Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 79 HEWITT AVENUE 4/30/2018
I O Date.,- ,. 2.�. .. TOWN OF NORTH ANDOVER ' PERMIT FOR MECHANICAL INSTALLATION 9 F, This certifies that � C. ! } 1 r , i -- L has permission for mechanical installation ..� :.�.!� C -'— in -'-in the buildings of . �.' �:. :.........: �.:: :� ....... . at . 1.` i ... � !l �- � :. ..-.......... , North Andover, Mass. Fee. /%/-'.. Lic. No. �. ?................. T........... GASINSPECTOR C,r WHITE: AppHcan, CANARY: Building Dept. PINK: Treasurer 1I Commonwealth of Massachusetts Sheet Metal Permit Date : -3 J/ 3, //S— Estimated Job Cost: �b C)• �? Plans Submitted: YES NO Business License # Business Information: Name:, Street: City/Town: W0,::c, 're, Telephone: %/;>,f k�fl- Photo I.D. required / Copy of Photo I.D. attached: Building Type: Permit # `� Permit Fee: $ Plans Reviewed: YES NO Applicant License # Property Owner / Job Location Information: Name:�� Street: City/Town: Telephone: YES NO Residential: 1-2 family �< Multi -family Condo / Townhouses Commercial: Office Retail Industrial Educational Institutional Building Cubic Footage: under 35,000 cu. ft. over 35,000 cu. ft. Sheet metal work to be completed: New Work: -,�= Renovation: HVAC "Metal Roofmg Kitchen -Exhaust System Chimney / Vents Provide brief description of work to be done: ��� �/l hL��- ��r-�-�•, l� �erc�Aa �— ate. ? '7�r�-� 1%fe, Q INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ❑ No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box0, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Date t Date z By_ Title City/Town Permit # Fee $ Inspector Signature of Permit Approval Progress Inspections Comments Final Inspection Type of License: ❑ Master ❑ Master -Restricted ❑Journeyperson ❑ Jo urneyperson-Restricted Comments Signature of Licensee License Number: Check at www.mass.-gov/dpl 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 sheetmetal work being performed with proper journeyperson-to-apprentice ratios Fire dampers with access door properly installed and checked for operation Smoke and combination fire / smoke dampers with access doors properly installed - actuator checked for proper operation (May also be verified by fire department during fire alarm testing) Duct smoke detectors with access doors properly located (May also be verified by fire department during fire alarm testing) Smoke / atrium exhaust systems installed and operation verified (May also be verified by fire department during fire alarm testing) Stair pressurization systems installed (where required) and operation verified (May also be verified by fire department during fire alarm testing) Grease / kitchen hood exhaust system installed with all seams and connections welded airtight with properly located cleanouts. Proper cle;;`ances, fire rated enclosures and pressure testing required. :; Sei raiy res saints install d trli t r quirecl on egtiIment and dku,.tz,-. 0r Duct penetrations in fir'e'iatc, %salt=3 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 -oft) Sheet Metal Residential Guidelines / Inspection Checklist Yes No N/A Detailed description and sketch of sheet metal system to be installed has been provided All workers performing sheet metal work onsite has valid Massachusetts sheet metal license All sheet metal work being performed with proper joumeyperson-to- apprentice ratios Equipment sized per heating / cooling load calculations Duct work sized per manual "D" calculations Bath / shower rooms contain mechanical exhaust fan vented outdoors Electric dryer exhaust properly installed maximum total run 35'-0", maximum flexible run 8'-0" Flexible duct runs installed 14'-0" maximum length Volume dampers installed for each supply air branch duct Ductwork installed using proper gauges and hangers Ductwork / plenum connections sealed substantially airtight Ductwork insulated by means of external covering or internal lining New/clean - properly sized filter installed (final inspection) Testing and Balancing report complete (final sign-ofo t Mi '�- wrightsoft- Load' Short Form Entire House Project Information 79 Hewitt Ave, North Andover, Ma Job: 01251504 Date: Jan 25, 2015 By: ykt@fwwebb.com Design Information Htg cig Infiltration Outside db (°F) 3 90 Method Simplified Inside db (°F) 70 75 Construction quality Average Design TD (°F) 67 15 Fireplaces 0 Daily range - M Inside humidity (%) 30 50 Moisture difference (gr/Ib) 28 34 HEATING EQUIPMENT COOLING EQUIPMENT Make Area (ft2) 32882 Make Trade Btuh 46974 Trade Model cfm 0.057 Cond AHRI ref in H2O 0.86 Coil 135 93 BR4 AHRI ref Efficiency 96 AFUE 131 Efficiency 12.8 EER, Heating input 64802 Btuh Sensible cooling Heating output 62210 Btuh Latent cooling Temperature rise 31 OF Total cooling Actual air flow 1857 cfm Actual air flow Air flow factor 0.028 cfm/Btuh Air flow factor Static pressure 0.10 in H2O Static pressure Space thermostat 122 1122 Load sensible heat ratio 15 SEER Area (ft2) 32882 Btuh 14092 Btuh 46974 Btuh 1857 cfm 0.057 cfm/Btuh 0.10 in H2O 0.86 1644 ROOM NAME Area (ft2) Htg load (Btuh) Clg load (Btuh) Htg AVF (cfm) Clg AVF (cfm) BR2 144 3397 1571 94 89 BR3 196 4887 1644 135 93 BR4 180 4751 1223 131 69 laundry 15 147 528 4 30 Bath 75 1689 336 47 19 Master Bath 80 1570 320 43 18 Master 388 9461 2999 261 170 2nd fl hall 122 1122 159 31 9 Eating 196 5658 2909 156 165 Living 196 5995 4203 165 238 Foyer 208 6215 3269 171 185 Family 234 10209 5594 281 317 Kitchen 182 5262 4138 145 235 Dining 182 6845 3825 189 217 Lav 71 1014 07 c n Calculations approved by ACCA to meet all requirements of Manual J 8th Ed 2015 -Feb -12 12:01:06 wrightsofC Right -Suite® Universal 2015 15.0.10 RSU18446 Page 1 /M ...t North Andover\79 Hewitt Ave.North Andover.rup Calc = MJ8 Front Door faces: NW Entire House 2419 67401 32747 1857 1857 Other equip loads 0 0 Equip. @ 1.00 RSM 32747 Latent cooling 5539 TnTAIQ 7A 10 Q7An4 2Q74R 4Qc7 14c7 - V I V V L V V I V V/ I U10 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. ,.-k;�_ + wrightsoft" Right -Suite® Universal 2015 15.0.10 RSU18446 ...t North Andover\79 Hewitt Ave North Andover.rup Calc = MJ8 Front Door faces: NW 2015 -Feb -12 12:01:06 Page 2 C = - wrightso' ft® Project Summary Entire House Project Information For: 79 Hewitt Ave, North Andover, Ma Notes: i, Job: 01251504 Date: Jan 25, 2015 By: ykt@fwwebb.com Weather: Lawrence Muni, MA, US Winter Design Conditions Summer Design Conditions Outside db 3 OF Outside db 90 OF Inside db 70 OF Inside db 75 OF Design TD 67 OF Design TD 15 OF Daily range M Relative humidity 50 % Moisture difference 34 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 59147 Btuh Structure 29916 Btuh Ducts 8254 Btuh Ducts 2831 Btuh Central vent (0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 67401 Btuh Use manufacturer's data y Rate/swing multiplier 1.00 Infiltration Equipment sensible load 32747 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 3205 Btuh Ducts 2334 Btuh Heating Cooling Central vent (0 cfm) 0 Btuh Area (ft') 2419 2419 Equipment latent load 5539 Btuh Volume (ft') 19993 19993 Air changes/hour 0.41 0.21 Equipment total load 38286 Btuh Equiv. AVF (cfm) 137 70 Req. total capacity at 0.70 SHR 3.9 ton Heating Equipment Summary Cooling Equipment Summary Make Make Trade Trade Model Cond AHRI ref Coil AHRI ref Efficiency 96 AFUE Efficiency 12.8 EER, 15 SEER Heating input 64802 Btuh Sensible cooling 32882 Btuh Heating output 62210 Btuh Latent cooling 14092 Btuh Temperature rise 31 OF Total cooling 46974 Btuh Actual air flow 1857 cfm Actual air flow 1857 cfm Air flow factor 0.028 cfm/Btuh Air flow factor 0.057 cfm/Btuh Static pressure 0.10 in H2O Static pressure 0.10 in H2O Space thermostat Load sensible heat ratio 0.86 Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wrightsoft` Right -Suite® Universal 2015 15.0.10 RSU18446 2015 -Feb -12 12:01:06 ...t North Andover\79 Hewitt Ave North Andover.rup Calc = MJ8 Front Door faces: NW Page 1 ACMEC-1 OP ID: PS CERTIFICATE OF LIABILITY INSURANCE DATEIM/ TE OdDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Foster Sullivan Insurance 163 Main St. CONTACT N AME: Pete Sullivan A/c° No Ext :978"686-2266 FnAic No :978-686-6410 North Andover, MA 01845 Stephen Sullivan E-MAIL ADDRESS: psullivan@fostersullivangroup.com INSURER(S) AFFORDING COVERAGE NAIC # GENERAL LIABILITY INSURER A: VERMONT MUTUAL INSURANCE CO 26018 INSURED AC Mechanical Scott Valeriani rgian 8 Georgianna Rd INSURER B: SAFETY INDEMNITY INS CO 33618 INSURER C:A LM MUTUAL INS CO 33758 INSURER D : Billerica, MA 01821 INSURER E: INSURER F: