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Miscellaneous - 73 MAYFLOWER DRIVE 4/30/2018
J w V 0or Date .....� 1`1........ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ....... �) .... I ...... F has permission to perform ......... ...... . ........ plumbing in the buildings of. .......... at .....:.9.7.,:....... . .......... North Andover, Mass. Fee ..1515 ..... Lic. No. .. ........ ............ . ........ ........................................................ PLUMBING INSPECTOR Check# `Z %-14 AA. 511-14 • r , y i i MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA. DATE - f PERMIT # b� JOBSITE ADDRESS OWNER'S NAME O l l Sg(e,'K POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL PRINT NEW')ff RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ CLEARLY FIXTURES 1 FLOOR- BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB 2 - CROSS CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIL/SANDSYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK I j LAVATORY II I IJ ROOF DRAIN SHOWER STALL 1 f� SERVICE / MOP SINK TOILET 1 2 URINAL j WASHING MACHINE CONNECTION 1 WATER HEATER ALL TYPES WATER PIPING OTHER INSURANCE COVERAGE: have a current liabifitV insurance policy or its substantial equivalent which, meets the requirements of MGL Ch_ 142. Yes &No ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY E� - OTHER TYPE OF INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement_ CHECK ONE BOX ONLY: OWNER ❑ AGENT ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of -my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter, 142 of the General Laws. PLUMBER NAME S i EP'11150 C CALINSKY SIGNATURE LIC # 11)3/11 MP [?' JP ❑ CORPORATION 1�1'# 3119116 PARTNERSHIP ❑ # LLC ❑ # COMPANY NAME 6A -1135 KY PLUM01Al to a- RVATI O ADDRESS: P. o • GG X f i l l CITY NA VERI+ILL STATE 171-A- ZIP 01131 EMAIL vyvvw. rnrplyrAbert[litrao�. Covet TEL gl�` 371- 'i 7+13 CELL rjDB - �0°I � ri 90H FAX Q7$- 5,11MAL I 0 O C x r C tz G) z b r� 0 z z 0 a r m --i m — a r- D r r y N ~_ r m D Z cn C-7 U) z 071 0 *7 N � c U' to � CD C -J cn O z ❑: r z h _y . O z z 0 H trJ r' � COMMONWEALTH OF MASSACHUSETTS Date........;1.1.1 ..................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................. I .............................................. has permission for gas installation ........................ in the burl gs .................................... . .. .................................... at ......... ... ... K ......... ........... ..... .. ....... .. ...... .... ..... .................. , North Andover, Mass. N -1 - Fee..... W ....... Lic. No. ...... ..................................................... GAS INSPECTOR Check # 0 Z f) 0 ..e U of hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cpplipnce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4—t _/� PLUMBER/GASFITTER NAME: ST E PFI E N C. G A L T N S KY LICENSE # 103,416 / SIGNATUTM COMPANYNAME: GA1.1r sK4 P%.001510. , -t 14CKt-Ih & ADDRESS: P.0- WX 1701 CITY: 14AVE-kHiLL, STATE: m. A- ZIP: 01$31 FAX: 979- 6ai-j113 TEL: 978-:3"7y- 17y3 CELL: ;01- 6bA-- 5944' EMAIL: W'W "W: Mrp1UMbefCC Garr MASTER IZ JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION [�# 31 qb PARTNERSHIP ❑ # LLC 0 # MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK - �1 s TYPE OR PRINT CLEARLY CITY: CM u MA. DATE: _ 16 "r y PERMIT # JOBSITE ADDRESS:_ �' �'/ GLA- Ot OWNER'S NAME: // SCLI - OWNER ADDRESS: TEL: FAX: OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW:' RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCESZ FLOOR— Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER 800STER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM 1 SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER I INSURANCE COVERAGE I have a current liabilitv insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY Q OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in cpplipnce with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. 4—t _/� PLUMBER/GASFITTER NAME: ST E PFI E N C. G A L T N S KY LICENSE # 103,416 / SIGNATUTM COMPANYNAME: GA1.1r sK4 P%.001510. , -t 14CKt-Ih & ADDRESS: P.0- WX 1701 CITY: 14AVE-kHiLL, STATE: m. A- ZIP: 01$31 FAX: 979- 6ai-j113 TEL: 978-:3"7y- 17y3 CELL: ;01- 6bA-- 5944' EMAIL: W'W "W: Mrp1UMbefCC Garr MASTER IZ JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION [�# 31 qb PARTNERSHIP ❑ # LLC 0 # 1 1 N V+ x� .t b r� n y O z z 0 H h m = m � v M a r V H z m o m m D z � • rn O � "' O t CD �N O z ❑o K 'r b n H O z z H .Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 3505125.00 m $ - $ 4,201.50 Plumbing Fee $ 525.19 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 525.19 Total fees collected $ 5,351.88 72 Mayflower Drive 836-14 on 5/19/14 Single Family Home 10011,111 J-1 Date ... La.:.ik-k y...... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING A This certifies that........ �: ..�.......4. �f.............. .................................................. has permission to perform ........x 4. x.0........0.99) - ....................................... k ' plumbing in the buildings of.... ol,�Q......Ss<<-,.....U;.tl 4 ........................... at ...... .. ......& 4 . �1L.� ...ja .............................. North Andover, Mass. Feeka.j:u .�!... Lic. No. 1. �3Y..f ... !......... f .. - 7 ,v'1 ............... PLUMBING INSPECTOR J Check # 7 7,> 7 t MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY MA. DATE t — 1 PERMIT # JOBSITE ADDRESS ©L%CT OWNER'S NAME 1 OWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL RESIDENTIALV PRINT NEW: ?,12 RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ CLEARLY FIXTURES -1 FLOOR- BSMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB Z CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYS DEDICATED GAS/OIUSAND SYS DEDICATED GREASE SYS DEDICATD GRAY WATER SYS DEDICATED WATER RECYCLE SYS DRINKING FOUNTAIN DISHWASHER FOOD DISPOSER FLOOR /AREA DRAIN I I INTERCEPTOR (INTERIOR) KITCHEN SINK 1 I LAVATORY I I ROOF DRAIN I I SHOWER STALL I I 1 1 I I I SERVICE/ MOP SINK I I I TOILET t 7- URINAL WASHING MACHINE CONNECTION I I I ( I WATER HEATER ALL TYPES I I I I WATER PIPING I I I I I I OTHER I I I INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which, meets the requirements of MGL Ch_ 142_ Yes ZNo C] IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW 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 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement_ CHECK ONE BOX ONLY: OWNER ❑ AGENT ❑ of Owner or I hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that ail plumbing work and installations performed under the perrAt issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter y4f of t4e General Laws. PLUMBER NAME STLP►{E►J C GALIPSKY SIGNATURE �U LIC # I D34t S MP G!r JP ❑ CORPORATION [-# 19 h PARTNERSHIP # LLC ❑ # COMPANYNAME &AwosKY PLOMOIiJ(p *- "VATI13 ADDRESS: P -D- CLQX 17ol CITY HAVCRK)" TEL q7t- 37'1- 174 3 STATE M -A- z1F 01131 EMAIL www. mrpiymb+`r(9)5LD1 • coy,, CELL .500 -'3oq--59014 FAX g7$-5AI-k1 1 r) x r C 7 z trJ CJ H z z 0 r UJ m m a 47 r z o N ~ m z - �E: C) o h � � ❑CEl o z r D *C Z� Z b H O z 0 H Date..................................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION . 6 Thiscertifies that.................................................................................................................... has permission for gas installation ..................................................................... in the buildings of .....j.......5 '�'" ................................................................................ at ..... 1.3 ....... In e,Jl'.................North Andover Mass. Lic. No. > c33Y ...........