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Miscellaneous - 75 SUMMER STREET 4/30/2018
.�. ��- �:.. ,;rte .,,,-.r �.:� �? ..i.•_�'A .c :! " J ky. �R :Y ^. s- 10942 Datellx- 414. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .... `........ .....5... ..............r.. a -,i ............. Vhas permission to perform ...W.P........ �!�t1�rv�-.:........................................ plumbing in the buildings of -4 e -4.9A -:............. ....... :............................ at .... ..�� .....�.� V.Y—..h ......�-� .............................. ..:....... North Andover, Mass. eR i... Fee ................ .. Lic. No. ............................................................................... 151 PLUMBING INSPECTOR Check* e5f4 5b7 -(e-5 JY,- P TYPE OR PRINT CLEARLY MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITY ND6u0-Z MA DATE 12 3DIli PERMIT# 1 0"V-4-1 JOBSITE ADDRESS %,K.9 a-- S� , OWNER'S NAME C1.4; s �ees�i ck_ OWNER ADDRESS TEL 9-7S-9 79-/Z6-- FAX ; OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL EH NEW: [It RENOVATION: ® REPLACEMENT: Q RESIDENTIAL PLANS SUBMITTED: YES ® NO FLOOR -- NO= :: �I--- I�rlZ-1�--l� �i�l�li�lF i --F Ir —��l�� CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OILISAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN FOOD DISPOSER FLOOR/ AREA DRAIN INTERCEPTOR (INTEF KITCHEN SINK LAVATORY ROOF DRAIN SHOWER STALL SERVICE / MOP SINK TOILET URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER F INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES d NO 01 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY N( OTHER TYPE OF INDEMNITY D BOND D 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 M AGENT 101 SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information 1 have submitted or entered regarding this application are true and that all plumbing work and installations performed under the permit issued for this application will be in compli Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAME 1 on�,43 LICENSE # fS / lMP 0i JP Me- Mte to the best of my knowl all Pertinent provision of the SIGNATURE CORPORATION FA#PARTNERSHIPEI#LLC 0 COMPANY NAME �A1 ADDRESS CITY yam, _ _ I STATE ZIP d (�j b� - it TEL FAX CELL 29097-03771/ EMAIL4S<3a2N t�-Lun�g;� CZ) o z W LU W The Commonwealth of Massachusetts j Department of lndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name I Address: % 'J q ee 0 s4zwe_ City/State/Zip: L quer m a4 . Q iY 0g- Phone 9: `7 8 t - 361 -857rV? Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. El am a general contractor and I mployees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. t ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comm. insurance reouired.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 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 anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: Expiration Job Site Address:City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA fgx insurance coverage verification. I do hereby certify III pa' is and penalties ofperjury that the information provided above is true and correct. Si afore: Date: Z .3o4i `7 Phone #: ?61 D Sr,� cl Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense 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 #: Information and Instructions `+ Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or. written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who.has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license 'or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department ofThdustrial Accidents Office of Investigation a 600 Washington Street Boston, MA. 02111 Tel. # 617-727-4900 ext 406 or 1.-877rM SSAFE Revised 5-26-05 Fax #. 617~727-7749 cWww.mass.govaa. Ile- I I ......................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION ............ This certifies that ..... (fh- &�-: ..... .... . ...................................... kst4a-ation sOmp-, A-cQ- cas plers'slon or gas ut.Q-P6�1-- a 04. .in the buildings of ......... 4--1- ... fie .. C- rj/ ............................................................. ...... . ... . North Andover, Mass. .. ......................................... Fee ...10r.(An- Lic. No. .3.1.6341 ...... INSPECTOR Check A" bZ 9 �( MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY o !Z. IA tJ� ad 2- MA DAPERMIT # , JOBSITE ADDRESSr. 