BP18002085 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 UBR POLICY NUMBER EFF MMIDDPOLICY/YYYY POLICY EXP MM DDNM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR BP18002085 06/0612014 06/06/2015 pREMISES Ea occurrenEu ce $ 50,000 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,00 X POLICY PRO- RO LOC JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 B ANY AUTO 6203293 04/02/2014 04/0212015 BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE PERACCIDENT $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A VWC-100-6014851-2014A 12/21/2014 12/21/2015 WC STATU- OTH- X TORY LIMITS1 ER E.L. EACH ACCIDENT $ 100,00 E.L. DISEASE - EA EMPLOYE $ 100,00 (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS below PROPERTY 5,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ** EVIDENCE ** TOWN OF NORTH ANDOVER mdeems@townofnorthandover.com 1600 OSGOOD STREET NORTH ANDOVER, MA 01845 \.A Ilk., r_ LLA 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 r v Tris -21J IU ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD i Date ... !VIA `�... TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING Th' rtfi th ' t is%;,%,i es a....................................................................................................................... has permission to perform ....... ............................................................ plumbing in thebuildin s ofd'! .................................................................. at .... 7.....�4Q � .....lko.n�....... North Andover, Mass. Fee '53-6_' Lic. No.3/5Y/ Check # %✓ 7 ......................................... PLUMBING INSPECTOR H� 12711t1151 I G MACHINE CONNECTION HEATER ALL TYPES WATER OTHER 01INSURANCE COVERAGE: 1 have a current liabilit insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO M-1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITYE] BOND Ell 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 �0 SIGNATURE OF OWNER OR AGENT herecertify that all of the details and information 1 have submitted or entered regarding this application are by and that all plumbing work and installations performed under the permit issued for this application will be in Massachusetts State Plumbing Code and Chapter 142 of the General Laws. AVA-Ar ILICENSE# F91by/ PLUMBERS NAME MP © JP d COMPANY NNAMECITY I (NYAAJ a cc urate to the best of my Knowe with all Pertinent provision of the SIGNATURE CORPORATION 0#=PARTNERSHIP Q# [ LLC L I ZIPaE_..__ FAX � [CELL F ------- ] EMAIL UNIFORM APPLICATION FORA PERMIT TO PERFORM PLUMBING WOR MASSACHUSETTS MA DATE f (_ [ PERMIT # 111 CITY o OWNER'S NAME C t ► JOBSITE ADDRESS " 11 TEL 78 - l FAX OWNER P ° TYPE R OCCUPANCY TYPE O COMMERCIAL Q EDUCATIONAL RESIDENTIAL SUBMITTED: YES [] N0[W PRINT d RENOVATION: ® REPLACEMENT: Q CLEARLY NEW: 6 7 8 9 10 11 12 13 14 FIXTURES FLOOR- BSM 1 2 3 4 5 I _ -- --- � BATHTUB CROSS CONNECTION DEVICE I DEDICATED SPECIAL WASTE SYSTEM _ - -) DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN__— FOOD DISPOSER FLOOR I AREA DRAIN I _W._. (w__J _ ._. __.___ ___ _ ! .__.. i - I INTERCEPTOR (INTERIOR) ! (__ _l �_ .( •__--- __ KITCHEN SINK LAVATORY ROOF DRAIN (__ _ i . i __ i ..__._ J i _— f _J SHOWER STALL � J TOILET _j G MACHINE CONNECTION HEATER ALL TYPES WATER OTHER 01INSURANCE COVERAGE: 1 have a current liabilit insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. YES NO M-1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITYE] BOND Ell 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 �0 SIGNATURE OF OWNER OR AGENT herecertify that all of the details and information 1 have submitted or entered regarding this application are by and that all plumbing work and installations performed under the permit issued for this application will be in Massachusetts State Plumbing Code and Chapter 142 of the General Laws. AVA-Ar ILICENSE# F91by/ PLUMBERS NAME MP © JP d COMPANY NNAMECITY I (NYAAJ a cc urate to the best of my Knowe with all Pertinent provision of the SIGNATURE CORPORATION 0#=PARTNERSHIP Q# [ LLC L I ZIPaE_..__ FAX � [CELL F ------- ] EMAIL The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 t Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le it Name (Business/Organization/Individual): Address: qq City/State/Zip: ak-x- V-.1, S'. Are you an employer? Check tlie appropriate box: Phone #: '7 8 (- `3 6'''7-0 6-91 1. ❑ I am a employer with ! employees (full and/or part-time).* 2. V1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors bade employees and have workers' comp. insurance.$ 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no. employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. 0 Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. [-.✓]'Plumbing repairs or additions 13. ❑ Roof repairs 14. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box mustattached. an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub-coriiractors "have employees, they must provide their workers' comp. policy number. ' I am an employer t[zat is providing workers' compensation insurance for my employees.' Below is thepolicy 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 MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. A n I do hereby certify ul(derldy/e pains and penalties of perjury that the information provided above is/true and correct. tV, S Phone #• .� -76o '367 - 6!5�q Ft I Of 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): i 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-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi• confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call.the Department at the number listed below. Self-insured companies should'enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 wwvVmass.gov/dia ar Date .....�T05...................... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ................`. a..s.....S ^'�~ .......................`........................................... has permission for gasi stallation ................. ....................................................... in the buildings of .........'t '! r. ..... ...c - .................................................... .. . . ................. at .... ..wc.lf..................P.............................., North Andover, Mass. Fee./6.6 ....... Lic. No. 3 / /.......................................................................... �/ GAS INSPECTOR Check #127V G TYPE OR PRINT CLEARLY MASSACHUSETTS'l1NIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK Dov MA DATE PERMIT # CITY JOBSITE ADDRESS %OWN ER'S NAME 2c'S OWNER ADDRESS TE 79 171 1 Z FAX OCCUPANCY TYPE COMMERCIAL FJ EDUCATIONAL NEW: Cj RENOVATION: [I REPLACEMENT: EI APPLIANCES 7 FLOORS- BSM BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOFTOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER RESIDENTIAL 2 PLANS SUBMITTED: YES 0 NO a' 10 1 11 1 12 1 13 1 14 `-- INSURANCE COVERAGE have a current liabilit insurance policy or its substantial equivalent which meets the requirements of MOL. Ch. 142 YES [] NO Ell IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY [i OTHER TYPE INDEMNITY (j BOND F 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 I have submitted or entered regarding this application are true a a to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in complian t a I ertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME wa�,5 �d2�`�E LICENSE # 3fSyj I SIGNATURE MP E MGF [=— JP [V JGF u LPGGII j CORPORATION ®# PARTNERSHIP [3#= LLC E]# COMPANY NAME: QS �D__, _I1 iNADDRESS �e wJ i CITY _ �� STATE _M �, ZIP 1 TEL FAX CELL [:=- EMAIL 6&omF on eEsti O _ 1! = on z d� ~ W LU LL Z w a* 'a a CO) LUC z w ui w I e. 10 Date Aq..�..I.V5 TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .......... ..... . . ............................ ........... ...... .... .... ..... ........... has permission to perfonu.................. 5p .... ................................................ ..... ....... ........ wiring in the building of..` --1 4 a L Vvo� ......... .......................................................... �4 ... p 515 ........N *orh Andover,over, M.a..s...s...aFee...5..Lic. No.''t�� RI��T Check # ° �� -1 � cam.. � �-i � b ��. A. _i by Commonwealth of Massachusetts fficial(U�se my Department of Fire Services Permit No. Occupancy and Fee Checked a BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00 (PLEASE PNM WINK OR TYPE ALL ) FORMATION) Date: -3-9-/5 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) -) � ISP w i f ihe Owner or Tenant _ 14?, Y, r t (X O eye (y tp e4e .