�.......................................J.......................... GASINSPECTOR Check #-2? S - .1730 hereby certify that all of the details and information I have submitted (or entered) regarding this application ar rue nd accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applicatio i in mpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER/GASFITTER NAME: STIEPREN C. C-ALI-NSKY LICENSE# 10314IS SIGNATURE COMPANYNAME: GAL4t5Kq PLUMAJOC -t 14C9t-W& ADDRESS: P.O. WX 1701 CITY: 9 AV iFkH I STATE: rn - A - ZIP: OIS31 FAX: q79' 5611-g13i TEL: 371- I7y3 CELL: 5,0q - SiAi- 5goq EMAIL: www. mrolumbefC D� MASTER JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION /#-:31 9& PARTNERSHIP ❑ # LLC ❑# MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK W) GOWNER TYPE OR PRINT CLEARLY CITY: Rd 4A- MA. DATE:.'1 I -F-(y PERMIT # Il� "lT dOBSITE ADDRESS: IS rn,-, �7 2I Q W eA/L - OWNER'S NAME: 00 S c� I C ✓"n VA.'t- ADDRESS: TEL: FAX: OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIAL NEW;P RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO ❑ APPLIANCESI FLOOR- Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER INSURANCE COVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES 9 NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box below. LIABILITY INSURANCE POLICY Q' OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information I have submitted (or entered) regarding this application ar rue nd accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this applicatio i in mpliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER/GASFITTER NAME: STIEPREN C. C-ALI-NSKY LICENSE# 10314IS SIGNATURE COMPANYNAME: GAL4t5Kq PLUMAJOC -t 14C9t-W& ADDRESS: P.O. WX 1701 CITY: 9 AV iFkH I STATE: rn - A - ZIP: OIS31 FAX: q79' 5611-g13i TEL: 371- I7y3 CELL: 5,0q - SiAi- 5goq EMAIL: www. mrolumbefC D� MASTER JOURNEYMAN ❑ LP INSTALLER ❑ CORPORATION /#-:31 9& PARTNERSHIP ❑ # LLC ❑# O ci t x Gn Gn cn b 7 H z z 0 GO m = m N n � y v r 0 O y z r U) - t7-1 tn ti m D z H � � tt t _ C m z _0 � 3 O cn aE o z El - �It r b y O z z H t=i L % L,. Date.....,. �.� ' ...... ,HORTM TOWN OF NORTH ANDOVER pf 4 1ti PERMIT FOR MECHANICAL INSTALLATION p This certifies that ...'? �'+.� ....►! ..(� �` has permission formechanical installation . , �, {k'G'�� ............ in the buildings of A Gx'?!;-�............................. at —J.North Andover, Mass. Fee..4. <-.. Lic. No. 16k ... .........�"� ...... . !` GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer R r (ommonwealth o :(/VO of 'Massachusetts Sheet Metal Permit Date: Estimated Job Cost: $ `�. 000 y Plans Submitted: YTS NO Business License 11 196 Permit # Permit Pee: $ t U Plans Reviewed: YES NO Applicant License it Business Information: Property Owner / Job Location Information: Name: J&J Heating 6 Air Conditioning Name: - n C— Street: 17 Arlington St.. Street:/. � � // %r�Oy6v City/Town: Dracut, MA 01826 City/Town: North Andover, MA 01845 Telephone: .978-454-8197 Telephone: 97k 3 / 6 , 3 Photo I.D. required / Copy of Photo I.D. attached: YES NO Staff Liltial J-1 / M -1 -unrestricted license J-2 / M-27restricted to dwellings 3 -stories or less and cominercial up to 10,000 sq. ft. / 2 -stories or less Residentiah- 1--21dibily Multi -family Condo / Townhouses, Other Commercial: Office Retail Industrial Educational Institutional Other Square Footagc: under 10,000 sq. ft. t/ over 10,000 sq. ft. Number of Storics: Sheet metal work to be completed: New Work: Y Renovation: HVAC ✓ Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: CY a ,o l i'II %a ll /1� e- 7a l d 4 e- ' to a r 144 c INSURANCE COVERAGE: 1 have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes 3-1qo ❑ If 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 gignature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box0, 1 hereby certify that all of the details and Information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Date Date Progress Inspections Comments Final Inspection Type of License: By ❑ Master Title ❑ Master -Restricted City/Town ❑Journeyperson Permit # ❑Journeyperson-Restricted Fee $ Inspector Signature of Permit Approval Comments Signature of Licensee License Number: /5 ja Check at www.mass.govldpi ACORD. CERTIFICATE OF LIABILITY INSURANCE F DATE(MM/DD/YYYY) 06/10/2014 PRODUCER 978.887,4900 FAX 978.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE .1.6 South Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P. 0. Box 457 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Topsfielci, MA 01983 INSURERS AFFORDING COVERAGE NAICJI INSURED J&J Heating & Air Conditioning, Inc. INSURER& Great American Alliance Ins Co 17 Arlington Street INSURERB: Safety Insurance Company 39454 Dracut, MA 01826 INSURERC A.I.M. Mutual Insurance Co. INSURER D:----- ----- ---------- INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. --- LTR- NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM DD/YYYY POLICY EXPIRATION DATE Mld DD YV ------ LIMITS $ 1,000,000 GENERAL LIABILITY PAC6418906-08 06/01/2014 06/01/2015 EACH OCCURRENCE X COMMERCIAL_ GENERA_ I_IARII_ITY DAMAGE FO RENTED — CLAIMS MADE FXI OCCUR PREMISES (Ea occurrence) — $ _ 300 , 0_0_0 A -- MED EXP (Any one person) $ 1.0 , 000 --- PERSONAL & ADV INJURY - .$ 1_000,000 -- GENERAL AGGREGATE $ 2,000,000 EN'L AGGREGATE LIMff APPLIES PER: PRO- -- PRODUCTS - COMP/OP AGG _ $ 2,000,000 _ POLICY ,IECf LOC - _ _ AUTOMOBILE LIABILITY 2434550 06/01/2014 06/01/2015 ANY AUTO COMBINED SINGLE LIMIT $ — (Ea accident) 1,000,000 ALL OWNED AUTOS --------- - X _ H SCEDULED AUTOS BODILY INJURY (Per person) 4 X HIRED AUTOS - — X NON -AWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ --- -------------------- — (Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT s --- OTHER THAN 1_A ACC - $ — AUTO ONLY: AGG $ _EXCESS/ UMBRELLA LIABILITY- X OCCUR CLAIMS MADE UMB6418958-06 06/01/2014 06/01/2015 EACH OCCURRENCE s 2,000,00 AGGREGATE — s 2, 000, OOO A -I —1 -- — DEDUCTIBLE -J — --- RETENTION .6 WORKERS COMPS LIABII ON AND EMPLOYERS' LIABII_ITV ILITY LAI - bTFT= WMZ-800-8006553-2014A 06/02/2014 06/02/2015 X Y / N ANY PROPRIETOR/EXCLUDEDR/E XECUTIVE('� �- TORY LIMITS OFRCEII/MEMBER EXCLUDED? I I E.L. EACH ACCIDENT :6 1,000,000 (Mandatory in NII) —J ------ If yes, descrihe under E.L. DISEASE - EA EMPLOYEE s 1,000,000 SPECIAL_ PROVISIONS below ---- - - OTH[R E.L. DISEASE - POLICY LIMIT !6 1,000,000 DESCRIPTION OF OPERATIONS / t_OCATIONS / VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Evidence of Insurance AUTHORIZED REPRESENTATIVE .J — �— Peter Sennott/LAfi ,.cs•fs;.,. ACORD 25 (2009/01) ,,"�' © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r The Commonwealth ofMassachuselts Department of Industrial Accidents r Office of Investigations 600 Washington Street Boston, MA 02111 w"Iminass.gov/dia Workers' Compensation Insurance Mfidavit: Builders/Contractors/Electricians[Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): J&J Heating & Air Conditioning, INc. Address: 17 Arlington St. City/State/Zip: Dracut, MA 01826 Pholle it: 978-454-8197 Are you an employer? Check the appropriate box: 1. ® I am a employer with 40 4. [] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed. on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. ittsurance.t required.] 5. [] We are a corporation and its 3.0 I am a ltomQowner doing all work officers have exercised their myself. [No workers' comp, right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. [] Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.[] Roof repairs. 13.0 Other ''Any applicant that checks box #1 must also fill. out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they ere doing all work and then hire outside cont actbrs must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' cony, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A.I.M. Mutual Insurance Policy # or Self -ins. Lie. #t: WMZ-800-8006553-2013A Expiration Date: 06/01/15 Job Sitc Address:City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $25 ay against the violator. a advised that a copy of this statement may be forwarded to the Office of Investivrions of fliq DIA forpnsujatzc ovc gc verification. I do her ertif.) nder #1a1 pfand&4*krvf perjury that the information provided above is true and correct. 