75 �M,�-� S ewe+�( OWNER'S NAME GOWNERADDRESS FAX TYPE OR OCCUPANCY TYPE COMMERCIAL E] EDUCATIONAL ® RESIDENTIAL PRINT CLEARLY NEW: 9 RENOVATION: E] REPLACEMENT: ® PLANS SUBMITTED: YES 0 NO APPLIANCES 7 FLOORS- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER - N --- f -- FIREPLACE . .. . - FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT. -- OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER I VENTED ROOM HEATER WATER HEATER OTHERI - — - ...._............. .. ......V ......... INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES J[dNO [[ I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVE GE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY E( BONDI 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 0 AGENT SIGNATURE OF OWNER OR AGENT hereby certify that all of the details and information 1 have submitted or entered regarding this application are true and to to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complia wit al P inept provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUM BER-GASFITTER NAME L RS 0s4oanS-_ J LICENSE# SIGNATURE MP El MGF El JP JGFLPGI ®� CORPORATION E]# � PARTNERSHIP 0#E LLC D#= COMPANY NAME: ADDRESS �/____ e �� _�Ft�-, _�_,____. ____.___ _ •_ CITY rt/N _ � STATE [ ZIP ©I Z) TEL FAX(�� CELL(EMAIL DS40a�jE z� 0 H U ya o F1 z O N W 4a)❑ � W OF O a W 1-- 0 91.4 Q w to a o w w W¢ co a gcc J F a a a c w EE w F- LL F O O F ' U � a c7 iN The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): ( ,0r 5 J. 5- g a e p E / 0 S U juj 1F `7 Address: 7jLe City/State/Zip: (�N t� A O I90 c, Phone #: `7 S Are you an employer? Check the appropriate box: Type of project (required): L ❑ I am a employer with 4. El am a general contractor and I 6. E] New construction -,employees (full and/or part-time).* 2. I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. F1 Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 5. El We are a corporation and its 9. [_1 Building addition [No workers' comp. insurance required.] officers have exercised their 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11. [dumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy # or Self -ins. Lie..#: Expiration Date: Job Site Address:City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one: -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify ujqef th#afns andpenalties ofperjury that the information pro vided above is true andcorrect Phone #: 7C(— �' I 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 CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: • 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract ofhire,- express or implied, oral or written." An employeris defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer'." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retained to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. ' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The CoMYAORWealtb. of Massachusetts Department of Industrial Accidents Office of Investigations 6.00 Washington Street Boston} MA 02111 � Tel, # 617-727-4900 oxt 406 or 1-877:MASSAFB Revised 5-26-05 Fax # 617-727.7749 wwtiv-Mass,govaa 01905-1 335 Date��'.��....... NpR*H TOWN OF NORTH ANDOVER pf 1. ,tip PERMIT FOR MECHANICAL INSTALLATION `oma a w ISSACHUSE }{{ � 7 This certifies that....'' .' p.`.: . has permission for mechanical installation in the buildings of` 7': .�L� o. l:g. %O.'?- =: .... . at ..� � � � .`??.. 7 ......� . 1j /- ...... North Andover, Mass. Fee .11 S'<a Lic. No. /-36b ; j . !1 .....Y ... . !A Q - L.- 'k�+-� GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Sheet Metal Permit Date: `3� / Permit # �,�//� Estimated Job Cost: r �,C?6 0, Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License # C ?5f c -P Applicant License # / Business Information: Property Owner / Job Location Information: Name: A C, 0'76c- kz -eco l Name: f,� err,-�% � •k �— Street: Cl?D e�,� � lid Street: : City/Town: j // Zry City/Town: /V zi, Telephone: C9?,f 's -S Telephone: Photo I.D. required / Copy of Photo I.D. attached: YES NO Building Type: Residential: 1-2 family -�< Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. K over 35,000 cu. ft. Sheet metal work to be completed: New Work: _X— Renovation: HVAC Metal Roofing Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done:r-� ) / S //4tl T/' INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes 0 No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy FfOther type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[], I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date Progress Inspections Comments a Final Inspection Date Comments A Type of License: By `Master Title - ❑ Master -Restricted Cityrrown ❑Journeyperson Permit # Signature of Licensee ❑Journeyperson-Restricted License Number: 13rcJrd Fee $ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval Sheet Metal Commercial Guidelines / Life Safety / Critical Systems Inspection Checklist Yes No N/A„ Set of stamped engineering documents and detailed description of mechanical system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be. verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper cld&anoes, fire rated enclosures and pressure testing required. _ _ Seirri xe mints is*rstall Ear"li.e required 'on equipment and Duct penetrations in fiie'rdte %Tali:: and floors sealed Metal roofing systems installed watertight'using proper materials and fasteners Flexible duct runs installed 6'-0" maximum length Ductwork installed using proper hanger spacing, hanger stock, threaded rod and angle iron Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining Volume dampers installed for each supply air branch duct New/clean - properly sized filters installed (final inspection) Testing and Balancing report complete (final sign -off) t Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign -off) For: Load Short Form Entire House 75 Summer St, North Andover, Ma Job: 01251503 Date: Jan 25, 2015 By: ykt@fwwebb.com Design Infe e Htg Clg Infiltration Outside db (°F) 3 90 Method Simplified Inside db (°F) 70 75 Construction quality Semi -tight Design TD (°F) 67 15 Fireplaces 0 Daily range - M Inside humidity (%) 32 45 Moisture difference (gr/Ib) 29 39 HEATING EQUIPMENT Make Generic Trade Model AFUE 96 AHRI ref Efficiency .. Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 96 AFUE 13338 58815 Btuh 56463 Btuh 35 °F 1482 cfm 0.025 cfm/Btuh 0 in H2O.. COOLING EQUIPMENT Make Generic Trade Cond SEER 15.0 Coil AHRI ref Efficiency Sensible cooling Latent cooling Total cooling Actual air flow Air flow factor Static pressure Load sensible heat ratio 12.8 EER, 15 SEER 31122 Btuh 13338 Btuh 44460 Btuh 1482 cfm 0.043 cfm/Btuh 0 in H2O • �. 0.84 Basement Zone ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ftz) (Btuh) (Btuh) (cfm) (cfm) Basement Zone 1120 17776 4720 452 203 2nd Floor Zone 1502 17019 12866 433 554 1 st Floor Zone 1696 23451 18918 597 815 Entire House 4318 58246 33431 1482 1482 Other equip loads 0 0 Equip. @ 1.00 RSM 33431 Latent cooling 6234 TnTAI e I eo-10 I cosec I nn— I ..., , I ... , Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. A! WrWM50 C2015 -Jan -30 22:58:10 Right-Suite®U riiversal 2015 15.0.10 RSU18446 A! ...St North AndoveA75 Summer St North Andovecrup Calc = MJ8 Front Door faces: NW Page 1 .. wrightsoft' Load Short Form 1st Floor Zone Job: 01251503 Date: Jan 25, 2015 By: ykt@fwwebb.com 75 Summer St, North Andover, Ma Design Information Htg Clg Infiltration Outside db (°F) 3 90 Method Simplified Inside db (°F) 70 75 Construction quality Semi -tight Design TD (°F) 67 15 Fireplaces 0 Daily range - . M Inside humidity (%) 30 50 Moisture difference (gr/lb) 28 34 HEATING EQUIPMENT Make n/a Trade n/a Model n/a AHRI ref n/a Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 1 n/a n/a 0 Btuh 0 'F 0 cfm 0 cfm/Btuh 0 in H2O COOLING EQUIPMENT Make n/a Trade n/a Cond n/a Coil n/a AHRI ref n/a Efficiency Sensible cooling Latent cooling Total cooling. Actual air flow Air flow factor Static pressure Load sensible heat ratio n/a 0 Btuh 0 Btuh 0 Btuh 0 cfm 0 cfm/Btuh 0 in H2O 0 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF Project (ftz) Information (Btuh) (cfm) (cfm) Den 108 2411 75 Summer St, North Andover, Ma Design Information Htg Clg Infiltration Outside db (°F) 3 90 Method Simplified Inside db (°F) 70 75 Construction quality Semi -tight Design TD (°F) 67 15 Fireplaces 0 Daily range - . M Inside humidity (%) 30 50 Moisture difference (gr/lb) 28 34 HEATING EQUIPMENT Make n/a Trade n/a Model n/a AHRI ref n/a Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat 1 n/a n/a 0 Btuh 0 'F 0 cfm 0 cfm/Btuh 0 in H2O COOLING EQUIPMENT Make n/a Trade n/a Cond n/a Coil n/a AHRI ref n/a Efficiency Sensible cooling Latent cooling Total cooling. Actual air flow Air flow factor Static pressure Load sensible heat ratio n/a 0 Btuh 0 Btuh 0 Btuh 0 cfm 0 cfm/Btuh 0 in H2O 0 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ftz) (Btuh) (Btuh) (cfm) (cfm) Den 108 2411 1924 61 83 Living 266 3907 3448 99 149 Foyer 195 1799 928 46 40 Dining 195 1712 1042 44 45 Lay. 30 547 585 14 25 Kitchen -Eating 326 2622 3670 67 158 Family Room 576 10453 7321 266 316 1 st Floor Zone 1696 23451 18918 597 815 Other equip loads 0 10 Equip. @ 1.00 RSM 18918 Latent cooling 2355 Tl1TAIC I dCnC I nnAGA I nAnI Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. ` wrighftOf �Ca " 2015 -Jan -30 22:58:10 ' Right -Suite® Universal 201515.0.10 RSU18446 Paget St North Andover\75 Summer St North Andover.rup Calc = MJ8 Front Door faces: NW I For: Load Short Form 2nd Floor Zone 75 Summer St, North Andover, Ma Job: 01251503 Date: Jan 25, 2015 By: ykt@fwwebb.com ROOM NAME Htg Htg load (Btuh) Clg Infiltration Clg AVF (cfm) BR2 Outside db (°F) 3 1500 90 Method Simplified 392 Inside db (°F) 70 82 75 Construction quality Semi -tight Design TD (°F) 67 18 15 Fireplaces 182 0 Daily range - 72 M 144 2073 1608 Inside humidity (%) 30 laundry 50 542 908 14 Moisture difference (gr/Ib) 28 274 34 2258 81 97 HEATING EQUIPMENT 135 COOLING EQUIPMENT 1721 Make n/a 74 7-,4C:l U,11 Inc Make n/a IOc c Trade n/a Trade n/a Model n/a Cond n/a AHRI ref n/a Coil n/a AHRI ref n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 °F Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 ROOM NAME Area (ft2) Htg load (Btuh) Clg load (Btuh) Htg AVF (cfm) Clg AVF (cfm) BR2 156 2029 1500 52 65 Master 392 3212 2562 82 110 Bath2 64 709 499 18 22 BR3 182 2703 1675 69 72 BR4 144 2073 1608 53 69 laundry 49 542 908 14 39 Master Bath 274 3187 2258 81 97 Excercise/Sitting 135 2369 1721 60 74 