{ Telephone No. -jlg 7 n - IZ Z, Owner's Address 64 - Is this permit in conjunction with a Tbildingy permit? Yes [0' No ❑ (Chec Appropriate Box) Purpose of Building /V ew e l /Lt? Utility Authorization o. / $ R7 ,1� - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service WO Amps 1 Zp / 2H a Volts Overhead Undgrd ❑ No. of Meters / Number of Feeders and Ampacity /a -U% .. /7 - Location 7 -Location and Nature of Proposed Electrical Work: il/ , . , ri,,.(f t Vl.C1 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 No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ rnd. rnd. o. oEmergency Lighting Battery Units No. of Receptacle Outlets 41 No. of Oil Burners FIRE ALARMS No, of Zones No. of SwitchesNo. of Gas Burners No. of Detection and Initiatin Devices Co No. of Ranges / TotS No. of Air Cond. I Tons 3 No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number .................................................................. Tons KW No. of Self -Contained \ Detection/Alerting Devices No. of Dishwashers f Space/Area Heating KW Local ❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: 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 Wtres. 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 cove age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE Er BOND ❑ OTHER ❑ (Specify:) Icertify, itnder the pains and pen Ities of erjury, that the in or Cation on this application is true and complete. FIRM NAME: , rl( 04tV LIC. NO.: J6 Z18 I� Licensee: (',� Y- 6 JJp y1y- 1C, �- Signature LTC. NO.: (Ifapplicable, enter "exempt" in the license number line), Bus. Tel. No.• o29 q 21 IZ&2 Address: %fit', (✓�� ,� 5 Al, A-f.,)� KIy MA- Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Delfartment 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 Signature Telephone No. PERMIT FEE. $ ��� ❑ 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: --J,, I - Trench Inspection Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass IN l Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: V Date: PARTIAL ROUGH INSPECTION: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTIO Pass 0 Failed EN Re- Inspection Required ($.) ❑ Inspectors Commen s: 4 on Inspectors Signature: Date: FINAL INSPE ON: Pass 0 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com 0— The Commonwealth of Massachuseft M. Department of adustvialAccid&ts Office oflnvestigations 600 Washington Street .Boston, MA 02111 vww.massgov/dza Workers' Compensation Insurance Affidavit: Builders/Contractoro/Eh AvAeant 3hformation -- _-- NaMe (Business/Organiization/Xnd!Wdual): Address: IL �✓ a AL \ S S- City/State/Zip:^A) , 20hone #: q Z 9 q ? q Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. [] Now construction f employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner have lifted the, sub -contractors listed on the attached sheet. 7• El Remodeling ship and'haveno.employees These sub -contractors have S. Demolition ❑ working forme in any capacity. workers' comp. insurance, 5. ❑ We are a corporation and its q. ❑ Building addition [No workers' comp. insurance required.] officers have exercised.their 10.0 Electrical repairs or additions 3.E1 I am a homeowner 4oing all work right of exemption per MGL 11. ❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4), and wehave no 12,❑ Roofrepairs " insurancerequired.] "i employees. [No workers' 1311 Other comp, insurance required.] xAny applicant that checks box#1 must also fill out the section below showingtheir Workers' compensationpolicy information. T'Iiomeowners who submit this affidavit indicatingthey Mie doing allwork 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 ofthe sub -contractors and their workers' comp. policy information. -Taman employer that isproviding workers' eoynueyzsation insurance formy employees Below is thepolley and job site information. Insurance Company Name:_ 111:5 1��n W t r Policy # or Self -ins. Lic. #: Expiration Date: rob Site Address; cL L 2 ► City/State/tip:y— r Attach, a copy of the workers' compensation-poUcy declaration page (showing the policy number and expiration date). :Failure to secure coverage as requiredunder Section 25A of MGL o.152 can lead to the imposition. of criminal penalties of a Ne 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 fns of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do Hereby Bert unor the pains and penallies ofperjury that file information provided above is true and correct. Phone #: Official use onfy..Do not write in this area, to be completed by city or torn official. City or Town: Permit/License # cirAM Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone Information and Instructions Massachusetts General, Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an e�r�ployee is defined as ".-every person tri the service of another under any contract ofhire,• express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the Forex gift engaged in a joint ente rise and including the legal representatives of a•deceased employer, or the gy.l7_J �� 9 g g receiver or to &e- of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having notmore than three apartments and who resides therein, or the occupant of the dwelling house of another who employs poisons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employes." MGL chapter 152, §25C(6) also states that "every state or local lic$nsing 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 b con presented to. the contracting authority." Applicants Please till 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 theircertaticate(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 LL C or LLP does have employees, a policy is required. B e advised thatthis affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit: The affidavit should be returned to the city or town that the application for the. permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensationpolicy, 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 whichwill be used as a reference number. In addition, an applicant that must submitmultiple permit/license applications in any given year, need only submit one affidavit indicating current PORGY information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or town): ' A copy of the affidavit that has been officially stamped or marked by fihe 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 clog license or permit to burn leaves eta.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thole 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 an:d fax Dumber: T.Q CQmmonwaltbL of Moa..ch setEs - Wparbont QfJaduaWal Araoldoaa ofaee OuRvestiga-000u 6b WaSWgton Street Bostans MA 02111 Tool. # 617-7.27-4900 Q 406 ox. 1.8,77-MMSAFE Revised 5-26-05 Fax # 617-727-7749 �.�taSs,g4v�dia I m SUESHE FOLLOWING �T.H M -E -L lk-b A$.T AL:1 E R 0 p A H CK .VS'T H E R, FRAN-5-ts"bl READ L -K G 44 018647 16 2189W1 gE11616: 2 Date........y.... x( .................... TOWN OF NORTH ANDOVER PERMIT FOR WIRING P�-. �P � c �p..r*--- /Cr1� 5 �P R 1 i�!' Thiscertifies that ....................................................................................... c. has permission to perform ......... . .............................. .......... ... .. . ............ wiring in the building of::7..e ... I..t .. ..... vv, --T ...... .......... .. ...... ................. e— orth Andover Mass at j ...................... ......................................................................... t --6 .. . .. .......... �0 > Lic. No. Hl ... V� . .... ... .. , Fee....... ............... ............... ... . . ... .. . .. e INSPECTOR Check # r At-, `-,Q_^ Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Permit No. Official Use Only �2R74 Occupancy and Fee Checked tev. 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 IN HK OR TYPE ALL INFORMATION) Date: j/ - 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 & Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes [�:4' No U (CheckAppropriateBox) Purpose of Building =j IyAL $ i &, r l \ j AH Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service (06 Amps / Volts Overhead R Undgrd ❑ No. of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: w, jq„e, j-� p,•� ,,^y �/tai 5GV'1/`iGP Com letion of the following table may be waived by the Inspector of Wires. I Attach additional detail f desired, or as required by the Inspector of res. ha,stimated Value of Electrical Work: (When required by municipal policy.) Work to Start:/- 3 - 14 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove ge 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 information on this application is true and complete. FIRM NAME:. Z LTC. NO.: Licensee: CL1 his Signature LIC.NO.: l� (If applicable, enter "exempt" in the license number line) Bus. Tel. Address: (q FP,,rncns 0- AAkt"l vW Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) [I owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. — p No. of Total No. of Recessed Luminaires No. of Cell: Susp. (Paddle) Fans Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires AboveIn- Swimming Pool rnd. ❑ rnd. ❑ o. o mergency Lig ting Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Detection and No. of Switches No. of Gas Burners Initiating Devices No. of Ranges Tot No. of Air Cond. Tons No. of Alerting Devices Heat Pump Number Tons KW ........ No. of Self -Contained No. of Waste Disposers P Totals: ....._.......... Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Municipal Other Local ❑ E]Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or E uivalent No. of WaterKW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or Equivalent THER: Wi Attach additional detail f desired, or as required by the Inspector of res. ha,stimated Value of Electrical Work: (When required by municipal policy.) Work to Start:/- 3 - 14 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove ge 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 information on this application is true and complete. FIRM NAME:. Z LTC. NO.: Licensee: CL1 his Signature LIC.NO.: l� (If applicable, enter "exempt" in the license number line) Bus. Tel. Address: (q FP,,rncns 0- AAkt"l vW Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) [I 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 Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass IN V Failed Re- Inspection Required ($.) ❑ Inspectors Comm nts: ` Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass ed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 , www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,,-�1/` UU16 p -p `YWtAI U -,(- Address:- t9 City/State/Zip_ . gem&M Af14- 0IWo4' Phone #: !3 71 `i 7`1 1 ZC2 Are you an employer? Check the appropriate box: 1. m a employer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* VI have hired the sub -contractors 2.m a sole proprietor or partner- listed on the attached sheet. I 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. E] I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no in„ A ance required.] i employees. [No workers' comp. insurance required.] Type of , roject (required): 6. Tew construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. F] Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ Other Amy 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 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. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site iformation. isurance Company Name: olicy # or Self -ins. Lic. #: Expiration Date: )b Site Address: City/State/Zip: Itach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ne up to $1,1500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine F up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ivestigatioQ of the DIA for insurance coverage verification. do hereby certify uncle the painsa d penalt' s of perjury that the information provided above is trite and correct. Ignnature: A „�, �%Date: Official use only. Do not write in ibis 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 #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: evised 5-26-05 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1,$77-MASSAFB Fax # 617-727-7749 www marc ssnv/rlia Date .. �1. C7/G S ... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that .....!`!r�'�K ° has permission for gas installation ............................ in the buildings of ... at .... ? f. .�.. ?`7 ........... , Nort Andover, Mass. Fee. .... Lic. .. ..... G S INSPECTOR Check # /C') b' 66)',r, Installing Company Ad Business Telephone MASSACHUSETTS -,UNIFORM APPL CATION FOR'PERMIT TO DO GASFITTING (P nt or Type) ass. 15aie0 Permit 2 Bull Ing Location (,{� Owner am Type of occupancy a New Renovation p Replacement Plans Submitted: Yes p No ❑ r 3 -I— I Check one: Certificate ❑ Corporation ❑ Partnership ,Q,-vfrm t o. i • i • MM �m mom MMM Fame of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability 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. A liability insurance policy Other type of indemnity ❑ Boni ❑ OWNER'S INSURNACE WAIVER: i am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application valves this requirement Check one: Signature o owner or Owners Agent Owner p Agent ❑ I hereby certlfy that all of the details and Information I have submitted for entereca In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under theper s ued for this applicatto 11 be in complia ce w{th all pertinent provisions of the Massachusetts 5 tate C as Code and Chapter 142 of the C ne I L Type of License: , BY p Plumber a re of L tensed i ber ar Gas Fitter Title ❑ G stet C;ryl7ovrn ter License Number APPROVED (OFFICE USF OTiLY) 0 JOyrr€eYlTtan Check one: Certificate ❑ Corporation ❑ Partnership ,Q,-vfrm t o. INSURANCE COVERAGE: I have a current liability 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. A liability insurance policy Other type of indemnity ❑ Boni ❑ OWNER'S INSURNACE WAIVER: i am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application valves this requirement Check one: Signature o owner or Owners Agent Owner p Agent ❑ I hereby certlfy that all of the details and Information I have submitted for entereca In above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performed under theper s ued for this applicatto 11 be in complia ce w{th all pertinent provisions of the Massachusetts 5 tate C as Code and Chapter 142 of the C ne I L Type of License: , BY p Plumber a re of L tensed i ber ar Gas Fitter Title ❑ G stet C;ryl7ovrn ter License Number APPROVED (OFFICE USF OTiLY) 0 JOyrr€eYlTtan Date .. ....... ..... TOWN OF NORTH ANDOVER • PERMIT FOR GAS INSTALLATION This certifies that ............. ............................. has permission for gas installation in the buildings of ,f ......'..... . �r-� . ..... . /f at .�....TT-?� . �1. , North Andover, Mass. Fee--??.. .. Lic. No. ��5 . ...�......... . /r' r GAS INSP�CT61 ' Check # 624.8 MASSACHUSETTS -UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING [Prinor T ) Mass. Gate /V4' ✓ a -t 1 '.Q Permit # ►, - Building Location / � h// % - ✓7 �`� Owners Name _109/i Id 7o A�'-5 A/py UiF4 / % /; Type of Occupancy YCS/ n . G New. [p Renovation ❑ Replacement Pians Submitted: Yes❑ . No* Inotal" Campany Name BukkAd�lress iness Telephone. BRADFORD PLUMBING & HEATING Lic. #12580 Tel. #(978) 521-0262 P.O. Box 5269 BRADFORD, MA 01835-0269 Name of licensed Plumber OK Gas Fater CS Check other Corporation ❑ . Partnership EJ Firm/Co. 7-G'-AlrZ6 Certilicate -Q5-66 INSURANCE COVERAGE: I two a -.. amity insurance. policy or #s substantial equivalent which nteete the requirements of MGL Ch. 142. Yes N&\0 N yod have des, piease Indicate the type coverage by checking the appropriate box A UW*ty insurance policy 'Othm type nt indemnity ❑ Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Maes. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ SrarMbn of Owner or OWM A Amid I hereby 1=W that all of the details and indomhation I have submitted (Or entered) in above applwation are true and acaffate t�o thth aabest of my --iarowled9e auhd *Ad pkimbahg work aunt irhstal ab= pNf WM unft the permit - #or this Wi fiCabM WIR rrsaffipTiarrce with all pertuherht pwvWons of the Massadu�s State Gas Cade and Chapter 142 of the Laws t3y of License or Gas Fit—w True Gaditter/ 5- . Number ,�YAPPRW�EIi t�Fft�i " _ Joumeyman � , .• W � W m Y Z 41C vi . Q O iy w cc O v ah F' x 0 z o< s o o z �- s o m s errre = _ }O — a. .o c < +e m�� q a .A <;S m a, < o a O b U w:v hi o ham- ac A z < rc z < arc < < o _ ,°o SUB—BS#tT. +` BAS£M£NT ._- ' 1ST FLOOR $ND FLOOR 3RD FLOOD ATN FLOOR STH FLOOR 8TH FLOOR 7TH FLOOR eTH FLOOR Inotal" Campany Name BukkAd�lress iness Telephone. BRADFORD PLUMBING & HEATING Lic. #12580 Tel. #(978) 521-0262 P.O. Box 5269 BRADFORD, MA 01835-0269 Name of licensed Plumber OK Gas Fater CS Check other Corporation ❑ . Partnership EJ Firm/Co. 7-G'-AlrZ6 Certilicate -Q5-66 INSURANCE COVERAGE: I two a -.. amity insurance. policy or #s substantial equivalent which nteete the requirements of MGL Ch. 142. Yes N&\0 N yod have des, piease Indicate the type coverage by checking the appropriate box A UW*ty insurance policy 'Othm type nt indemnity ❑ Bond O OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Maes. General Laws. and that my signature on this permit application waives this requirement. Check one: Owner❑ Agent ❑ SrarMbn of Owner or OWM A Amid I hereby 1=W that all of the details and indomhation I have submitted (Or entered) in above applwation are true and acaffate t�o thth aabest of my --iarowled9e auhd *Ad pkimbahg work aunt irhstal ab= pNf WM unft the permit - #or this Wi fiCabM WIR rrsaffipTiarrce with all pertuherht pwvWons of the Massadu�s State Gas Cade and Chapter 142 of the Laws t3y of License or Gas Fit—w True Gaditter/ 5- . Number ,�YAPPRW�EIi t�Fft�i " _ Joumeyman � , .