4-8197 Official use only. Do not write in this area, to be completed by city or town official. City or Town: PerriliULicense ft Issuing Authority (circle one): 1. Board of Ifealth 2. Building Department 3. Cityrlbwn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone It: I E4'S'ACII1<JISE,TT`; MV A DRIVER'S II LICENSE s 1 i 4 ISS Ba END 4A NUMBER !105.03 2011 NONE S9g655$71 �� :41 .EXP . 3 DOR': �, r 016 052 X98.0 � _ }I'nYfq •:t x05,3 .:. AS CLASS x`:72 REST' 15 SE8 M --1 +N 6 09 NONE } �r .1 Al:' WORKERS vri u's'e' P .1 .. .. f KLINE u •, c �, �• '� ;� 2 ERIC RJ r• olkz 100..:. a 83 LONG DR DRACUT, MA 01826-2048 AS'.A 5 DD MI -2011 R.v.1-112008 - ylpyv ;1v COMMONWEALTH OF MASSACHUSETTS: II A R 0 A BOARD W SHEEf..AET Al:' WORKERS ISSUES THL F0LLOWIN `LICEAW AS'.A :ASTER—UN,R.ESTRICTE" J & J HEATING & AC ERIC'"R KL<J:NJ & J HEATING & AC 17 ARL:J NGTON ST:° ORACUT MA 01826-39 1568 .' 05/28/ ,6 21 4539 n -- wrightsoft. Load Short Form Entire House Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: Project�ln#ormatior � � ��� a For: - 1 Hepatica• •• 01845 HEATING EQUIPMENT Make Trade Model AHRI ref Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 80 AFU E 0 Btuh 0 Btuh 0 °F 895 cfm 0.028 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 895 cfm 0.048 cfm/Btuh 0 in H2O 0.86 110 ROOM NAME Area (ft2) Htg load (Btuh) Clg load (Btuh) Htg AVF (cfm) Clg AVF (cfm) kitchen 392 5171 2353 143 113 1/2 bath 110 2140 1214 59 58 Living room 226 3279 2322 91 112 Entry 192 2079 332 57 16 Dining room 196 3202 1889 89 91 Bedroom 2 196 3359 2727 93 131 Bedroom 3 196 3359 2410 93 116 Bath 1 81 1114 526 31 25 bath 2 81 1114 526 31 25 W.I.0 63 1543 265 43 13 Master bedroom 247 3816 2004 106 96 Bedroom 4 129 1940 1903 54 91 1) A Fl....r L...11 inn neo aon n Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wri htsoft° 2014 -Dec -04 07:08:30 9 Right-SuiteO Universal 2015 15.0.04 RSU05790 Page 1 ACCN ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Entire House 2232 32363 18632 895 895 Other equip loads 4746 2389 Equip. @ 0.88 RSM 18435 Latent cooling 3555 TnTA I C 0040 474 nn n4 nnn nnr uL v I I U.7 c I UUU OyJ MID Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. .L wrightsoft' Right -Suite® Universal 2015 15.0.04 RSU05790 ACCK ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N 2014 -Dec -04 07:08:30 Page 2 Building AnalJob: lot 16 May Flower Dr ss wrightsoft'� y Date: Feb 2, 2014 Entire House By: For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 r7-77 7tll A ® • o • •s, ' w Win. Walls Location: 8609 Indoor: Heating Cooling Worcester, MA, US 11.5 Indoor temperature (°F) 68 75 Elevation: 1010 ft Ceilings Design TD (°F) 63 8 Latitude: 420N 1.8 Relative hums lty (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: Adjustments 0 Dally range6 °F) - 17 (M) Method Simplified 12.8 Wet bulb (° -69 Wind speed (mph) 15.0 7.5 Construction quality Fireplaces Ti ht 1 Tight) Adjustments ` rxp�yig . n Heating M'm N Component Btuh/ft2 Btuh % of load Walls 4.1 8609 23.2 Glazing 20.3 4265 11.5 Doors 20.9 1272 3.4 Ceilings 1.6 1828 4.9 Floors 1.8 2006 5.4 Infiltration 4.3 10293 27.7 Ducts 25.6 4089 11.0 Piping Adjustments 0 0 Humidification 21021 4746 12.8 Ventilation 0 0 Adjustments 0 Total 1 371091 100.0 Component Btuh/ft2 Btuh % of load Walls 0.6 1325 6.3 Glazing 30.1 6321 30.1 Doors 6.9 422 2.0 Ceilings 1.2 1288 6.1 Floors 0.2 245 1.2 Infiltration 0.5 1235 5.9 Ducts 2405 11.4 Ventilation 0 0 Internal gains 5390 25.6 Blower 2389 11.4 Adjustments 0 Total 1 21021 100.0 Latent Cooling Load = 3555 Btuh Overall U -value = 0.063 Btuh/ft2-°F Data entries checked. .; IltSOFt" 2014 -Dec -04 07:08:30 WCI 9 Right -Suite® Universal 2015 15.0.04 RSU05790 Page 1 ACCK ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N -- wrightsoft- Component Constructions Entire House FEW For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: 0� � -_ - ®- • • � e 4.09 2003 Location: 308 Indoor: Heating Cooling Worcester, MA, US 2333 Indoor temperature (°F) 68 75 Elevation: 1010 ft 21.0 Design TD (°F) 63 8 Latitude: 420N w 527 Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: 0.63 1325 Daily range (°F) - 17 (M) Method Simplified 756 Wet bulb (°F) - 69 Construction quality Ti ht 0 Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) all 61 Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain W Btuh/ft2-°F ft2-'F/Btuh Btuh/W Btu Btuh/ftp Btu Walls 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors Door, wd sc type: Door, wd sc type Ceilings 16B-38ad:Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 ceil ins Floors 19A-30bswp: Part floor, hrd wd fir fnsh, r-30 ins, frm flr, 10" thkns n 489 0.065 21.0 4.09 2003 0.63 308 e 570 0.065 21.0 4.09 2333 0.63 359 s 516 0.065 21.0 4.09 2113 0.63 325 w 527 0.065 21.0 4.10 2160 0.63 333 all 2102 0.065 21.0 4.09 8609 0.63 1325 n 27 0.300 0 18.9 509 7.47 201 e 17 0.570 0 35.9 613 56.9 973 e 44 0.300 0 18.9 832 27.6 1217 w 122 0.300 0 18.9 2312 27.6 3382 all 210 0.300 0 20.3 4265 27.4 5772 e 40 0.300 0 18.9 756 6.27 251 w 21 0.390 0 24.6 516 8.15 171 all 61 0.390 0 20.9 1272 6.92 422 1116 0.026 38.0 1116 0.034 30.0 1.64 1828 1.15 1288 1.80 2006 0.22 245 wri htSOft 2014 -Dec -04 07:08:30 g Right -Suiten Universal 2015 15.0.04 RSU05790 Page 1 ACCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N -- wrightsoft- Component Constructions kitchen MIME WA ,_... ° 1 ro 7 , nformation � HepaticaFor: Key Lime INC 10 •Andover, Ma 01845 Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: Construction descriptions Or Area U -value 18.9 Location: 7.47 Indoor: Heating Cooling Worcester, MA, US Loss Indoor temperature (°F) 68 75 Elevation: 1010 ft ft� Design TD (°F) 63 8 Latitude: 420N Btuh/ft2 Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: n 107 Daily range (°F) - 17 (M) Method Simplified 0.63 Wet bulb (°F) - 69 Construction quality Ti ht 0.065 Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) 121 Construction descriptions Or Area U -value 18.9 254 7.47 100 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; e Insul R Htg HTM Loss Clg HTM Gain 56.9 486 ft� Btuh/ftz-°F ft� °F/Btuh Btuh/ft2 Btu Btuh/ft2 Btu Walls Doors 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" n 107 0.065 21.0 4.09 438 0.63 67 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud a 192 0.065 21.0 4.09 787 0.63 121 all 299 0.065 21.0 4.09 1225 0.63 189 Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 n 13 0.300 0 18.9 254 7.47 100 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; e 9 0.570 0 35.9 307 56.9 486 6.67 ft head ht all 22 0.300 0 25.5 561 26.7 587 Doors Door, wd sc type: Door, wd sc type a 40 0.300 0 18.9 756 6.27 251 Ceilings (none) Floors 19A-30bswp: Part floor, hrd wd fir fnsh, r-30 ins, frm fir, 10" thkns 392 0.034 30.0 1.80 705 0.22 86 2014 -Dec -04 07:08:30 rF wri itSOfRight-Suite@ Universal 2015 15.0.04 RSU05790 Page 2 ACCA ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MA Front Door faces: N -- wrightsoft- Component Constructions 1/2 bath For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: F, ._ Or • • • R. Insul R Location: Indoor: Heating Cooling Worcester, MA, US Gain Indoor temperature (°F) 68 75 Elevation: 1010 ft ft�'F/Btuh Design TD (°F) 63 8 Latitude: 42°N Walls Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: 0.065 21.0 Daily range (°F) - 17 (M) Method Simplified gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud Wet bulb (F) - Wind speed (mph) 15.0 69 7.5 Construction quality Fireplaces Ti ht 1 Tight) 4.09 Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain W Btuh/ft2-°F ft�'F/Btuh Btuh/ft2 Btu BNh/ft2 Btu Walls 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" a 86 0.065 21.0 4.09 352 0.63 54 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud s 86 0.065 21.0 4.09 352 0.63 54 all 172 0.065 21.0 4.09 705 0.63 108 Partitions (none) Windows 1 D-c2ow: 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, e 9 0.570 0 1/4" thk; 6.67 ft head ht Doors (none) Ceilings (none) Floors 19A-30bswp: Part floor, hrd wd flr fnsh, r-30 ins, frm flr, 10" thkns 110 0.034 30.0 . - 9- wrightsoft' Right-Suite(A) Universal 2015 15.0.04 RSU05790 ACC- ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N 35.9 307 56.9 486 1.80 198 0.22 24 2014 -Dec -04 07:08:30 Page 3 wri htsoft Component Constructions Job: lot 16 May Flower Dr 9 Date: Feb 2, 2014 Living room By: For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 Construction descriptions Or Area U -value Insul R Location: Indoor: Heating Cooling Worcester, MA, US Clg HTM Indoor temperature (°F) 68 75 Elevation: 1010 ft Stuh/ftz °F Design TD (°F) 63 8 Latitude: 420N Btu Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: 155 0.065 Daily range (°F) - 17 (M) Method Simplified 98 Wet bulb (F) - 69 Construction quality Tiht 21.0 Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain ft' Stuh/ftz °F W-T/Btuh Btuh/V Btu Btuh/W Btu Walls 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" s 155 0.065 21.0 4.09 634 0.63 98 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud w 85 0.065 21.0 4.09 348 0.63 54 all 240 0.065 21.0 4.09 982 0.63 151 Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 w glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors (none) Ceilings (none) Floors 19A-30bswp: Part floor, hrd wd fir fnsh, r-30 ins, frm flr, 10" thkns 27 0.300 0 226 0.034 30.0 18.9 509 27.6 744 1.80 406 0.22 50 wri htsofRight-Suite® Universal 2015 15.0.04 RSU05790 2014 -Dec -04 07:08:30 Page 4 ACCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N wri htsoft Component Constructions Job: lot 16 May Flower Dr Q Date: Feb 2, 2014 Entry By: For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 21 Or Area U -value Insul R Htg HTM Location: Clg HTM Indoor: Heating Cooling Worcester, MA, US Btuh/ftz'F Indoor temperature (°F) 68 75 Elevation: 1010 ft Btu Design TD (°F) 63 8 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: 0.63 11 Daily range (°F) - 17 (M) Method Simplified 21.0 Wet bulb (F) - 69 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) 4.09 Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ftz'F ft2-°FBtuh Btuh/ft2 Btu RAW Btu Walls 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" n 17 0.065 21.0 4.09 70 0.63 11 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud s 17 0.065 21.0 4.09 70 0.63 11 w 82 0.065 21.0 4.09 337 0.63 52 all 117 0.065 21.0 4.09 477 0.63 74 Partitions (none) Windows (none) Doors 11 DO: Door, wd sc type w Ceilings (none) Floors 19A-30bswp: Part floor, hrd wd fir fnsh, r-30 ins, frm fir, 10" thkns 21 0.390 0 192 0.034 30.0 24.6 516 8.15 171 1.80 345 0.22 42 12014 -Dec -04 07:08:30 W11 htsoft Right-SuiteUniversal 2015 15.0.04 RSU05790 Page 5 ACCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd. rup Calc = MJ8 Front Door faces: N Component Constructions Job: lot 16 May Flower Dr wrightsoft ponenons Date: Feb 2, 2014 Dining room By: For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 .. Or Area U -value Insul R Location: 7.47 Indoor: Heating Cooling Worcester, MA, US Clg HTM Indoor temperature (°F) 68 75 Elevation: 1010 ft Btuh/ft2-°F Design TD (°F) 63 8 Latitude: 420N Btu Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: 107 0.065 Daily range (°F) - 17 (M) Method Simplified 67 Wet bulb (°F) - 69 Construction quality Ti ht 21.0 Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) Construction descriptions Or Area U -value Insul R 254 7.47 100 glazing, clr outr, air gas, wd frm mat, cir innr, 1/4" gap, 1/4" thk; w Htg HTM Loss Clg HTM Gain 509 27.6 W Btuh/ft2-°F ft2-°F/Btuh Btuh/V Btu BtAM2 Btu Walls 845 Doors 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" n 107 0.065 21.0 4.09 438 0.63 67 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud w 93 0.065 21.0 4.10 383 0.63 59 all 200 0.065 21.0 4.10 821 0.63 126 Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 n 13 0.300 0 18.9 254 7.47 100 glazing, clr outr, air gas, wd frm mat, cir innr, 1/4" gap, 1/4" thk; w 27 0.300 0 18.9 509 27.6 744 6.67 ft head ht all 40 0.300 0 18.9 763 20.9 845 Doors (none) Ceilings (none) Floors 19A-30bswp: Part floor, hrd wd flr fnsh, r-30 ins, frm flr, 10" thkns 196 0.034 30.0 1.80 352 0.22 43 VA I t2014 -Dec -04 07:08:30 _rF Wrl ItSQf' Right-SuiteUniversal 2015 15.0.04 RSU05790 Page 6 ACCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Component Constructions Job: lot 16 May Flower Dr wrighfisoft`� P Date: Feb 2, 2014 Bedroom 2 By: y E o For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 ff Or Area U -value Insul R Htg HTM Location: Clg HTM Indoor: Heating Cooling Worcester, MA, US Btuh/ft2-°F Indoor temperature (°F) 68 75 Elevation: 1010 ft Btu Design TD (°F) 63 8 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: 0.63 76 Daily range (°F) - 17 (M) Method Simplified 21.0 Wet bulb (°F) - 69 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) 4.09 Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ft2-°FBtuh Btuh/112 Btu Btuh/ft2 Btu Walls 12F-Osw: Frm wall, vni ext, 1/2" wood shth, r-25 cav ins, 1/2" n 120 0.065 21.0 4.09 493 0.63 76 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud w 93 0.065 21.0 4.10 383 0.63 59 all 214 0.065 21.0 4.09 876 0.63 135 Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 w 27 0.300 0 18.9 509 27.6 744 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors (none) Ceilings 1613-38ad: Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 196 0.026 38.0 1.64 321 1.15 226 ceil ins Floors (none) " 2014 -Dec -04 07:08:30 rF Wrl ItSOftRight-Suite® Universal 2015 15.0.04 RSU05790 Page 7 ACCA ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Component Constructions Job: lot 16 May Flower Dr wrightsoft°' Date: Feb 2, 2014 Bedroom 3 By: ■ 0 0 For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 Construction descriptions Or Area 1.1 -value Location: Indoor: Heating Cooling Worcester, MA, US Loss Indoor temperature (°F) 68 75 Elevation: 1010 ft W Design TD (°F) 63 8 Latitude: 420N Btuh/ft2 Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: n 120 Daily range (°F) - 17 (M) Method Simplified 0.63 Wet bulb (°F) - 69 Construction quality Ti ht 0.065 Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) 59 Construction descriptions Or Area 1.1 -value Insul R Htg HTM Loss Clg HTM Gain W Btuh/ftz-°F ft2-°F/Btuh Btuh/ft2 Btu Btuh/ft2 Btu Walls 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" n 120 0.065 21.0 4.09 493 0.63 76 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud a 93 0.065 21.0 4.10 383 0.63 59 all 214 0.065 21.0 4.09 876 0.63 135 Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 e glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors (none) Ceilings 16B-38ad: Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 ceil ins Floors (none) 27 0.300 0 196 0.026 38.0 18.9 509 27.6 744 1.64 321 1.15 226 rF 2014 -Dec -04 07:08:30WI1 htsofRight-Suite® Universal 2015 15.0.04 RSU05790 Page 8 ACCA ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd. rup Calc = MJ8 Front Door faces: N Component Constructions Job: lot 16 May Flower Dr wrightsoft- Date: Feb 2, 2014 Bath 1 By: For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain W Btuh/ft2-°F ft2-°F/Btuh Btuh/W Btu Btuh/ftz Btu Walls 12F-Osw: Firm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" e gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 e glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors (none) Ceilings 1613-38ad: Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 ceil ins Floors (none) 69 0.065 21.0 9 0.300 0 81 0.026 38.0 4.09 282 0.63 43 18.9 161 27.6 236 1.64 133 1.15 94 rF Wr 1 htsoft' 2014 -Dec -04 07:08:30 g Right -Suite® Universal 2015 15.0.04 RSU05790 Page 9 AGCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Location: Indoor: Heating Cooling Worcester, MA, US Indoor temperature (°F) 68 75 Elevation: 1010 ft Design TD (°F) 63 8 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: Daily range (°F) - 17 (M) Method Simplified Wet bulb (°F) - 69 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain W Btuh/ft2-°F ft2-°F/Btuh Btuh/W Btu Btuh/ftz Btu Walls 12F-Osw: Firm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" e gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 e glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors (none) Ceilings 1613-38ad: Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 