7-,4C:l U,11 Inc Inc IOc c n Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. +`2015 -Jan -30 22:58:10 Rig ht-Suite®Universal 2015 15.0.10 RSU18446 Page 3 ..St North Andover\75 Summer St North Andover. rup Calc = MJ8 Front Door faces: NW 2nd Floor Zone 1502 17019 12866 433 554 Other equip loads 0 0 Equip. @ 1.00 RSM 12866 Latent cooling 2977 -Al n I 4CAA I 4COA7 I A'30 I CCA Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 2015 -Jan -30 22:58:10 WrightSOft` Right -Suite® Universal 2015 15.0.10 RSU18446 Page4 ...St North Andover\75 Summer St North Andover.rup Calc = MJ8 Front Door faces: NW 0 wrightsoW,Load Short Form Job: 01251503 Date: Jan 25, 2015 Basement Zone By: ykt@fwwebb.com 75 Summer St, North Andover, Ma Area Htg load Clg load Htg AVF Clg AVF Project (ft2) Information Design o, (cfm) Basement 1120 Htg 75 Summer St, North Andover, Ma ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) Design o, (cfm) Basement 1120 Htg 4720 Clg Infiltration Basement Zone 1120 Outside db (°F) 3 452 90 Method Simplified 0 Inside db (°F) 70 75 Construction quality Semi -tight Design TD (°F) 67 15 Fireplaces 0 Daily range - Tr)TAI C M -1-7-7-7c I ccno I Inside humidity (%) 35 35 Moisture difference (gr/Ib) 33 54 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref n/a Coil n/a AHRI ref n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 °F Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) Basement 1120 17776 4720 452 203 Basement Zone 1120 17776 4720 452 203 Other equip loads 0 0 Equip. @ 1.00 RSM 4720 Latent cooling 878 Tr)TAI C -1-7-7-7c I ccno I Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. W 2015 -Jan -30 22:58:10 Rig ht -Suite® Universal 2015 15.0.10 RSU18446 Page 5 ...St North Andover\75 Summer St North Andover.rup Calc = MJ8 Front Door faces: NW is wrightsoWProject Summary Entire House For: Notes: Project Information 75 Summer St, North Andover, Ma DesignInformation Weather: Lawrence Muni, MA, US Winter Design Conditions Outside db. Inside db Design TD Job: 01251503 Date: Jan 25, 2015 By: ykt@fwwebb.com Summer Design Conditions 3 °F Outside db 70 °F Inside db 67 °F Design TD Daily range Relative humidity Moisture difference Heating Summary Structure 53408 Btuh Ducts 4838 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Piping 0 Btuh Equipment load 58246 Btuh Method Construction quality Fireplaces Infiltration Simplified Semi -tight 0 Heating Cooling Area (ftp 4318 4318 Volume (ftp) 36049 36049 Air changes/hour 0.19 0.10 Equiv. AVF (cfm) 114 60 Heating Equipment Summary Make Trade Model AHRI ref Generic AFUE 96 Efficiency Heating input Heating output Temperature rise Actual air flow Air flow factor Static pressure Space thermostat r 90 °F 75 °F 15 °F M 45 % 39 gr/Ib Sensible Cooling Equipment Load Sizing Structure 31089 Btuh Ducts 2341 Btuh Central vent (0 cfm) 0 Btuh Blower 0 Btuh Use manufacturer's data y Rate/swing multiplier 1.00 Equipment sensible load 33431 Btuh Latent Cooling Equipment Load Sizing Structure 4308 Btuh Ducts 1927 Btuh Central vent (0 cfm) 0 Btuh Equipment latent load 6234 Btuh Equipment total load 39665 Btuh Req. total capacity at 0.77 SHR 3.6 ton Cooling Equipment Summary 12.8 EER, 15 SEER 31122 Btuh Make Generic Btuh 44460 Trade 1482 cfm Cond SEER 15.0 cfm/Btuh 0 Coil 0.84 AHRI ref 96 AFUE Efficiency 58815 Btuh Sensible cooling 56463 Btuh Latent cooling 35 °F Total cooling 1482 cfm Actual air flow 0.025 cfm/Btuh Air flow factor 0 in H2O Static pressure Load sensible heat ratio 12.8 EER, 15 SEER 31122 Btuh 13338 Btuh 44460 Btuh 1482 cfm 0.043 cfm/Btuh 0 in H2O 0.84 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. _ 2015 Jan30 22:58:x'1 W t* Right-Suite®Universal 201515.0.10RSU18446 Page,1 94CM...St North Andover\75 Summer St North Andover. rup Calc = MJ8 Front Door faces: NW Project Summary • 1st Floor Zone For: Notes: Project Information 75 Summer St, North Andover, Ma Design Information Weather: Lawrence Muni, MA, US Winter Design Conditions Outside db 3 °F Inside db 70 °F Design TD 67 °F Heating Summary Daily range M Structure 20136 Btuh Ducts 3316 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Piping 0 Btuh Equipment load 23451 Btuh Infiltration Job: 01251503 Date: Jan 25, 2015 By: ykt@fwwebb.com Summer Design Conditions Outside db 90 °F Inside db 75 °F Design TD 15 °F Daily range M Use manufacturer's data Relative humidity 50 % Moisture difference 34 gr/Ib Sensible Cooling Equipment Load Sizing Structure 17070 Btuh Ducts 1848 Btuh Central vent (0 cfm) 0 Btuh Blower 0 Btuh Use manufacturer's data y Rate/swing multiplier 1.00 Btuh Equipment sensible load 18918 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Semi -tight Fireplaces 0 Structure 1287 Btuh Ducts 1068 Btuh Heating Cooling Central vent (0 cfm) 0 Btuh Area (ft2) 1696 1696 Equipment latent load 2355 Btuh Volume (fP) 15076 15076 Air changes/hour 0.18 0.09 Equipment total load 21273 Btuh Equiv. AVF (cfm) 44 23 Req. total capacity at 0.77 SHR 2.0 ton Heating Equipment Summary