• W `r F 36 66 0 Au 4L 06 IL 4c IL 3. I - C6 96 a ot vi 62 Am Y 4c 4c 4c o O W Id Date.&-...�Z ... 0.7.. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that ............................................................................................. has permission to perform ....... ....................... wiring in the building of ....... .......""°'' ...1......................................................... ......... /�� nA c at ... ................................................. North Andover, Mass. • ?:50 Fee- ................. Lic. Nof -�'zy ............... . .... ............ a ELECTRICAL INSPE4R' Check # `i a.vuu1ivttwCd/rn uT massachusetts Official Use Only 1 �' Department of Fire Services Permit No. 7pqy BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07) eave blank Y 0 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 W INK OR TYPE ALL INFORMATION) Date: .3 M 1 2 -fib -7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or h r intention to perform the electrical work described below. Location (Street & Number) —T ` Owner or Tenant�h 9. Telephone No. Owner's Address Is this permit in conjunction with a builpu per 't? yes ❑ No `�(Check Appropriate Boz) Purpose of Building_ \"``•�— Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No, of Meters New Service Amps / Volts Overhead ❑ Und d �' ❑ No. of Meters Number of Feeders and Ampacity and Nature of Proposed Electrical Work: No. of Recessed Luminaires INo, of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches No. of Ranges No. of Waste Disposers No. of Dishwashers the No. of Ceil.-Susp. (Paddle) Fans o. of Hot Tubs wimming �0�0k, o. of Oil Burners o. of Gas Burners o. of Air Cond. table maybe waived by the Inspector of Wires. IT' 4 Generators ❑ In- ❑ o. o me: d. Battery Un Space/Area Heating KW No. of Dryers Het No. of water KW No. Heaters No. Hydromassage Bathtubs • 01 KVA KVA ALARMS No. of Zones lvo. or Detection and Initiating Devices Tons otsl No. of Alerting Devices Appliances KW No. of s Ballasts . No. of Motors Total HP Local ❑ iviunicipal Connection Other Security Systems:* No. of Devices or Equivalent Data Wiring: No. of Devices or Equivalent elecommunicanons Wiring: No. of Devices or Equivalent Attach additional detail if desired, oras required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Startk— _ 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 MC BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penaidess ofperjury, that the information on this application is true and complete. FIRM NAME: �� i" LIC. NO.: Licensee: ®� �"�• Signature ft (If applicable, enter "exempt " in the license number line.) LIC. NO.: 10 Address: Bus. Tel. No.• *Per M.G.L c. 147, s. 57-61, security work requires D „ „ Alt. Tel. No.: Department of Public Safety S License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ "j w till -,i The Commonwealth of Massachusem Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r Z www rn iss.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/Piwmbers aDlicant rnfi nn!%f•inn Name (Business/Organization/individual): ,N. Citystate/Zip: : fix-�I�SL .t '\J��"� Phone Are you an employer? Cheek.the appropriate box: I. i' am a • employer with 4. ❑ tam a general contractor and I employees (full and/or part-time).* 2. E3 I am.a.sole proprietor have hired the sub -contractors listed or pmtner- on the attached sheet ship and have no employees These su&contractors have working for me .in any capacity, [No workers' comp, insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. Q I sin a homeowner doing officers have exercised their all work right of exemption per MOL Myself. [No -workers' comp. c. 152, § 1(4),'and we have no insurance required.] -t employees. [No workers' comp. insurance required_] ' e alo Type of project (required: 6. ❑ Now construction 7. ❑ Remodeling 8. Q Demolition 9. ❑ Building addition 10.❑ -Electrical repairs or additions I 1.0 Plumbing repairs or additions 12.[] Roof repairs 1 M .Other "Any applicant that checks bo><# I m Houst also fin out the section below showing their woikerc' 'aompensstion policy cy information. t meowners who submit this affidavit indicating they are doing all wo* Md then hire outside contractors must submit a new affidavit indiosting such. ;Contractors that check this box mustattacdnd an additional sheet showing the name of the sub-contractom and their workers' ebm p. policy information am an employer that is provuCurg workers' compensationinformation. insurance for my. employeeL Below is -the policy and job site Insurance Company Name: �`c>,�A� k) 23r'S _ Policy # or Self -ins. Lie. #:C.C.O I�ZZ�Cx�l �p Expiration Date: Q Job Site Address: City/State2ip: 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 $1,50o.00 a $1,500a day prrn and/or one-year imi $ of up to sonent, as well as civil penalties in the form of a STOP WORK ORDER and a fine ay 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 cerci er th p ' and penalties of perjury that the infnrrnation provided above is troy and correct Si ature: Qf xial use only. Do not write in fhis area, to be completed by city or town of ldaL City or Town: Permit/License # Issuing Authority (circle one): I. 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 ortrustee-of an individual, partnership, association or other legal entity, employing employees. 'However the owner, of a dwelling house having not more thait 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 focal 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 lot compliance with the insurance coverage required." Additionally, MOL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented .to the contracting authority." Applicants Please fill out the workers' compensation• affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es).and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or.Limited Liability Partnerships (LLP) with, no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidentsfor 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' oompensation .policy, please call the Department at the number. listed below. Self-insured companies should enter their self insurance' Iicense number on die' appropriate line. City or Town Officials ' Please be sure that the affidavit is complete and printed iegibly. 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 permittlicense number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense 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 fiA= permits or licenses. Anew affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 as a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA €12111 Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE Fax # 617-727-7744 Revised 5 -26 -QS www.mass.gov/dia . '.. ! ,P �r •� e /`OP's y This certifies that •..... .. . has permission for gas installtion ..f!.....�%f ........... . in the buildings of . .....�................................. . at ... -7. L!... 1V�? '�! ....... , North Andover, Mass. Fee. Lic. No. GAS INSPECTOR Check # % L/� (o 640 Date �.7 ... HORT TOWN OF NORTH ANDOVER DI)II PERMIT FOR GAS INSTALLATION . '.. ! ,P �r •� e /`OP's y This certifies that •..... .. . has permission for gas installtion ..f!.....�%f ........... . in the buildings of . .....�................................. . at ... -7. L!... 1V�? '�! ....... , North Andover, Mass. Fee. Lic. No. GAS INSPECTOR Check # % L/� (o 640 MASSACHUSE'T'TS UNEFORM APPLICATON FOR PERmrr TO DO GAS FITTING (Type or print) Date NORTH ANDOVER, MASSACHUSETTS - Building Logations Z (,/ -/ " " - �'' ' ' " Owner's Name New 0 . Renovation D Replacement IT D�' SUB -BASEMENT BASEMENT 1ST. FLOOR 2N D. FLO O R 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type) Name Address Permit # L� 0 Amount $ �%v�ed�e2 Plans Submitted �siness I e ep one _� -7 Name of Licensed Plumber'or Gas Fitter Check one: Certificate Installing Company 0 Corp. Partner. 