ceil ins Floors (none) 69 0.065 21.0 9 0.300 0 81 0.026 38.0 4.09 282 0.63 43 18.9 161 27.6 236 1.64 133 1.15 94 rF Wr 1 htsoft' 2014 -Dec -04 07:08:30 g Right -Suite® Universal 2015 15.0.04 RSU05790 Page 9 AGCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N --htsoft- 9 Component Constructions Job: lot 16 May Flower Dr wrt p Date: Feb 2, 2014 bath 2 By: For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 Construction descriptions Or Area U -value :. Htg HTM Location: Cig HTM Indoor: Heating Cooling Worcester, MA, US ftz-°FBtuh Indoor temperature (°F) 68 75 Elevation: 1010 ft Walls Design TD (°F) 63 8 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: Daily range (°F) - 17 (M) Method Simplified Wet bulb (°F) - 69 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) Construction descriptions Or Area U -value Insul R Htg HTM Loss Cig HTM Gain W Btuh/ft2-°F ftz-°FBtuh BtuhM Btu MOM Btu Walls 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" a 69 0.065 21.0 4.09 282 0.63 43 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 e 9 0.300 0 18.9 161 27.6 236 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors (none) Ceilings 16B-38ad: Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 81 0.026 38.0 1.64 133 1.15 94 cell ins Floors (none) wri htsoft' 2014 -Dec -04 07:08:30 9 Right-Suite(R) Universal 2015 15.0.04 RSU05790 Page 10 ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Component Constructions Job: lot 16 May Flower Dr wrightsoft- Date: Feb 2, 2014 W./.0 By: zj o • "ul For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 stt . D • • • o �" -.�, Location: Indoor: Heating Cooling Worcester, MA, US Indoor temperature (°F) 68 75 Elevation: 1010 ft Design TD (°F) 63 8 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: Daily range (°F) - 17 (M) Method Simplified Wet bulb (F) - 69 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain ftz Btuh/ft2-°F W T/Btuh MOM Btu Btuh/ftz Btu Walls 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud Partitions (none) Windows (none) Doors (none) Ceilings 16B-38ad: Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 ceil ins Floors (none) e 60 0.065 21.0 4.09 247 0.63 s 77 0.065 21.0 4.09 317 0.63 all 138 0.065 21.0 4.09 563 0.63 63 0.026 38.0 1.64 103 1.15 38 49 87 73 Wrl htsoft% 2014 -Dec -04 07:08:30 9 Right -Suite® Universal 2015 15.0.04 RSU05790 Page 11 ACCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N --9 - Component Constructions Job: lot 16 May Flower Dr wri htsoft Date: Feb 2, 2014 Master bedroom By: �� '1 � .�., � x ° �r «��P''-K?n:"2F�g:,�'� 3.�� ;" � 0 0 �.0 .:... � d �' '® � ..�: §,� �� ..y : pp,,. &•,.� For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 5. d • • • • :; Insul R Htg HTM Loss Clg HTM Gain Location: ft2 Btuh/ft2-°F Indoor: Heating Cooling Worcester, MA, US Btu Walls Indoor temperature (°F) 68 75 Elevation: 1010 ft Design TD (°F) 63 8 Latitude: 420N 163 0.065 Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: 54 Daily range (°F) - 17 (M) Method Simplified 1017 Wet bulb (F) - 69 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) (none) Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ft2-°F ft2-°FBtuh Btuh/112 Btu Btuh/ft2 Btu Walls 12F-Osw: Frm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" s 163 0.065 21.0 4.10 669 0.63 103 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud w 85 0.065 21.0 4.09 348 0.63 54 all 248 0.065 21.0 4.09 1017 0.63 157 Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 w 27 0.300 0 18.9 509 27.6 744 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors (none) Ceilings 166-38ad: Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 247 0.026 38.0 1.64 405 1.15 285 ceil ins Floors (none) L2014 -Dec -04 07:08:30 wri htsoft" Right -Suite® Universal 2015 15.0.04 RSU05790 Page 12 ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N --9 - Component Constructions Job: lot 16 May Flower Dr wri htsoft Date: Feb 2, 2014 Bedroom 4 By: For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 k ZFE x x Area Location: Insul R Indoor: Heating Cooling Worcester, MA, US Indoor temperature (°F) 68 75 Elevation: 1010 ft Btuh/112 Design TD (°F) 63 8 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: 21.0 4.09 Daily range (°F) - 17 (M) Method Simplified s Wet bulb (°F) - 69 Construction quality Ti ht 70 Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) 89 Construction descriptions Or Area U -value Insul R Htg HTM Loss Cig HTM Gain W Btuh/ftz °F ft2-°F/6tuh Btuh/112 Btu Btuh/ft2 Btu Walls 12F-Osw: Firm wall, vnl ext, 1/2" wood shth, r-25 cav ins, 1/2" n 17 0.065 21.0 4.09 70 0.63 11 gypsum board int fnsh, 2"x6" wood frm, 16" o.c. stud s 17 0.065 21.0 4.09 70 0.63 11 w 89 0.065 21.0 4.09 363 0.63 56 all 123 0.065 21.0 4.09 503 0.63 78 Partitions (none) Windows 2 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk: 2 w 15 0.300 0 18.9 277 27.6 405 glazing, clr outr, air gas, wd frm mat, clr innr, 1/4" gap, 1/4" thk; 6.67 ft head ht Doors (none) Ceilings 16B-38ad:Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 129 0.026 38.0 1.64 211 1.15 149 ceil ins Floors (none) -"�2014-Dec-04 07:08:30 rF Wrl htsoft Right -Suite® Universal 2015 15.0.04 RSU05790 Page 13 ACCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Component Constructions Job: lot 16 May Flower Dr wrightsOft� p Date: Feb 2, 2014 2nd floor hall By: e For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 fav g t Location: Indoor: Heating Cooling Worcester, MA, US Indoor temperature (°F) 68 75 Elevation: 1010 ft Design TD (°F) 63 8 Latitude: 420N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: Daily range (°F) - 17 (M) Method Simplified Wet bulb (°F) - 69 Construction quality Ti ht Wind speed (mph) 15.0 7.5 Fireplaces 1 Tight) Construction descriptions Or Area U -value Insul R Htg HTM Loss Clg HTM Gain ft2 Btuh/ftp-°F ftz-°FBtuh Btuh/112 Btu Btuh/ftz Btu Walls (none) Partitions (none) Windows (none) Doors (none) Ceilings 16B-38ad: Attic ceiling, asphalt shingles roof mat, r-2 roof ins, r-38 123 0.026 38.0 1.64 201 1.15 142 ceil ins Floors (none) ti� 2014 -Dec -04 07:08:30 WrI ltSOfRight-SuiteOUniversal 2015 15.0.04 RSU05790 Page 14 ACCK ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd. rup Calc = MJ8 Front Door faces: N -- wrightsoft° Project Summary Entire House For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 Notes: Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: IDIOM WN; 1 UesI Information. Weather: Worcester, MA, US Winter Design Conditions Summer Design Conditions Outside db 5 OF Outside db 83 OF Inside db 68 OF Inside db 75 OF Design TD 63 OF Design TD 8 OF Daily range Relative humidity M 50 % Moisture difference 24 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 28274 Btuh Structure 16227 Btuh Ducts 4089 Btuh Ducts 2405 Btuh Central vent (0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 4746 Btuh Blower 2389 Btuh Piping 0 Btuh Equipment load 37109 Btuh Use manufacturer's data n Rate/swing multiplier 0.88 Infiltration Equipment sensible load 18435 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Tlght Fireplaces 1 (Tight) Structure 2944 Btuh Ducts 611 Btuh Heating Cooling Central vent (0 cfm) 0 Btuh Area (ft2) 2232 2232 Equipment latent load 3555 Btuh Volume (ft3) 19195 19195 Air changes/hour 0.11 0.06 Equipment total load 21990 Btuh Equiv. AVF (cfm) 154 151 Req. total capacity at 0.80 SHR 1.9 ton Heating Equipment Summary Cooling Equipment Summary Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 80AFUE Efficiency 0 SEER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 OF Total cooling 0 Btuh Actual air flow 895 cfm Actual air flow 895 cfm Air flow factor 0.028 cfm/Btuh Air flow factor 0.048 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat Load sensible heat ratio 0.86 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. ,y WI'1 htsoft' g Right -Suite® Universal 2015 15.0.04 RSU05790 2014 -Dec -0407:08:30 Page 1 '�� ...p\wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Job: lot 16 - - wrightsoft. AED Assessment Date: Feb 2, 2014 lower Dr Entire House By: Pro'ect Informatlony � � "� For: Key Lime INC 10 Hepatica Dr, North Andover, Ma 01845 �.o Testfor Atle irate 'Exosure Dversit �; Hourly Glazing Load Hour of Day / H rly / Avxege / AFD 11. Maximum hourly glazing load exceeds average by 41.0%. House does not have adequate exposure diversity (AED), based on AED limit of 30%. AED excursion: 549 Btuh (PFG - 1.3*AFG) 1 Wrl hltSOftm 2014 -Dec -04 07:08:30 ,.