Cooling Equipment Summary Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref n/a Coil n/a AHRI ref n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 °F Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. " Right-Suite®Universal201515.0.10RSU18446 2015 -Jan -30 22:58:11 St North AndoverV5 Summer St North Andover.rup Calc = MJ8 Front Door faces: NW ` Paget Project Summary Job: 01251503 1 ' �7 Date: Jan 25, 2015 2nd Floor Zone By: ykt@fwwebb.com For: Notes: Project Information 75 Summer St, North Andover, Ma Weather: Lawrence Muni, MA, US Winter Design Conditions Summer Design Conditions Outside db 3 °F Outside db 90 °F Inside db 70 °F Inside db 75 °F Design TD 67 °F Design TD 15 °F Daily range M Relative humidity 50 % Moisture difference 34 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 15497 Btuh Structure 12194 Btuh Ducts 1522 Btuh Ducts 673 Btuh Central vent (0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 17019 Btuh Use manufacturer's data y Rate/swing multiplier 1.00 Infiltration Equipment sensible load 12866 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Semi -tight Fireplaces 0 Structure 2119 Btuh Ducts 858 Btuh Heating Cooling Central vent (0 cfm) 0 Btuh Area (ft2) 1502 1502 Equipment latent load 2977 Btuh Volume (fP) 12013 12013 Air changes/hour 0.22 0.12 Equipment total load 15843 Btuh Equiv. AVF (cfm) 45 24 Req. total capacity at 0.77 SHR 1.4 ton Heating Equipment Summary Cooling Equipment Summary Make n/a Make n/a Trade n/a Trade n/a Model n/a Cond n/a AHRI ref n/a Coil n/a AHRI ref n/a Efficiency n/a Efficiency n/a Heating input Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Temperature rise 0 °F Total cooling 0 Btuh Actual air flow 0 cfm Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Static pressure 0 in H2O Space thermostat n/a Load sensible heat ratio 0 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 4 Rig ht-Suite®Universal 201515.0.10 RSU18446 2015 -Jan -30 22:58:11 e Page St North AndoveA75 Summer St North Andover. rup Calc = MJ8 Front Door faces: NW 4 Project Summary EV Basement Zone For: Notes: Project Information 75 Summer St, North Andover, Ma Design Information Weather: Lawrence Muni, MA, US Winter Design Conditions Outside db Inside db Design TD Job: 01251503 Date: Jan 25, 2015 By: ykt@fwwebb.com Summer Design Conditions 3 °F Outside db 70 °F Inside db 67 °F Design TD Daily range Relative humidity Moisture difference Heating Summary 1120 Structure 17776 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Piping 0 Btuh Equipment load 17776 Btuh Method Construction quality Fireplaces Infiltration Simplified Semi -tight 0 Heating Cooling Area (ftp 1120 1120 Volume (ft') 8960 8960 Air changes/hour 0.17 0.09 Equiv. AVF (cfm) 25 13 Heating Equipment Summary Make n/a y Trade n/a 1.00 Model n/a 4720 Btuh AHRI ref n/a Structure 878 Efficiency Ducts n/a Heating input Central vent (0 cfm) 0 Heating output 0 Btuh Temperature rise 0 °F Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Space thermostat n/a Cond n/a 90 °F 75 °F 15 °F M 35 % 54 gr/Ib Sensible Cooling Equipment Load Sizing Structure 4720 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Blower 0 Btuh Use manufacturer's data y Rate/swing multiplier 1.00 Equipment sensible load 4720 Btuh Latent Cooling Equipment Load Sizing Structure 878 Btuh Ducts 0 Btuh Central vent (0 cfm) 0 Btuh Equipment latent load 878 Btuh Equipment total load 5598 Btuh Req. total capacity at 0.77 SHR 0.5 ton Cooling Equipment Summary Make n/a Trade n/a Cond n/a Coil n/a AHRI ref n/a Efficiency n/a Sensible cooling 0 Btuh Latent cooling 0 Btuh Total cooling 0 Btuh Actual air flow 0 cfm Air flow factor 0 cfm/Btuh Static pressure 0 in H2O Load sensible heat ratio 0 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 1 2015 -Jan -30 22:58:11 FTEMLUWSi North Andover\ 75 Summer Rig ht -Su ite® Universal 2015 15.0.10 RSU18446 Page 4 St North Andover.rup Caic = MJ8 Front Door faces: NW 4 ACMEC-1 OP ID: PS CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 03/16/2015 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 Foster Sullivan Insurance 163 Main St. North Andover, MA 01845 Stephen Sullivan CONTACT NAME: Pete Sullivan AIC, o Ext :978-686-2266 �c No): 978-686-6410 E-MAIL ADDRESS: psullivan@fostersullivangroup.com INSURER(S) AFFORDING COVERAGE NAIC # 06/06/2014 INSURER A: VERMONT MUTUAL INSURANCE CO 26018 EACH OCCURRENCE $ 1,000,00 INSURED AC Mechanical INSURER B: SAFETY INDEMNITY INS CO 33618 Scott Valeriani 8 Georgianna Rd INSURER C:AIM MUTUAL INS CO 33758 INSURER D: Billerica, MA 01821 INSURER E : $ INSURER F: AUTOMOBILELIABILITY COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DDL SUBR POLICY NUMBER EFF MM/DDIIYYYY MMPOLICY ICY EXP L DDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR BP18002085 06/06/2014 06/06/2015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,00 PERSONAL BADV INJURY . $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ B AUTOMOBILELIABILITY ANY AUTO ALL