13 Firm/Co. INSURANCE COVERAGE I have a current liability Insurance•policy or it's substantial equivalent. YesCheck one: 13 If you have checked Les, please indicate the type coverage by checking the appropriate box No Liability insurance policy 1311" Other type of indemnity D 1 Bond Owner's Insurance Waiver: 1 -am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner � Agent 13 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and install ' n perfo ed under Permit Iss ed for this a plication will be in compliance with all pertinent provisions of the Massachuse S e G ode and apter If of the Ge al Laws. /7 (Title PPROVED (OFFICE USE ONLY) ,,Signature of Licensed P4 mber Or Gas Fitter Plumber I Gas Fitter License Number •b Master C3Journeyman Z w O w a w y Z v w U z d w F z F w � w w v � x o' x � z �siness I e ep one _� -7 Name of Licensed Plumber'or Gas Fitter Check one: Certificate Installing Company 0 Corp. Partner. 13 Firm/Co. INSURANCE COVERAGE I have a current liability Insurance•policy or it's substantial equivalent. YesCheck one: 13 If you have checked Les, please indicate the type coverage by checking the appropriate box No Liability insurance policy 1311" Other type of indemnity D 1 Bond Owner's Insurance Waiver: 1 -am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner � Agent 13 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and install ' n perfo ed under Permit Iss ed for this a plication will be in compliance with all pertinent provisions of the Massachuse S e G ode and apter If of the Ge al Laws. /7 (Title PPROVED (OFFICE USE ONLY) ,,Signature of Licensed P4 mber Or Gas Fitter Plumber I Gas Fitter License Number •b Master C3Journeyman Date. . A TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .433�.. .................... has permission to perform .4�}'/^'f..... plumbing in the buildings of at..:7QQ /. A, .. . ............... North Andover, Mass. Fee3a. Lic. No ... .... ............. PLUMBING INSPECTOR Check ff 7587 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Paint. Type). Mass. Date G► V A • 200 Pecmit # Building Location_ ` l /�'�/J /cYl� Owner's Name4�� A�+ IZ Type of occupancy New ❑ Renovation ❑ Replacement Pians Submitted: Yes ❑ No i FIXTURES Installing Company Name Address But:iness T Name of i.icensed Plumber BRADFORD PLUMBING & HEATING Lic. #12580 Tel. #(978) 521-0262 P.O. Box 5269 BRADFORD, MA 01835-0269 Check one: 1%-Qwporation ❑: Partnership ❑ Finwco. V4r LL Certificate INSURANCE COVERAGE: I have aY rreqt: liabiliity N Oce policy or Its substantial equitvalent which meets the requirements of MGL Ch. 142. If you have checked yes. please indicate the type coverage by checking the appropriate box, 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 142 of the Mass. General Laws. and that my signature on this permit application .waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that an of the details and information i have submitted for entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit ismied for this application writ be in compliance with all pertinent provisions of the Massachusetts State Ptumbamg Chapter 142 of the General taws. try- e of Lm - 'Title - ::. Type of Ucense: Master Journeyman 0 City/Town AP0PO4p tOFFICE USE ONL Veense Number. L� U SIi a .�, � J I a N Z w 4 a Q � U O U b O U O O 0 X 0 CILI) U a p \ 0 ci.� p) orf zoo N Z w 4 a Q 0 I 3 W Z O C=www a u) �w�w m g II Wo MZ a } Q (n ozUIND O it w F n Of W UJ >O QQMF Q L- LLJ00QZw W Za U Ix O mQ �QQW 20 p w >�_ 00o 30~~ zWN~o w Z o_ Q IM W J(nQ ZUpa w Q0W) OQ0m R FQ_ L�] O Qin .QUO¢ m ¢ap N =w o Li M 0 w J W J LLJ ? W i LLJ 0 U= Q Z Q U Q Li wp U W oo Q c= _ 8 m0pw Q c9 F - W U p mQ Z$i�W (n JV}W N J� W ~ Q �Q 0LLJ Z�Z Zi 00 Qf QZZmvj W N 0 N �m p NWWJX Z UJ 0 �Q F- M (n- 0 _j m m W Q 0 d OW Q} a O p J O L� p �' Z U' W= mZ�NU J W <M Q Q W �' Q �W�~ = N J a V W W . 0- < QF-�FQ-F-0 R0 �QZOQ (nLLJ m m w< Zi -0a wX pm QUZwx W J W OZ Nm<00 �(� pWWw0 ~� �_ = O m (n Ul0 wv W0WF- Ymoa� WO F -p UF-�mU g�w J �N (n o O Z MW pF oQJNW 3-iwF-U) �W 30 X2pQF- NZU�w CD Z MM F- N M F - J CL J F J CL J 0 J w Li W Qm 0- O O QQOHU N Qp = W Qp(nF-(n w Qli J Q W O Z W 0 .- N m w I 0 10 rlol ------- r I I ------- N -J r- --� L---- 1 I I I I I r - ---------J L ---- I I I I U � I I I I I I -I I I I I I I V w �V- I I = IIII -� N IIII 1 I I 1 I I 1 , I , NI 1 , I , I , I , I , I , I , I , I , I , I , I , I I I N _ p z e a I�� NY Q a ID ---------------i I O N I N I 0 o a 'off 0 .o v I I VZ I x � I I I I � I U �V- I I = IIII -� N IIII 1 I I 1 I I 1 , I , NI 1 , I , I , I , I , I , I , I , I , I , I , I , I I I N _ p z e a I�� NY Q a ID ---------------i I O N I N I a Q J W 0 Lz Z iE LLJ >0 U LLI mQ I , I 1 1 a e U I x � I I U I a Q J W 0 Lz Z iE LLJ >0 U LLI mQ I'm Iv Q J W 0 LL. Z wD of >0 U W U mQ OW Ho Q W� a Q� oz WW LL.� UU) W D a� moo. V) Q J }. Q Z � Q W Q z � Z Q D clf QO U cn Q z� oZ Wo Z U W :2 W W Qm O Z I I I I I I I I i I I I I �I I I I °I I �I I �I W 0 LLZ WE >o m¢ 0 Li w -E QF- oZ W W U V) W � a� Vo J r gz aQ Li az �z Q z U Z OZ Wo Z U W M W D � W Q m O Z f J� WCC EZ_ r0. jR0 Z W Cc p (-' U W OL � O LL \ \. < U \` W W Ld U) U W j O �J a Q N J O �J W a Z r �Q Z LL - Z< Q OUi Z O w� ~ MW o o� Q Qm o UJ O Z Cj f I t 0 N p O >. z CL �z 0 >o UJ mQa z W oQ o R� w ¢� (Ln, Uw z O L� � ND 0 �O a �r Z Q wQ O �Q o z z0 O O�-Z Z o z ui :2w o p� Q w Qm O H O z N oo o ° p O >. z CL �z 0 >o UJ mQa z W oQ o R� w ¢� (Ln, Uw z O L� � ND 0 �O a �r Z Q wQ O �Q o z z0 O O�-Z Z o z ui :2w o p� Q w Qm O H O z N / L— — — — — — — — — — — — — — — — — — — — / Q � 00, / o�� \ \ \ \ `o \ o N D \ \ L----1L-r-ri ` iii 'F ---------------- \ --- zo 0 0 U a�Q o�1 O UZ O N� H N N W F- O Z p J wZ m— Fr p wQ� >O W CC) m¢ Ow F- p Wg CE ¢ cn F - p z ww m U N W C V) p (n Q J )- < Q w ¢ w p �z Q p(If Qo U V) Q z w O Z NO z U W W p F- < m ¢m z 0- z O Q p Z O L� w U-1 En z O Q O LLZ Z O p z D 0 J Q z O F- 0 O N CD v I rD Cl) ~ N O 0� M505 N N W F- O Z p J wZ m— Fr p wQ� >O W CC) m¢ Ow F- p Wg CE ¢ cn F - p z ww m U N W C V) p (n Q J )- < Q w ¢ w p �z Q p(If Qo U V) Q z w O Z NO z U W W p F- < m ¢m z 0- z O Q p Z O L� w U-1 En z O Q O LLZ Z O p z D 0 J Q z O F- 0 O N I ko o �,NO O z O g J H Z m 3 W O z O J U p Z Q Z O Q U LL. W a. N W D) O m O LLIw W ir P, 0' W L 1 N m p J d Fm -Q W U W O x W C7 NZW>Z � F=- W J Q Q W Z W N O >O w(Uj QNM� Q Ll w 1U- W mQ =w�W Hp=O w > pQZw 302 d LLJ OQ �i(I-F O ZOV�p W O. W wJ(n U Q w a W a�W LL. a W m U R - Z F-O QFC- QVO MX W m 0 OZ� pQa w a_ N =p Q Y Z W uj U O J g w Q O Z W D w p U Q OW ~ W� U w w w p0 = fn W Z= m0pa U U UW O V) Z��N fn JU w N WX F - WW (Q wZW0 U U QZZm(N Q j J O Q Z � J w p cn LL. J a' Z �j Wp ag\W MJpmV) aF" m000=� W m z�W-- Z Q O a Z Q Q~C�mp �J Z O a O a Q wowmm J JW W W Q ~QWL Vi J J v0 U ZO U Q a. WX a. =) L) cn Of m Zm NU 0 1 -J _j LLI 2 m -5 Z Q a J�US`9 9 X W" Z m ui J � J Q _j mWU0�0 mO =Jm00 J = �= (np W Z yJ0M UF -g O J N �N Mw OQJcnw H Q D Q ? p� 3v—�w�t~i� 3a N2L) LLI ap a. Q Jr � -CCL 0 JN J F -=w CL J -j J w Qm QQOF-U Qp QpfnF-(n W QLD Q z w o _ N M c6 Iz z O g J H Z m 3 W O z O J U p Z Q Z O Q U LL. W a. N W D) O m O LLIw W ir P, ®BolseCascade Triple 1-3/4" x 11-1/4" VERSA -LAM® 2.0 2800 DF Floor Beam1FB01 BC CALL® Design Report Dry 1 span I No cantilevers 0/12 slope Sunday, September 14, 2014 Build 3272 File Name: New Col 28x40 Job Name: New Colonial Home Description: Designs\FB01 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 1 st Floor Framing Cautions Member is not fully supported at post BO. A connector is required at this bearing Member is not fully supported at post B1. A connector is required at this bearing Notes Design meets Code minimum (U240) Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1 ") Maximum total load deflection criteria.rBAtAN Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the results. Page 1 of 2 Total Horizontal Product Length = 14-00-00 Reaction Summary (Down / Uplift) ( lbs ) Bearing BO, 3-1/2" Live Dead Snow Wind Roof Live 3,920/0 1,086/0 B1, 3-1/2" 3,920/0 1,086/0 Load Summary Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 1st Floor Load Unf. Area MA L 00-00-00 14-00-00 40 10 14-00-00 Controls Summary Value % Allowable Duration Case Location Pos. Moment 16,393 ft -lbs 63% 100% 1 07-00-00 End Shear 4,127 lbs 36.8% 100% 1 01-02-12 Total Load Defl. 0374 (0.434") 64.1% n/a 1 07-00-00 Live Load Defl. U478 (0.34") 75.3% n/a 2 07-00-00 Max Defl. 0.434" 43.4% n/a 1 07-00-00 Span / Depth 14.4 n/a n/a 0 00-00-00 Bearing SupportS Dim (L x W) Value % Allow Support % Allow Member Material BO Post 3-1/2" x 