� 9 Right -Suite@ Universal 2015 15.0.04 RSU05790 Page 1 RCCA ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Location: Indoor: Heating Cooling Worcester, MA, US Indoor temperature (°F) 68 75 Elevation: 1010 ft Design TD (°F) 63 8 Latitude: 42°N Relative humidity (%) 50 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 47.0 23.6 Dry bulb (°F) 5 83 Infiltration: Daily range °F) - 17 (M ) Wet bulb (°F) - 69 Wind speed (mph) 15.0 7.5 �.o Testfor Atle irate 'Exosure Dversit �; Hourly Glazing Load Hour of Day / H rly / Avxege / AFD 11. Maximum hourly glazing load exceeds average by 41.0%. House does not have adequate exposure diversity (AED), based on AED limit of 30%. AED excursion: 549 Btuh (PFG - 1.3*AFG) 1 Wrl hltSOftm 2014 -Dec -04 07:08:30 ,.� 9 Right -Suite@ Universal 2015 15.0.04 RSU05790 Page 1 RCCA ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N • wrightsoft' Right -J® Worksheet Entire House Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: 1 Room name Entire House kitchen 2 Exposed wall 276.0 ft 42.0 ft 3 Room height 8.6 ft 8.6 ft heat/cool 4 Room dimensions 28.0 x 14.0 ft 5 Room area 2232.0 ft2 392.0 ft2 Ty Construction U -value Or HTM Area (ftz) Load Area (ftz) Load number (Btuh/ft2-°F) (13t ft2) or perimeter (ft) (Bt h) or perimeter (ft) (Btuh) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6 12F-0sw 0.065 n 4.09 0.63 516 489:._.._,.-2003 308 120 107 438 67 2 glazing,_clr outr, 0.300 n 18.90 7.47 27 0 509 .201 13 0 254 100 VVV���JJJ 12F-Osw 0.065 a 4.09 0.63 671 570 2333 _ 359 241 192 787 121 1./,. 1 D-c2ow 0.570 a 35.91 56.94 17 0 613 973 9 0 307 486 11 2 glazing, clr outr, 0.300 a 18.90 27.65 44 0 832 1217 0 0 0 0 _ _Door, wd..sc tVpe, 0.300 e 6.27 40 40 756 25140 40 756 251 W _._.. 12F-Osw 0.065 _ s ._.18.90 4.09 0.63 516 516. 2113 . .... 325 ..,:. ,_-0; ,,,, 0 0 0 V+/ 12F-Osw 0.065 w 4.09 0.63 671 527 2160 333 . 0 0 0 0 2 glazing, clr outr, 0.300 w 18.90 27.65 122 0 2312 3382 0 0 0 0 11 DO 0.390 w 24.57 21 21 516 171. 9 0 C _ _ 166-38ad 0.026 1.64 _.8.15 .1. 15. ........ 1116 .., .. 1116 , 1828 1288 ,. _ _ 0 _.__ .-0 _0 0 .• 0 F .19A-30bswp 0.034 _ -_ 1.80 , ... _ 0.22 1116 ,_.111,6 _2006. 245. _... 39,2.......,.....392. ...... ........705 ....... ..... .,.._86 _. _ n ...... 6 c) AED excursion 549 -204 Envelope loss/gain 17981 9602 3247 908 12 a) Infiltration 10293 1235 1566 188 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 3 690 0 0 Appliances/other 4700 1200 Subtotal (lines 6 to 13) 28274 16227 4813 2296 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 28274 16227 4813 2296 15 Duct loads 1 140/. 15% 4089 2405 7% 2% 357 57 Total room load 32363 18632 5171 2353 Air required (cfm) 895 895 143 113 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. At= r_F wrightsOft- Right -Suite@ Universal 2015 15.0.04 RSU05790 2014 -Dec -04 07:08:31 ,,*--C$" ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Page 1 AL wrightsoftf Right -J® Worksheet Entire House Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: 1 Room name 1/2 bath Living room 2 Exposed wall 21.0 ft 31.0 ft 3 Room height 8.6 ft heat/cool 8.6 ft heat/cool 4 Room dimensions 11.0 x 10.0 ft 1.0 x 226.0 ft 5 Room area 110.0 ft2 226.0 ft2 12 Ty Construction U -value Or HTM Area (ft2) Load Area (ft2) Load b) Room ventilation number (Btuh/W2'F) 0 (Btuh/ft2) or perimeter (ft) (Btuh) or perimeter (ft) (Btuh) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool Appliances/other 6 y✓ 12F-Osw 0.065 n V 4.09 0.63 0 0 0. 0 0 W ry -0 0 0 L-{ 2 glazing,. clr outr; 0.300 n. 18.90 7.47 0 0 01 0 ; 0 - 00 0 0 �/ 1217-0sw 0.065 a 4.09 0.63 95 86 352 54 _ 0 0 0 0 14 �C 1 D-c2ow 0.570 a 35.91 56.94 9 0 307 486 0 0 0 0 11 ��-(D 2 glazing, clr outr, 0.300 a 18.90 27.65 0 0 0 0 0 0 0 0 Air required (cfm) Door, wd sc type 0.300 59 18.90 0 0 0 0 0 A 0 W ......... 12F-Osw' _... ._ .. 0.065 s" 4.09 .......6.27 0.63 86 86 352 ._.....-... _ 54 155 . _.8 :. :155 - ........ 634 .. ......... 98 �--G 12F-Osw 0.065 w 4.09 0.63 0 0 0 0 112 85 348 54 2 glazing, clr outr, 0.300 w 18.90 27.65 0 0 0 0 27 0 509 744 :^..11DO ._0.390 _w_ 24.57 8.15 0 0 0._... 0 0,_.. 0 0 C 168-38ad ... 0.026 -_ 1.64 . ......1.15 0 0_ 0 0:, 0 .. 0 ---0 0 _ 0 F 19A-30bswD 0.034 1.80 0 99 lin 11n 19a 9a 99a 991; Ana 1� 61 c) AED excursion 1-28 182 Envelope loss/gain 1209 591 1896 1127 12 a) Infiltration 783 94 1156 139 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 0 0 0 0 Appliances/other 500 1000 Subtotal (lines 6 to 13) 1992 1185 3053 2266 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 1992 1185 3053 2266 15 Duct loads 7% 2% 148 29 71% 20% 227 56 Total room load 2140 1214 3279 2322 Air required (cfm) 59 58 91 112 Calculations approved by ACCA to meet all reauirements of Manual J 8th Ed. wrightsoft" Right -Suite® Universal 2015 15.0.04 RSU05790 2014 -Dec -04 07:08:31 ,4CCA Page 2 ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd. rup Calc = MJ8 Front Door faces: N • -�- wrightsoft• Right -J® Worksheet Job: lot May Flower Dr Entire House Date: Feb 2 2, 20,4 By: 1 Room name Entry Dining room 2 Exposed well 16.0 ft 28.0 ft 3 Room height 8.6 ft heat/cool 8.6 ft heat/cool 4 Room dimensions 12.0 x 16.0 ft 14.0 x 14.0 ft 5 Room area 192.0 ft2 196.0 ftz Ty Construction U -value Or HTM Area (ftz) Load Area (ftz) Load number (Btuh/ftz°F) (Btuh/ft2) or perimeter (ft) (Btuh) or perimeter (ft) (Btuh) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 10 10 _ .... 7� 10 _ 1 - 1i30 67 glazing, clr outr438 ; 0 ;,. 254 100 0.065 e. 4.09 0.63 1 D -clow 0.570 e 35.91 56.94 0 0 0 0 0 0 0 0 11 2 glazing, clr outr, 0.300 a 18.90 27.65 0 0 0 0 0 0 0 0 Door, wd sc tvpe . _ _ 0.300 ... e,.. 18,90 6.27 0 0 0 0 0 0 0 0, W 12F-Osw' 0.065 4.09 0.63 17 ' 17 ._.._ ..._ 7D ....... 11 0 t1 _. W 0 „ _ ., , 0 12F-Osw 0.065 w 4.09 0.63 103 82 337 52 120 93 383 59 2 glazing, clr outr, 0.300 w 18.90 27.65 0 0 0 0 27 0 509 744 11DO ,.. 0,390 w__ 24.57 8.15 21 21 516 171 0 0 0 0 0.026 _ 1,64 ,1.15 _ 0 _ 0 _ 0 .. ........ ... 0 _ �0 0 :,0 O. _19A-30bswp __Q.034 ._ -_.. ....1.80 0.22 _ _ _192192 ...... _ 345 42 ._........__196 _- _ 196. ......._352 43. -_ ..... 6 c) AED excursion -34 204 Envelope loss/gain 1339 253 1936 1218 12 a) Infiltration 597 72 1044 125 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 0 00 0 Appliances/other 0 500 Subtotal (lines 6 to 13) 1935 324 2980 1844 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 1935 324 2980 1844 15 Duct loads 7% 2% 144 8 7% 2% 221 46 Total room load 2079 332 3202 1889 Air required (cfm) 57 16 89 91 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wrightsoft" Right -Suite® Universal 2015 15.0.04 RSU05790 2014 -Dec -04 07:08:31 ,q05 Page 3 ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N -�- wrightsoft' Right -J® Worksheet Job: lot May Flower Dr Entire House Date: Feb 2 2, 2ota By: 1 Room name Bedroom 2 Bedroom 3 2 Exposed wall 28.0 ft 28.0 ft 3 Room height 8.6 ft heat/cool 8.6 ft heat/cool 4 Room dimensions 14.0 x 14.0 ft 14.0 x 14.0 ft 5 Room area 196.0 ft2 196.0 ft2 Ty Construction U -value Or HTM Area (ftz) Load Area (ftz) Load number (Btuh/ft2-°F) (Bt ft2) or perimeter (ft) (Bt h) or perimeter (ft) (Btuh) Heat Cool Grass N/P/S Heat Cool Gross N/P/S Heat Cool 6 12F Osw 0.065 n 4.09 0.63 --120 120 493 76 120 120 493 76 G. 2 glazing, clr,outr, 0.300 n 18.90 7.47 6 0 0, 0 0 0 0. " 0 12F-Osw 0.065 a 4.09 0.63 0 0 0 0 120 93 383 59 T�D 1 D-c2ow 0.570 a 35.91 56.94 0 0 0 0 0 0 0 0 11 2 glazing, clr outr, 0.300 a 18.90 27.65 0 0 0 0 27 0 509 744 Door, wd sc tVpe 0.300 a 18.90 6.27 0 0 0 R 0 W . 12F-0sw 0.065 s, 4:09 .. 0.63 0 0 "0' ...._.., 0 ......... .....A 0 _.. ;0 .._. .. ...0 _ 0 ,.._.._ .0. 