OWNED X SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS 6203293 04/02/2014 04/02/2015 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDENT UMBRELLA LIAB EXCESS LIAB __HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ - DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YI N OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yyes, describe under DESCRIPTION OF OPERATIONS below N / A VWC-100-6014851-2014A 12/21/2014 12/21/2015 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYE $ 100,00 E.L. DISEASE - POLICY LIMIT $ 500,00 PROPERTY 5,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ** EVIDENCE ** taK I It-lUA I t MULUtK GANGtLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. mdeems@townofnorthandover.com 1600 OSGOOD .STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Date ....A...!.. 16... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies thatIif.......,....`P�'�'1— has permission to perform J. ee j........I................................................... wiring in the building of. � ........ IM.ira .............................. R at..��7�}}\\.X�11!t............,................ North Andover, Mass. Fee:.JCJ .�..... Lic. No .............'' ELE ALINSPECTOR Check # 13141) PI �p2- 15 J1t- III2�I1� Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. I Occupancy and Fee Checked s BOARD OF FIRE PREVENTION REGULATIONS [Rev. l/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 IN NK OR TYPE ALL INFORMATION) Date: 3 -6 -Is 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) -26- 5 uvv m r 51 - Owner or Tenant Owner's Address Is Is this permit in conjunction with a building permit? Yes R No ❑ Telephone No. J7J q ?cf. I?A ?— Purpose of Building Al f w Utility Authorization - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service 7-0y Amps I ?0 / 0*b Volts Overhead Undgrd ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I Rq 7 50q 9 No. of Meters �—hr— No. of Meters / /1�4..- s-11-6 Completion of the following table maybe waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets l No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- Elo. rnd. rnd. o mergency ig ting BatterV Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches f No. of Gas BurnersNo. of Detection and Initiating Devices No. of Ranges No. of Air Cond. I TonTots 3 No. of Alerting Devices No. of Waste Dis posers p Heat Pump Totals: Number ** * ��� * ,Tons, K.W......... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers ! Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers / Heating Appliances KW SecNoto De ices or Equivalent No. of Water Heaters KW No. of No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent Hydromassage Bathtubs No. of Motors Total HP WirinNo. Telecommunications No. of Devices or Equivalent 9 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: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury, that the infirmation on this application is true and complete. FIRM NAME: , � ►'w LIC. NO.: Cn 1 $ Ig Licensee: 4krL1,f,4 Signature LIC. NO.: (If applicable, enter "exem t" in the license number line. Bus. Tel. No.: �l N g7cr I2loZ Address: l — iS I KC, 1144 Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Departmen of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance. with the provisions of M.G.L. c. 143, § 3L, the ' permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending -through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comm ts: Inspectors Signature: Date: PARTIAL ROUGH INSPEC ION: Pass IN Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M V Failed 0 Re- Inspection Required ($.) ❑ Inspectors Com nts: 3- -/s- Inspecto Signature: Date: FINAL INSPTION: Pass 0 Failed �^ Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature:Date: '` DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com v The Commonwealth ofMassachusetts Departmento, f'Indus€riglAceikuts Office oflnvesiigations 600 Washington Street Boston, MA 02111 -www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contract Name (Business/Organization&dividual): Irl Address: (a. .57 City/State/Zip: l , 12Y c,4 K 5 Vii ! Phona M '179 27T / Z6 ,2- Are you an employer? Check the appropriate box: Type of project (required): 1.E] I am a employer with 4. ❑ I am a general contractor and 1 6.` 6.0 Now construction - mployees Gull and/or part-time).* e have liiredthe sub -contractors listed. on the attached sheet. T 7• Remodeling 2. [� I am a sola proprietor or partner- ship and`have no.employees These sub -contractors have 8. ❑ Demolition working forme in any capacity. Workers' comp. insurance. g,ElBuilding addition [No workers' comp. insurance S.E] We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.E1 I am a homeowner doing all work officers have exercised.their right of exemption per MGL 11. ❑ Plumbing repairs or additions ' myself. [No workers' comp. c.152, §1(4), and wehave no 12. Q Roofrepairs insusancere ed. a employees. Mo workers' 13.