3-1/2" 5,006 lbs n/a 54.5% Unspecified B1 Post 3-1/2" x 3-1/2" 5,006 lbs n/a 54.5% Unspecified Cautions Member is not fully supported at post BO. A connector is required at this bearing Member is not fully supported at post B1. A connector is required at this bearing Notes Design meets Code minimum (U240) Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1 ") Maximum total load deflection criteria.rBAtAN Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the results. Page 1 of 2 Boise Cascade Triple 1-3/4" x 11-1/4" VERSA -LAM® 2.0 2800 DF Floor Beam1F1301 BC CALC® Design Report Dry 1 span No cantilevers 0/12 slope Sunday, September 14, 2014 Build 3272 Job Name: New Colonial Home File Name: New Col 28x40 Description: Designs\FB01 Address: 79 Hewitt Ave. City, State, Zip: North Andover, MA 01845 Specifier: Floor Support Beam Customer: Designer: KK Code reports: ESR -1040 Company: KDK Design Misc: See 1st Floor Framing Connection Diagram Disclosure �{ b �—d Completeness and accuracy of input must a be verified by anyone who would rely on • • • o o output as evidence of suitability for particular application. Output here based C • �_ • on building code -accepted design properties and analysis methods. e 0 0 o Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide a minimum = 2" C = 6-1/4" or ask questions, please call b minimum = 3" d = 24" (800)232-0788 before installation.\n\nBC e minimum = 3" CALC®, BC FRAMER®, AJSTm, ALLJOISTO , BC RIM BOARDT-, BCI®, Nailing schedule applies to both sides of the member. BOISE GLULAMTm SIMPLE FRAMING Member has no side loads. SYSTEM®, VERSA -LAM®, VERSA -RIM Connectors are: 16d Sinker Nails PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUD® are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 ®Boise Cascade Triple 1-3/4" x 9-1/4" VERSA -LAM® 2.0 2800 DF Floor Beam1F1302 BC CALC® Design Report Dry 14 spans I No cantilevers 10/12 slope Sunday, September 14, 2014 Build 3272 File Name: New Col 28x40 Job Name: New Colonial Home Description: Designs\FB02 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 1st Floor Framing Total of Horizontal Design Spans = 26-03-00 Reaction Summary (Down / Uplift) ( lbs ) Bearing Live BO Dead Snow Wind Roof Live 4,435/526 1,208/0 B1 11,920/0 3,354/0 B2 12,135/0 3,393/0 B3 11,070/0 3,134/0 B4 2,735 / 1,877 265/0 Load Summary Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start 1 1st Floor Load Unf. Area (Ib/ft-2) L 00-00-00 End 26-03-00 100% 40 90% 10 115% 160% 125% 2 2nd Floor Load Unf. Area (lb/ft-2) L 00-00-00 26-03-00 30 10 14-00-00 14-00-00 3 Attic Floor Load Unf. Area (Ib/ft^2) L 00-00-00 26-03-00 30 10 14-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 8,688 ft -lbs 48.3% 100% 2 03-01-03 Neg. Moment -10,957 ft -lbs 60.9% 100% 5 14-02-00 End Shear 4,097 lbs 44.4% Cont. Shear 6,439 lbs 100% 2 00-10-02 69.8% Uplift -1,612 lbs n/a 100% 100% 6 2 21-07-00 26-03-00 Total Load Defl. U999 (0.122") n/a n/a 2 18-02-13 Live Load Defl. U999 (0.101") n/a n/a 8 18-01-09 Total Neg. Defl. U999 (-0.055") n/a n/a 2 10-08-06 Max Defl. 0.122" n/a Span / Depth 10.8 n/a 2 18-02-13 n/a n/a 0 00-00-00 Cautions pop OF Uplift of -1,612 lbs found at span.4 - Right. V Notes MAN A NAyANAUG" Design meets Code minimum (U240) Total load deflection criteria. 871 )MOAL • Design meets Code minimum (U360) Live load deflection criteria. 09.41UI Design meets arbitrary (111) Maximum total load deflection criteria. �J,� �vtoy Minimum bearing length for BO is 1-1/2". Minimum bearing length for B1 is 3-7/811. OMi<L EMS\ Minimum bearing length for B2 is 3-15/16". Minimum bearing length for B3 is 3-5/8". Minimum bearing length for B4 is 1-1/2". Entered/Displayed Horizontal Span Length(s) = Clear Span + 1/2 min. end bearing + 1/2 intermediate bearing McSrle, LLC Calculations assume Member is Fully Braced. Structural DesIgn & Sales Design based on Dry Service Condition. 160 Sylvan Street Deflections less than 1/8" were ignored in the results. �' avers. Mt'. Q1923 Page 1 of 2 Boise Cascade Triple 1-3/4" x 9-1/4" VERSA-LAM(g) 2.0 2800 DF Floor BeamIF13O2 BC CALL® Design Report Dry 14 spans No cantilevers 10/12 slope Sunday, September 14, 2014 Build 3272 Job Name: New Colonial Home File Name: New Col 28x40 Description: Designs\FB02 Address: 79 Hewitt Ave. City, State, Zip: North Andover, MA 01845 Specifier: Floor Support Beam Customer: Designer: KK Company: KDK Design Code reports: ESR-1040 Misc: See 1st Floor Framing Connection Diagram Disclosure b d Completeness and accuracy of input must a be verified by anyone who would rely on • T • • ° T ° output as evidence of suitability for cl particular application. Output here based 1 on building code-accepted design properties and analysis methods. e • • ° ° ° Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide a minimum = 2" C = 4-1/4" or ask questions, please call b minimum = 3" d = 24" (800)232-0788 before installation.lnlnBC CALCO, BC FRAMER®, AJST"' e minimum = 3" ALLJOISTO , BC RIM BOARD-, BCI®, Nailing schedule applies to both sides of the member. BOISE GLULAM- SIMPLE FRAMING Member has no side loads. SYSTEM®, VERSA-LAM®, VERSA-RIM Connectors are: 16d Sinker Nails PLUS®, VERSA-RIM®, VERSA-STRAND®, VERSA-STUD® are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 Boise Cascade Double 1-3/4" x 9-1/4" VERSA -LAM® 2.0 2800 DF Floor Beam1F1303 BC CALC® Design Report Dry 12 spans I No cantilevers 0/12 slope Sunday, September 14, 2014 Build 3272 File Name: New Col 28x40 Job Name: New Colonial Home Description: Designs\FB03 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 1st Floor Framing Total Horizontal Product Length = 26-00-00 Reaction Summary (Down / Uplift) ( lbs ) Live Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 2,003/353 451/0 B1, 3-1/2" 5,759/0 1,573/0 B2, 3-1/2" 2,183/233 533/0 Load Summary Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start End 100% 906/0 115% 160% 125% 1 1 st Floor Load Unf. Area (Ib/ft"2) L 00-00-00 26-00-00 40 10 09-00-00 Controls Summary Value %Allowable Duration Case Location POS. Moment 7,435 ft -lbs 62% 100% 3 20-00-01 Neg. Moment -9,420 ft -lbs 78.6% 100% 1 12-04-00 End Shear 2,229 lbs 36.2% 100% 3 13-03-00 Cont. Shear 3,360 lbs 54.6% 100% 1 13-03-00 Total Load Defl. U346 (0.465") 69.3% n/a 3 19-05-08 Live Load Defl. U410 (0.393") 87.8% n/a 6 19-05-08 Total Neg. Defl. U999 (4124") n/a n/a 3 08-00-04 Max Defl. 0.465" 46.5% n/a 3 19-05-08 Span / Depth 17.4 n/a n/a 0 00-00-00 Bearing Supports Dim. (L x W) Value % Allow Support % Allow Member Material BO Post 3-1/2" x 3-1/2" 2,454 lbs n/a 26.7% Unspecified B1 Post 3-1/2" x 3-1/2" 7,332 lbs n/a 79.8% Unspecified B2 Post 3-1/2" x 3-1/2" 2,716 Ibs n/a 29.6% Unspecified Notes Design meets Code minimum (U240) Total load deflection criteria. +� Design meets Code minimum (U360) Live load deflection criteria. N OF Design meets arbitrary (1 ") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. OFOAN J. Deflections less than 1/8" were ignored in the results. KAVAlNAUGH STPA CWPAL « ,A W. 41 U2 jST StructurcalBD�e t8,, 160 Sylvan $tiggt Danvers, Mh 01923 Page 1 of 2 Boise Cascade Double 1-3/4" x 9-1/4" VERSA -LAM® 2.0 2800 DF Floor Beam\F13O3 BC CALC® Design Report Dry 2 spans No cantilevers 10/12 slope Sunday, September 14, 2014 Build 3272 Job Name: New Colonial Home File Name: New Col_28x40 Description: Designs\FB03 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Code reports: ESR -1040 Company: KDK Design Misc: See 1st Floor Framing Connection Diagram Disclosure �{ b f d Completeness and accuracy of input must a be verified by anyone who would rely on • • • output as evidence of suitability for particular application. Output here based c on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood '� • products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide a minimum = 2" c = 5-1/4" or ask questions, please call b minimum = 3" d = 24" (800)232-0788 before instal lation.