cooling 5600 Btuh Total cooling 28000 Btuh Actual air flow 933 cfm Air flow factor 0.048 cfm/Btuh Static pressure 0 in H2O Load sensible heat ratio 0.88 1624 ROOM NAME Area (ft2) Htg load (Btuh) Clg load (Btuh) Htg AVF (cfm) Clg AVF (cfm) bath 144 5013 1858 112 89 courtney 168 3603 2568 80 123 loft1 105 1284 278 29 13 loft2 105 1273 276 28 13 walk in 77 1624 288 36 14 hall 225 3211 1940 71 93 bed5 189 3286 1909 73 91 bath3 89 679 185 15 9 alexs 230 4135 2518 92 121 bath2 109 2962 1172 66 56 theater ...., 273 _,no 5210 nr_eo 1958 eee� 116 nee 94 nen Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2015 -Nov -10 09:31:14 .` + wrightsoftRight-Suite® Universal 2015 15.0.18 RSU10062 Page 2 ...roject\lot 7 regency ridge north andover ma.rup Calc = MJ8 Front Door faces: N (Rest of House) d 2322 41934 19469 933 933 Other equip loads 3106 585 Equip. @ 1.00 RSM 20054 Latent cooling 2727 TOTALS 2322 45041 22781 933 933 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2015 -Nov -10 09:31:14 At.wrightSOW Right -Suited Universal 2015 15.0.18 RSU10062 Page 3 AOM ..rojecl\lot 7 regency ridge north andover ma.rup Calc = MJ8 Front Door faces: N Load Short Form Job: POOZ&Z7 Date: May 06, 2015 first floor By: HEATING SERVICE Franks Heating Service 555 Woburn St, Tewksbury, MA 01876 Phone: 978-851-4403 Fax: 978-851-0398 For: lot 7 regency ridge north andover ma HEATING EQUIPMENT Htg CIg Outside db (°F) 1 88 Inside db (°F) 70 75 Design TD (°F) 69 13 Daily range - M Inside humidity (%) 30 50 Moisture difference (gr/Ib) 28 28 HEATING EQUIPMENT Area (ft2) Make American Standard Coil 4TXCB036BC3 Htg AVF (cfm) Trade GOLD ZM AHRI ref 7920891 33 Model AUH2C100A9V5VB* Efficiency 10.5 EER, 13 SEER AH R I ref 5722442 Sensible cooling 27520 Efficiency 96.7 AFU E Latent cooling Heating input 100000 Btuh Heating output 97000 Btuh Temperature rise 77 OF Actual air flow 1147 cfm Air flow factor 0.030 cfm/Btuh Static pressure 0 in H2O Space thermostat 311 eat Infiltration Method Construction quality Fireplaces Simplified Average 1 (Average) COOLING EQUIPMENT Make American Standard Trade AMERICAN STANDARD Cond 4A7A3036G1 Area (ft2) Htg load (Btuh) Coil 4TXCB036BC3 Htg AVF (cfm) Clg AVF (cfm) AHRI ref 7920891 33 70 Efficiency 10.5 EER, 13 SEER 0 Sensible cooling 27520 Btuh Latent cooling 6880 Btuh Total cooling 34400 Btuh Actual air flow 1147 cfm Air flow factor 0.045 cfm/Btuh Static pressure 0 in H2O Load sensible heat ratio 0.86 8763 ROOM NAME Area (ft2) Htg load (Btuh) Clg load (Btuh) Htg AVF (cfm) Clg AVF (cfm) lav2 33 70 11 2 0 Off 155 2597 2407 79 108 foy 182 2341 903 71 41 din 203 2416 2367 74 107 fam 550 8763 6907 267 311 eat 208 4191 3498 128 158 pant 58 0 0 0 0 kit 349 4849 4050 148 182 guest 354 5990 2612 182 118 g bath 58 1332 732 41 33 mud 192 2349 405 71 18 lav I.... 30 AO 0 '177L 0 AL77 0 OA 0 7A Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2015 -Nov -10 09:31:14 .i wrightSOW Right -Suite® Universal 2015 15.0.18 RSU10062 Page 4 . COCA ...roject\lot 7 regency ridge north andover ma.rup Calc = MJ8 Front Door faces: N first floor d 2469 37672 25466 1147 1147 Other equip loads 5426 1022 Equip. @ 1.00 RSM 26488 Latent cooling 4204 TOTALS 2469 43098 30692 1147 1147 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2015 -Nov -10 09:31:14 wrightSOW Right -Suite® Universal 2015 15.0.18 RSU10062 Page 5 /9�C� ...roject\lot 7 regency ridge north andover ma.rup Calc = MJ8 Front Door faces: N Load Short Form Job: %M -2M6 Date: May 06, 2015 8 mastersuite By: HEATING SERVICE Franks Heating Service 555 Woburn St, Tewksbury, MA 01876 Phone: 978-851-4403 Fax: 978-851-0398 For: lot 7 regency ridge north andover ma Htg Clg Infiltration Outside db (°F) 1 88 Method Simplified Inside db (°F) 70 75 Construction quality Average Design TD (°F) 69 13 Fireplaces 1 (Average) Daily range - M Inside humidity (%) 30 50 Moisture difference (gr/Ib) 28 28 HEATING EQUIPMENT Make Trade Model AHRI ref Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 80AFUE 0 Btuh 0 Btuh 0 OF 353 cfm 0.025 cfm/Btuh 0 in H2O COOLING EQUIPMENT Make Trade Cond Coil AHRI ref Efficiency Sensible cooling Latent cooling Total cooling Actual air flow Air flow factor Static pressure Load sensible heat ratio 0 SEER 0 Btuh 0 Btuh 0 Btuh 353 cfm 0.050 cfm/Btuh 0 in H2O 0.92 400 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ftz) (Btuh) (Btuh) (cfm) (cfm) mas 400 6081 1868 151 93 m bath 194 3469 2509 86 126 dress 187 4703 2677 116 134 master suite d 782 14252 7054 353 353 Other equip loads 0 0 Equip. @ 1.00 RSM 7054 