❑ Other comp. insurance required.] NAnyapplicautthatchecks box#l. must also fill out the section belowsnowmgtneirworxers'compensationponcymmmanon. - i'Homeowners who submit this affidavit indicatingthey tie doing allworK and then hire outside contractors must submit a new affidavit indicating such. TContractors that checkthis box must attached m additional sheet showingthe name of the sub -contractors and their workers' comp. policy information. I am an employer' that b vroviding workers' compensation insumee formy employees Below is flee policy and'rob site information. j I Insurance Company Name: /,f5 �`%t Pt wat" G Policy # or Self -ins. Lic. M Expiration Date:, Job Site Address: 75 5V M M -e V City/State/Zip: Q (- Attach a copy o#the workers' compensationpolley declaration page (showing the policy number and expiration date). Failure to secure coverage,as reVIIM dimder Section 25A ofMGL o.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 fins ofup 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 ver cation. X do liereby certo uiide�lie pain�s/an penalti ofperjury Haat flee information provided above is true and correct. 67 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 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an eraployee is defined as "...every person in the service of another under any contract ofhi m,• express orimpH4 oral orwritten." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a -deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compiiauce with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill. out the workers' compensaiion affidavit completely, by checking the boxes that apply to your situation and, if iiecessarq, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, arenotrequiredto carry workers' compensation insurance. IfanLLC orLLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Deparhnent 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 penult 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 onto appropriate line. City or Town Officials Please be sure that the affidavit is complete andprinted 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 bo -sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant thatmust submitmultiple permit/Ecome applications in any given year, need only submit one affidavit indicating current policy information (ifnecessary) and under "lob Site Address" the applicant shouldwrite "all locations in (city or town). " .A' copy of the affidavit that has been officially stainp ed or marked by the city or town may be provided to the applicant as proof that a valid affidavit -Ii 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 orpermit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do nothesitate to give us a call. The Department's address, telephone aid fax number: Tho CQwon-wealth ofMfossaahu.sotEs Dopa pent oflhdusWal.Acoldonts fafce offAvedtig4tions• do washillgwa stxoe't Bostw, MA021.Zx Tei. # 617-727-4900 QA 406 ox X-8,77 MASS Revised 5-26-05 Fax # 617-727-7749 �Fww.�ass,g4v�c�ia • Ll LH READ LNG. MA o1864-31 16218 ,A 07/3111'6 79886 :t Date ...... L4..--.�.'...��./....... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........ 6. G ...................................:.. .....�`.................................... � y(C c' has permission to perform.................................� ........................................ C -- wiring in the building of,,,,,, �rS VE/��..l%C ............................................................................................ at...75......5....U.W./i!(.............ST................... . North Andover, Mass. ---- eco Fees. ..... Lic. No.........°.... .......................... ELECTRICAL II�ECTOR Check # _c>� Commonwealth of Massachusetts Department of Fire Services .M BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. r Z'ct-�-o Occupancy and Fee Checked [Rev. 1/071 (leave blank 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 ININK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)_ -75 5,.)m v e.r -+ - Owner or Tenant �p,t rtL� iJC,,t\Q m dM-fy1-�- LLC- Tel ne No. -4257 97� J �. Owner's Address f- a 2,_z_> Is this permit in conjunction with a building permit? Yes ER" No ❑ (Ch Purpose of Building Utility AuthorizationN . %g 14L J % i - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ 0.0 New Service 1aa Amps 1 Zo / Vi Volts Overhead D Undgrd ❑ No. of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: IgxrAA) h00516, Completion of the_following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- El o mergency ig ting rnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers p Heat Pump Totals: N_ umber .._... Tons " KW ...' ""..........Detection/Alerting No. of Self -Contained 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 Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of WYres. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: j/-ZLJ-1 `i Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) X certify, antler the pains and penalties of perjury, that thiinforntation on this application is true and complete. FIRM NAME:. r/ G )O rhe GL -c- LIC. NO.: Licensee: 6h y- 1.5 I G I C Signature 4LIC. NO.: 1�1 IS R (If applicable, enter "exempt" in the license number lin .) Bus. Tel. No.: qYT 2 Z 1 1 U Z Address: -1 4rrg v� �5 f %e ✓i- Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Dtpartmerit of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed j on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass 0 '- Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass 1ZFailed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com ILX The Commonwealth ofMassachusetts Department oflndustrialAcciknts Office of Invesfigations 600 Washington Street Boston, MA 02111 www.mass.gov1d1a Workexs' Compensation Insurance Affidavit: Builders/Contract Name (Businessiorganizaiion/t clividual): ��-fP� r—r L•d;� uor,k o o VvAe k , Address: (A r-r0,i5C,t5 54— City/State/Zip:� ti� )'V) Phone 171 Are you an employer? Check the appropriate box: Type of project (required): 1. Q I am a employer with 4. Q I am a general contractor and' 6. [-Kew constmetion ,__.I�( employees (full and/or part-time).* have hired the sub -contractors 2. X11 am a sole proprietor or partner listed on the attached sheet. 7• E] Remodeling ship and"haveno.employees These sub -contractors have 8. Q Demolition working forme in any capacity, workers' comp. insurance. 9. Q Building addition [No workers' comp. insurance 5. Q We are a corporation and its required.] officers have exercised.theix 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work, right of exemption per MGL 11. ❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.Q Roofrepairs insurancerequired.j ► employees. [No workers' 1311 Other comp. insurance required.] ' IAny applicant that checks box#1 must also fill outthe section below showing their workers' compensation policy information. 'Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employeN that ispr oviding workers' compensation insurance for'my employees Below is the policy andjob site information. Insurance Company Policy # or Self ins.Lic. #: ExpirationDate: lob Site Address: City/State/Zip: Attach a copy of the workers' compensation-poliey declaration page (showing the policy number and expiration date). failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well .as civil penalties in the form of a STOP -WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of. Investigations of the DIA for insurance coverage verification. -1do hereby cert& uWer'thepairs andpefallies ofperjury that the informadonprovidedabove is true and eorrect. ey-1 y official use ortly. Do not write in ti'iis area, to be completed by city or town official City, or Town: Permit cense # Issuing Authority (circle one): 1. Board of Health 2. BuildingDepartment 3. City/Town. Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person; Phone 4: Information and Instructio'" Massachusetts General Laws chapter 152 requires all employers to provide workers' comp Bus ation for their employees. Pursuarit to this statute, an errVloyee is defined as "...every person tri the service of another under any contract ofhire,• express or implied, oral or written.." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or anyiwo oxmore Of the foregoing engaged in a joint enterprise, and including the legal representatives of a- deceased employer, or the redeiver ox 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 orrepair work on such dwelling house ox on the grounds or building appurtenant thereto shall not because of such employment be deemed to beau, employes." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required:' Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill. out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) andphone numbers) along withtheir 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,apolicyisxequired. Be advised that this affidavit maybe. submitted tothe, 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 soli insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete andprinted 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 peroaithicense number which will be used as a reference number. In addition, an applicant thatrnust submit multiple permitlEcense applications in. any given year, need only submit one affidavit indicating current policy information (if necessary) and under "lob Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has b sen officially stamped or marked by fibs city or town may be provided to the applicant as proof that a valid affidavit -lion file for future permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license orpermit to burn leaves eta) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Goxr_poawealth ofMassachvsPtrs - Y?epai�mo t d1Rdu&!a1 A,ccidenta Qfeo dTivestig tIom 6QG Waftg m ftGx t B090.4,M-A.O.2XIZ Tel. # 617-7-2-.7-4900 oA 496 ox 1 -877 - SAFE Revised 5-26-05 Fay # 617-727-7749 Www-maagovaa