0 V+/ 12F-Osw 0.065 w 4.09 0.63 120 93 383 59 0 _ 0 0 0 2 glazing, clr outr, 0.300 w 18.90 27.65 27 0 509 744 0 0 0 0 11 DO 0.390. w 24.57 8.15 0 0 0 0 0 0 0 0 C .16B-38ad 0.026 - 1.64 _ 1.15 196 196 321 226. 1 796 321 r "'226 F 19A-30bswp„.. 0.034 ..- _ 1.80. 0.22 0 . 0 _ O. ..._.. 0 ......._ ; „0 _,. 0 0 ... __.. 0 ,.- .,-..--._r_ _. ......... _.e --.r.- ...... .. ..... _ _ _ 6 c) AED excursion 194 -57 Envelope loss/gain 1706 1299 1706 1048 12 a) Infiltration 1044 125 1044 125 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 1 230 1 230 Appliances/other 500 500 Subtotal (lines 6 to 13) 2750 2154 2750 1904 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 2750 2154 2750 1904 15 Duct loads 22% 27% 609 573 220/. 271/. 609 506 Total room load 3359 2727 1 3359 2410 Air required (cfm) 93 131 93 116 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. Fk' wrightsoft" Right -Suite@ Universal 2015 15.0.04 RSU05790 2014 -Dec -04 07:08:31 '��p ...p\wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Page 4 - wrightsoft° Right -J® Worksheet Job: lot 16 May Flower Dr Entire House Date: Feb 2, 2014 By: 1 Room name Bath 1 bath 2 2 Exposed wall 9.0 ft 9.0 ft 3 Room height 8.6 ft heat/cool 8.6 ft heat/cool 4 Room dimensions 9.0 x 9.0 ft 9.0 x 9.0 ft 5 Room area 81.0 ft2 81.0 ft2 Ty Construction U -value Or HTM Area (ft2) Load Area (ft2) Load number (Btuh/ftMF) (Bt ft2) or perimeter (ft) (Btuh) or perimeter (ft) (Btuh) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6 1217.0sw „ 0.065 _...n 4.09 - 0.63 0 0 ... 0 :._... , b ... O p --d . _... O G..2 glazing, cir, outr, 0.300 n 18.90 . 7.47 0 0 0 0 0 •' 0 0 0 12F-Osw 0.065 a 4.09 0.63 77 69 282 43 77 69 282 43 b.. 1 D-c2ow 0.570 a 35.91 56.94 0 0 0 0 0 0 0 0 11 2 glazing, clr outr, 0.300 a 18.90 27.65 9 0 161 236 9 0 161 236 Door,_wd sc tvoe....__ 0.300 a 18..9.0. 6.27 0 0 9 0 0 0 0 W 12F-Osw 0.065 s 4.09 _ 0.63 0. _.:.. 0 .......... 0 ._ «. ._ 0 _0 :.. 0 _. ;'. 0 0 0 12F-Osw 0.065 w 4.09 0.63 0 0 0 0 0 0 0 0 2 glazing, clr outr, 0.300 w 18.90 27.65 0 0 0 0 0 0 0 0 . 11DO 0.390 w 24.57 8.15 0 0. 0 0,.,., 0 9 C iSB-38ad 0.026 1.64 1.15 81 81 _ .....:.... ._ 133 _........ :, .'` 94 81 81 w._._.,0 133 _.. __. 94 F ............... 19A-30bswP 0.034 - 1.80 0.22 0, 0... 0 0 0 0 0. _ _ _. _...... ..z_. ,_.., ..... _ . _... - G. 6 c) AED excursion 2 2 Envelope loss/gain 576 375 576 375 12 a) Infiltration 336 40 336 40 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 0 0 0 0 Appliances/other 0 0 Subtotal (lines 6 to 13) 912 415 912 415 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 912 415 912 415 15 Duct loads 22% 27% 202 110 220/. 27% 202 110 Total room load 1114 526 1114 526 Air required (cfm) 31 25 31 25 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. L vwrightsoft" Right-SuiteO Universal 2015 15.0.04 RSU05790 2014 -Dec -04 07:08:31 A55N ...p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N Page 5 -F- wrightsoft' Right -J® Worksheet Entire House Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: 1 Room name 1-221 W.I.0 1254 Master bedroom 2 Exposed wall 137 1930 1440 16.0 ft a) Infiltration 32.0 ft 72 3 Room height 143 b) Room ventilation 8.6 ft 0 heat/cool 8.6 ft 0 heat/cool 13 4 Room dimensions 0 0 7.0 x 9.0 ft 13.0 x 19.0 ft 5 Room area 0 63.0 ft2 Subtotal (lines 6 to 13) 247.0 ft2 209 3123 Ty Construction U -value Or HTM 0 Area (ft2) Load 0 Area (ftz) Less transfer Load 0 0 number (Btuh/ft2-°F) 0 (Btuh/ft2) or perimeter (ft) (Btuh) 0 or perimeter (ft) 0 (Btuh) 14 Subtotal 1263 209 Heat Cool Gross N/P/S 15 Heat Cool 27% Gross N/P/S 22% Heat Cool 421 6 Total room load 12FOsw V0065 n _ 4.09 0 .63 -_0 .. ........0 2004 __.. 0 0 _ .. 0 13 0- 0 96 0 2 glazing, clr outr, 0,300:, n 18:90 7.47 0 0 0 0 0 0 0 0 12F-Osw 0.065 a 4.09 0.63 60 60 247 38 0 0 0 0 1 D -clow 0.570 a 35.91 56.94 0 0 0 0 0 0 0 0 11 2 glazing, clr outr, 0.300 a 18.90 27.65 0 0 0 0 0 0 0 0 Door. wd sc tvoe__.. 0.300 .. a 18.90 _ 6.270 0 0 0 0 0 0 0 W .:.. 12F-Osw _.:.. ,.: '0.065 s . 4.09 0.63 `77 _......' 77 _....._.. .317 _ _ _ 49 ..... 163 .. 163 .. ,_.. ..669 703 VI/ 12F-Osw 0.065 w 4.09 0.63 0 0 0 0 112 85 348 54 2 glazing, clr outr, 0.300 w 18.90 27.65 0 0 0 0 27 0 509 744 L�_Gp 11DO . 0.390 w 24.57 8. 15 0 0 0. 0 0 0 0 0 C 1613.38acl 0.026' 1.64 ._ 1.15 63 F....:.. . 63 103 _. .. _ 73. 247.. 247 405 285 F .. 19A-30bswo............ 0.034 1.80. ._..._0,22 0 0 _ .. 0 _._. _. _ A _ ..... ..._0 .,..,, 0 - 0 0 k ' 6 c) AED excursion 1-221 1254 Envelope loss/gain 667 137 1930 1440 12 a) Infiltration 597 72 1193 143 b) Room ventilation 0 0 0 0 13 Internal gains: Occupants @ 230 0 0 0 0 Appliances/other 0 0 Subtotal (lines 6 to 13) 1263 209 3123 1583 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 1263 209 3123 1583 15 Duct loads 22% 27% 280 56 22% 27% 692 421 Total room load L 1543 1 265 3816 2004 Air required (cfm) 43 13 106 96 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. A :Z- � wrightsoft" Right -Suite@ Universal 2015 15.0.04 RSU05790 2014 -Dec -04 07:08:31 Page 6 ..p\Wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N • - wrightsoft° Right -J® Worksheet Entire House Job: lot 16 May Flower Dr Date: Feb 2, 2014 By: 1 Room name 171 Bedroom 4 -141 2nd floor hall Envelope loss/gain 2 Exposed wall 992 702 201 16.0 ft a) Infiltration 0 ft 72 3 Room height 0 0 b) Room ventilation 8.6 ft heat/cool 0 8.6 ft heat/cool 0'. 4 Room dimensions 1 230 1.0 x 129.0 ft 0 1.0 x 123.0 ft 5 Room area 0 129.0 ft2 Subtotal (lines 6 to 13) 123.0 ft2 1504 201 Ty Construction U -value Or HTM 0 Area (ft2) Load 0 Area (ft2) Load 0 number (Btuh/ftz°F) (Bt ft2) or perimeter (ft) (Bt h) or perimeter (ft) (Btuh) 0 0 14 Subtotal Heat Cool Gross N/P/S Heat Cool 201 Gross N/P/S Heat Cool 27% 6�12F=0sw 400 22% __0.065 n-- -4.09 0.63 X17 ---,— _�� 70 ._ .... - 11 .. _. 0 ,�� � —'d,`0 Air required (cfm) 54 2 glazing, clr outs, 0.300 n 18.90 7.47 0 0 0 0 0 0 0 .0 11 .90 26.27 Door, wd scrtvpe _.._. 0.300 a 18.90 0 0 0 0 0 0 0 0 103 70 ........... _.. . ..r ...0 _ .. _._.. _- 68.0 20.66 80 00 0 0 0 glazing, clr outr, 210 0 3005 w 15 2363 77 4 . ..._ 90 :. :... C, .,'. 168-38ad 0.026 1.64 1.15 129 129. _. 211 _._ , 149 . 123 ..... 123 201 .. 142', F ._ -.__ 19A30bswp 0.034 _. .. 1.80 0.22 ._ -0 0. ..... o_ R 0o 6 c) AED excursion 171 -141 Envelope loss/gain 992 702 201 128 12 a) Infiltration 597 72 0 0 b) Room ventilation 0 0 0 0'. 13 Internal gains: Occupants @ 230 1 230 0 0 Appliances/other 500 0 Subtotal (lines 6 to 13) 1588 1504 201 128 Less external load 0 0 0 0 Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 1588 1504 201 128 15 Duct loads 22% 27% 352 400 22% 27% 45 34 Total room load 1940 19037— 246 163. Air required (cfm) 54 91 7 8'. Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wrightsoft" 2014 -Dec -04 07:08:31 i4CC Right-Suite(R)Universal 2015 15.0.04 RSU05790 Page 7 ..p\wrightsoft HVAC\rainbow lot 1 38 kelly rd.rup Calc = MJ8 Front Door faces: N // 2 Date ..../.../............ �..:................ TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that......>�.{��.....6miR...`1......................................... has permission for gas installation...:.....:.".....���!..^.���'�R.:... ..-. in the buildings of ...... ....l y........'. �......``.:............... . at ......//.1.�'�.....l / /%.'............c1�` UIQ ........................ North Andover, Mass. Feet 0........ Lic. No... /.33.......... f��—.................................................... GASINSPECTOR Check # i5u3 Cum -Jt I cso /- 4�0v\-O, �o j MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK DATE: 12/5/2014 PERMIT # kv��,Jl CITY: NORTH ANDOVER MA. l JOBSITE ADDRESS: 73 MAYFLOWER DRIVE Lo�16 OWNER'S NAME: KEYLIME INC GOWNERADDRESS: TEL: 508-328-4630 FAX: TYPE OR OCCUPANCY TYPE: COMMERCIAL ❑ EDUCATIONAL ❑ RESIDENTIALLJ---- PRINT CLEARLY � NEW: fes? RENOVATION: ❑ REPLACEMENT: ❑ PLANS SUBMITTED: YES ❑ NO APPLIANCES FLOOR Bsmt 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Q BOILER BOOSTER t; CONVERSION BURNER COOK STOVE Q DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR e FURNACE GENERATOR e. GRILLE INFRARED HEATER LABORATORY COCK MAKEUP AIR UNIT OVEN ---� POOL HEATER ROOM/SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER — UNVENTED ROOM HEATER WATER HEATER oe fJ— INSURANCE COVERAGE I havea current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES 0 NO ❑ If you Pave checked YES, please indicate the type of coverage by checking the appropriate box below. (0 LIABILITY INSURANCE POLICY ❑4 OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER ❑ AGENT ❑ SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted (or entered) regarding this permit application is true and accurate to the best of my Knowledge. I certify that all plumbing work and installations performed under the permit issued, will be in compliance with all Pertinent provisions of the Massachusetts Uniform State Plumbing Code, and Chapter 142 of the General Laws. G yam, / PLUMBER/GASFITTER NAME: f.�=/ e�%jS6zI LICENSE #Y3_ SIGNATURE COMPANY NAME: OSTERMAN PROPANE LLC ADDRESS: 321A Merrimack St CITY: Methuen STATE: MA ZIP: 01844 FAX: 978-738-0118 TEL: 800-368-9956 CELL: EMAIL: INFO OSTERMANGAS.COM MASTER []JOURNEYMAN ❑ LP INSTALLER �®RPORATION ❑# PARTNERSHIP ❑# LLC ❑ -3 6 3 V Cum -Jt I cso /- 4�0v\-O, �o j 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations VX V I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Osterman Propane, LLC Address: One Memorial Square Whitinsville, MA 01588 Phone #: 508-234-1573 Are you an employer? Check the appropriate box: 1. Q I am a employer with 275 4. E] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. E] We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. F-1 Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.0 Roof repairs 13.0 Other LP Gas Install and Repairs Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Insurance Company of the State of PA Policy # or Self -ins. Lic. #: WC015883775 Expiration Date: 06/30/2015 Job Site Address: All Locations In: North Andover, NIA City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpen alties of perjury that the information provided above is true and correct Sienature: La.A.T-% June 27, 2014 - 5082341573 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: u COVERAGES CERTIFICATE NUMBER: 21752201 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TR Acow h® CERTIFICATE OF LIABILITY INSURANCE page 1 of 1 DATE 06/26/2 4' THIS CERTIFICATE IS ISSUED ASA 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. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis of Texas, Inc. c/o 26 Century Blvd. P.O. sox 305191 PHONE FAX • 877-945-7378 888-467-2378 E-MAIL certificates@willis.com Nashville, TN 37230-5191 I NSURER(S)AFFORDING COVERAGE NAIC # INSURERA:Lexington Insurance Company 19437-000 PERSONAL&ADV INJURY $ 2,000,000 INSURED NGL Energy Partners, LP INSURERB:The Insurance Company of the State of Pen 19429-100 GEN'LAGGREGATELIMITAPPLIESPER: X POLICY PRO LOC JECT 612 0S. Yale Avenue INSURERC: Suite 805 Tulsa, OK 74136 INSURERD: INSURER E: INSURER F: 6/30/2014 6/30/2014 COVERAGES CERTIFICATE NUMBER: 21752201 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TR TYPEOFINSURANCE DD' SUB vwn pOLICYNUMBER POLICY EFF POLICYEXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 034205248 6/30/2014 6/30/2015 EACH OCCURRENCE $ 2,000,000 PRE MISESOEaoccTurence $ 100 000 MED EXP (Anyone person) $ PERSONAL&ADV INJURY $ 2,000,000 GENERALAGGREGATE $ 4,000,000 GEN'LAGGREGATELIMITAPPLIESPER: X POLICY PRO LOC JECT PRODUCTS -COMP/OPAGG $ 4,000,000 $ B AUTOMOBILE LIABILITY X ANYAUTO ALLOWNED SCHEDULED AUTOS AUTOS HIREDAUTOS NON -OWNED AUTOS CA4584397 AOS CA4584396 MA 6/30/2014 6/30/2014 6/30/2015 6/30/2015 COMBINEDSINGLELIMIT (Ea accident) $ 5,000,000 BODILYINJURY(Perperson) $ BODILY INJURY(Per accident) $ PROPERTY DAMAGE (Per accident) $ A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE 015881338 6/30/2014 6/30/2015 EACH OCCURRENCE $ 51000,000 AGGREGATE $ 51000,000 DED I X RETENTION$ 10,000 $ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) fyes,descnbeunder DESCRIPTION OF OPERATIONS below NIA WC015883775&079331530 6/30/2014 6/30/2015 X WCSTATU- 0TH - E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Town of North Andover 120 Main Street N. Andover, MA 1845 Coll e 4451094 Tnl a 1829649 Cert: 23'752'201 171988-2010 ACORD CORPORATION. All riahts reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 10 u NGL Energy Partners LP Named Insured Schedule NGL Energy Partners, LP Osterman -Brunswick NGL Energy Operating, LLC Osterman -Hallowell NGL Propane, LLC Osterman -Waterville NGL Retail Supply, LLC Osterman -Mt. Vernon Osterman Propane, LLC Osterman -Windham Downeast Energy Osterman -S. Portland Thompson Oil Osterman -Springvale NGL -MA Osterman-Kennebunk NGL -NE Osterman -Dover NGL Retail Supply Osterman -Brunswick Lessig Oil & Propane Osterman -Waldo Whiting Oil Downeast- Denmark Proflame Downeast- Brunswick Brantley Gas Downeast- Hallowell Allied Energy Downeast- Waterville Bernville Quality Fuels Downegst- Mt. Vernon Judd & Simms Downeast- Windham Propane Energies Group Downeast- S. Portland North Georgia Propane Downeast- Springvale North American Propane Downeast- Kennebunk RB Gas Downeast- Dover Osterman -Palmer Downeast- Brunswick Osterman-Whitinsville Downeast- Waldo Osterman -Sunderland Osterman -Blackshear Osterman -Southbridge Osterman -Douglas Osterman -Bridgewater Osterman -Jesup Osterman -Sterling Osterman-Nahunta Osterman -Northbridge Osterman -Waycross Osterman -Montville Osterman-Dahlonega Osterman -Plainfield Osterman -Gainesville Osterman -Adams Osterman -Blairsville Osterman -Lee Osterman-Hayesville Osterman -Methuen Osterman -Asheville Osterman -Pen Argyl Osterman -Dalton Osterman-Slatington Osterman -Calhoun Osterman -Wind Gap Osterman -Cartersville Osterman-Ashburnham Hicksgas, LLC Osterman -Hope Valley Propane Central Osterman -North Haven Rocket Supply Osterman -Chester Rocket Propane Osterman -Reading Pittman Propane Osterman -Elkton Global Propane Osterman -Denmark Liberty Propane F, I L WUMBERS ISSUES TH1 ow-, I Xt LP C. Date ...... [Z7�77q7zx.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................... .. has permission to perform ........ 4�G+CJ ... -7 . . . ........................................ wiring in the building of .................. & ..... ;7;�,,- ............................. at .. . ...... 7 .............. f�,W-IefiL .................... -, North Andover, Mass. .................. Lic. No. I,; AV Fee... �eij ............ ............... .. RICAL INSPECTOR Check # Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. / g -!az , Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) "73 Owner or Tenant ' E < Telephone No. ,Z r 3,)- 6-1G 3G Owner's Address t8 bQftob )�wa�tA Is this permit in conjunction with a building permit? Yes 0 No ❑ (Check Purpose of Building e',i„,,\c Utility Authoriz, Existing Service Amps / Volts Overhead ❑ Undgrd New Service `1Lc, Amps )70 / O'kU Volts Overhead ❑ Undgrd Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �✓�Y.� ��t,,, \�pySC W No. of Meters No. of Meters \ 4-vrh /Z 19-/ Completion of the ollowin table may be waived bv the In ector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ElIn- Elo. o mergency Lighting rnd. rnd. Batte Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Number TonsKW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: 1� �o�� (When. required by municipal policy.) Work to Start: inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE VN BOND ❑ OTHER ❑ (Specify:) I certify, under thepains andpenalties of perjury, that the information on this application is true and complete. FIRM NAME: y,- r a, -,c LIC. NO.: Licensee: & .1 1V,)4"\Sk\,f Signature Jw � LIC. NO.: (If applicable, enter "exempt" in the lice se number line.) Bus. Tel. No.: q? a A'cl 1--1 13 G Address: a\ Ar4a-� NV,. �r Q�r� MN. olg3�, Alt. Tel. No.: 111 *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. 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 a ent. Owner/Agent Signature Telephone No. PERMIT FEE: $ e�q 12. -�, 10 — )y A &4f 12- l8- lY � CP �