Latent cooling 627 TlITAIC 74'f 4e7c1) 7004 oce nc� Calculations approved by ACCA to meet all requirements of Manual J 8th Ed 2015 -Nov -10 09:31:14 wrightSOW Right -Suite® Universal 2015 15.0.18 RSU10062 Page 6 ...roject\lot 7 regency ridge north andover ma.rup Calc = MJ8 Front Door faces: N Client#: 53676 MII 1 IRFRON2 ACORD,M CERTIFICATE OF LIABILITY INSURANCE D 9/09/ /DD/YYYY) 9/09/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER HUB International New England Wil ington, M 0 Wilmington, MA 01887 978 657-5100 NAAM:NECertificate Desk H NN Ext ; 978 657-5100 AAT /C N,, 866-475-7959 E-MAIL Ss, nee.certificates@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC/ INSURER A: Liberty Mutual Insurance Co INSURED Hillis Corp INSURER 8: Atlantic Charter 01/01/2016 EACHOCCURRENCE $1,000,000 DBA Frank's Heating Service INSURER C: 555 Woburn St INSURER 0: Tewksbury, MA 01876 INSURER E: INSURER F: I:UVtKAGtS CERTIFICATE NUMRFR! RFVl-gfnN NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDNAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 ADDL SUBR POLICY NUMBER POLICY EFF MM/DDIYYYY) POLICY EXP (MIMIDDNYM LIMITS A GENERAL LIABILITY X X BKS55555637 1/01/2015 01/01/2016 EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY AMAGE RENTED REMISE Ea occurrence $3002000 CLAIMS -MADE a OCCUR MED EXP (Any one person) s15, 000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY X PRO- T El LOC 6 A AUTOMOBILE LIABILITY X X BA1656678207 1/01/2015 01/01/201 BINED SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY (Per person) 6 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED PROPERTY DAMAGE $ AUTOS Per accident $ A X UMBRELLA UAS X OCCUR X X US055555637 0 1/01/2015 01/0112010 EACH OCCURRENCE $3000000 EXCESS LIAR CLAIMS -MADE AGGREGATE s3,000,000 DED I X RETENTION $10000 $ B WORKERS COMPENSATION WCI00113102 MA 6/30/2015 06/301201 X WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEWCA00520207 NH 6/30/2015 06/30/201 E.L. EACH ACCIDENT s500000 OFFICEWMEMBER EXCLUDED? a N I A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $500 OOO If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 6500,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Town of Tyngsborough 25 Bryant Lane SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Tyngsboro, MA 01879 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1453919/M1408208 DKO04 The Commonwealth of Massachusetts - Department of -Industrial Accidents lf�a _ Office of Investigations 600 Washington Street Boston, MA 02111 www mass.govl a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Businesdorganizadon/indilIvidual): ! 1 l l' i S (acv 1 (� / & A ((ti K K's I�` �� � ►-� Address: S S S W O b� (V, S� City/State/Zip: /-e w k -A , ( y ,SAA U 1 S-) b Phone #: Are you an employer? Check the apr 1. 21-a21-am.aa employer with t 0 employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t riate box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. incnrance.t 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comn. insurance reauired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. EJ Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other H V A L *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. 7 am an employer rs prov g wo�rers' compensation r"nsuranee for my employe u e po •-- job r—`-- -- information. Insurance Company Name:, - ,— c 1 Policy # or Self -ins. Lic. #: W 1 ` C- TC) U 31 t) Expiration Job Site Address: :2 I Rer�-(.ti t' r+1- City/State/Zip: 0'r- �uwr A IIf 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 underrains and penalties of perjury that the information provided above is true and correct. i Phone#:(9)Liy3 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 Cleric 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #' Z fL-I CD V a �- 0 y y f 00 3 J A Q' O O N 3 �' N O O �. Ep ►"i Cn N J Cn r A J N r A r CD CL V n 3 CA ID M fD L `o G p � EP c.. j/CD v CL M 3 < CL/ EL 3 3 3 A 3 V. S N s X, O ;w 7 cD TI n V\ co @ \ 3 co c, N 2 3 =g CD W z OCD C '. x o3 co 4-4 N w -� (( A^ ao -4 CD v i a ao 0' =r O (D W Op i !T 00 70 CD Q C CD Z CD obi@) m o0 �< CL n 0 V d CD i6 K) O 3 N O d Cn 2 v ` ' Z V Q N ......... S 3 m - 7 O O`r v fD N W 'I n � 3 cn N v c Tom, (D N YS Q L NJ _ a cD D, N 0- 57 ,o vr CD � 1' c0i lD w Ci O L 0 3 m Q / C J s O / G_ O s 3 3 � N r N ` W n ` N O S =rO as �- �� v cn cn y Qc�'i, 2 CD w� 03 cr x o� .. — N CO co goC;) OD J �• 6CD CD 00 Cb CD CD _� � N O M C, �. Upo. c N CD Z�;w (D CD O ®0) = A in 7 (D OD w 0 0) C) (CD ANN O 3 v O N U1 2 U