\n\nBC CALC®, BC FRAMER®, AJS-, Member has no side loads. ALLJOISTV , BC RIM BOARD-, BCI®, Connectors are: 16d Sinker Nails BOISE GLULAM- SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUDS are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 ®Boise Cascade Quadruple 1-3/4" x 9-1/4" VERSA -LAM® 2.0 2800 DF Floor BeamIF1304 BC CALC® Design Report Dry 11 span I No cantilevers 0/12 slope Saturday, September 13, 2014 Build 3272 File Name: New Col_28x40 Job Name: New Colonial Home Description: Designs\FB04 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 2nd Floor Framing 61 Total Horizontal Product Length = 14-00-00 Reaction Summary (Down / Uplift) ( lbs ) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 2,940/0 1,096/0 B1, 3-1/2" 2,940/0 1,096/0 Load Summary Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 2nd Floor Load Unf. Area (Ib/ft^2) L 00-00-00 14-00-00 30 10 14-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 13,218 ft -lbs 55.1% 100% 1 07-00-00 End Shear 3,424 lbs 27.8% 100% 1 01-00-12 Total Load Defl. U344 (0.473") 69.8% n/a 1 07-00-00 Live Load Defl. U472 (0.34411) 76.2% n/a 2 07-00-00 Max Defl. 0.473" 47.3% n/a 1 07-00-00 Span / Depth 17.6 n/a n/a 0 00-00-00 Bearing Supports Dim. (L x W) Value % Allow Allow Support oMember Material BO Post 3-1/2" x 3-1/2" 4,036 lbs n/a 43.9% Unspecified B1 Post 3-1/2" x 3-1/2" 4,036 lbs n/a 43.9% Unspecified Cautions Member is not fully supported at post BO. A connector is required at this bearing. Member is not fully supported at post B1. A connector is required at this bearing. Notes Design meets Code minimum (U240) Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the results. V Page 1 of 2 ®Boise Cascade Quadruple 1-3/4" x 9-1/4" VERSA-LAMO 2.0 2800 DF Floor Beam1F1304 BC CALC® Design Report Dry 1 span No cantilevers 10/12 slope Saturday, September 13, 2014 Build 3272 File Name: New Col_28x40 Job Name: New Colonial Home Description: Designs\FB04 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 2nd Floor Framing Connection Diagram Disclosure b d Completeness and accuracy of input must be verified by anyone who would rely on a output as evidence of suitability for particular application. Output here based on building code -accepted design c properties.and analysis methods. Installation of BOISE engineered wood 0 products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide a minimum = 2" C = 5-1/4" or ask questions, please call (800)232-0788 before installation.M\nBC b minimum = 2-1/2"d = 24" CALC®, BC FRAMER®, AJSTM, ALLJOBeams 7 inches wide will be assumed to be either top -loaded only, ore equally loaded from BOISE ST®, BCRIMSIMPLE FBOARD" BCIG , p Y� 9 Y BOISE GLULAM SIMPLE FRAMING each side. SYSTEM®, VERSA -LAM®, VERSA -RIM Bolts are assumed to be Grade A307 or Grade 2 or higher. PLUS®, VERSA -RIM®, Member has no side loads. VERSA -STRAND®, VERSA -STUD® are Connectors are: 1/2 in. Staggered Through Bolt trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 Boise Cascade Double 1-3/4" x 9-1/4" VERSA -LAM® 2.0 2800 DF Floor BeamIF13O5 Dry I 1 span I No cantilevers 10/12 slope Saturday, September 13, 2014 BC CALC® Design Report Build 3272 File Name: New Col_28x40 Job Name: New Colonial Home Description: Designs\FB05 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 2nd Floor Framing B1 Total Horizontal Product Length = 14-00-00 Reaction Summary (Down / Uplift) ( lbs ) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 1,890/0 688/0 B1, 3-1/2" 1,890/0 688/0 Load Summary Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 2nd Floor Load Unf. Area (Ib/ft^2) L 00-00-00 14-00-00 30 10 09-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 8,443 ft -lbs 70.4% 100% 1 07-00-00 End Shear 2,187 lbs 35.6% 100% 1 01-00-12 Total Load Defl. U269 (0.604") 89.1% n/a 1 07-00-00 Live Load Defl. U367 (0.442") 98% n/a 2 07-00-00 Max Defl. 0.604" 60.4% n/a 1 07-00-00 Span / Depth 17.6 n/a n/a 0 00-00-00 Bearing Supports Dim. (L x W) % Allow Value Support % Allow Member Material BO Post 3-1/2" x 3-1/2" 2,578 lbs n/a 28.1% Unspecified B1 Post 3-1/2" x 3-1/2" 2,578 lbs n/a 28.1% Unspecified Notes uesign meets Uoae minimum (L1240) Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the results. Page 1 of 2 Mc9d Structural 8 Sales Dan e�MA 01923 ®Boise Cascade Double 1-3/4" x 9-1/4" VERSA -LAM® 2.0 2800 DF Floor Beam1F13O5 BC CALL® Design Report Dry 1 span No cantilevers 10/12 slope Saturday, September 13, 2014 Build 3272 File Name: New Col 28x40 Job Name: New Colonial Home Description: Designs\FB05 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 2nd Floor Framing Connection Diagram Disclosure b d Completeness and accuracy of input must a be verified by anyone who would rely on • • • output as evidence of suitability for particular application. Output here based C on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood ' • products must be in accordance with Page 2 of 2 current Installation Guide and applicable building codes. To obtain Installation Guide a minimum = 2" c = 5-1/4" or ask questions, please call b minimum = 3" d = 24" (800)232-0788 before installation.\n\nBC CALCO, BC FRAMER®, AJSTM, Member has no side loads. ALLJOIST®, BC RIM BOARD-, BCI®, Connectors are: 16d Sinker Nails BOISE GLULAMTM SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUB are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 Boise Cascade Triple 1-3/4" x 16" VERSA -LAM® 2.0 2800 DF Floor BeamkFB06 Dry 11 span I No cantilevers 10/12 slope Saturday, September 13, 2014 BC CALC® Design Report mm— Build 3272 File Name: New Col 28x40 Job Name: New Colonial Home Description: Designs4t06 Address: 79 Hewitt Ave. Specifier: Attic Support Beam City State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 2nd Floor Framing Total Horizontal Product Length = 24-06-00 Reaction Summary (Down / Uplift) ( lbs ) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 2,940/0 1,734/0 B1, 3-1/2" 2,940/0 1,734/0 Load Summary Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Attic Load Unf. Area (Ib/ft^2) L 00-00-00 24-06-00 20 10 12-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 27,570 ft -lbs 54.5% 100% 1 12-03-00 End Shear 4,054 lbs 25.4% 100% 1 01-07-08 Total Load Defl. 0360 (0.8") 66.6% n/a 1 12-03-00 Live Load Defl. U573 (0.503") 62.8% n/a 2 12-03-00 Max Defl. 0.8" 80% n/a 1 12-03-00 Span / Depth 18 n/a n/a 0 00-00-00 Bearing Supports Dim. (L x W) % Allow %, Allow Value Support Member Material BO Post 3-1/2" x 3-1/2" 4,674 lbs n/a 50.9% Unspecified B1 Post 3-1/2" x 3-1/2" 4,674 lbs n/a 50.9% Unspecified Cautions Member is not fully supported at post B0. A connector is required at this bearing Member is not fully supported at post B1. A connector is required at this bearing Notes L-bly, 1 meets wue minimum (UZ4U) I otal load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the results. Page 1 of 2 OF BRIAN J. G KAVANALIGH STi t1CTVFIAt_ Me. 41141 McBrie, LLC St l Design & Sales 160mSylvan StFW Danvers, MA 01923 M Boise Cascade Triple 1-3/4" x 16" VERSA -LAM® 2.0 2800 DF Floor Beam1F1306 BC CALC® Design Report Dry 1 span No cantilevers 10/12 slope Saturday, September 13, 2014 Build 3272 File Name: New Col 28x40 Job Name: New Colonial Home Description: Designs\FB06 Address: 79 Hewitt Ave. Specifier: Attic Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See 2nd Floor Framing Connection Diagram Disclosure b d Completeness and accuracy of input must a be verified by anyone who would rely on • T • • ° ° output as evidence of suitability for T particular application. Output here based C •_ on building code -accepted design properties and analysis methods. e • 0 0 o Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide a minimum = 2" c = 11" or ask questions, please call b minimum = 3" d = 24" (800)232-0788 before installatio0n\nBC CALC®, BC FRAMER®, AJS-, e minimum = 3" ALLJOISTO , BC RIM BOARD-, BCI®, Nailing schedule applies to both sides of the member. BOISE GLULAMTm SIMPLE FRAMING Member has no side loads. SYSTEM®, VERSA -LAM®, VERSA -RIM Connectors are: 16d Sinker Nails PLUS®, VERSA -RIME), VERSA -STRAND®, VERSA -STUD® are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 a Boise Cascade Double 1-3/4" x 11-1/4" VERSA -LAM® 2.0 2800 DF Floor BeamkFB07 BC CALL® Design Report Dry 11 span 1 No cantilevers 10/12 slope Saturday, September 13, 2014 Build 3272 File Name: New Col Job Name: New Colonial Home _28x40 Description: Designs\ tO7 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Mist: See Attic Floor Plan B1 Total Horizontal Product Length = 14-00-00 Reaction Summary (Down / Uplift) ( lbs ) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 2,940/0 1,051 /0 B1, 3-1/2" 2,940/0 1,051/0 Load Summary %AllowSupport Member Material BO Post 3-1/2" x 3-1/2" 3,991 lbs n/a 43.4% Unspecified Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start End 100%° 90% 115% 160% 125% 1 Attic Floor Load Unf. Area (Ib/ft^2) L 00-00-00 14-00-00 30 10 14-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 13,068 ft -lbs 75.3% 100% 1 07-00-00 End Shear 3,290 lbs 44% 100% 1 01-02-12 Total Load Defl. U313 (0.519") 76.7% n/a 1 07-00-00 Live Load Defl. U425 (0.383") 84.8% n/a 2 07-00-00 Max Defl. 0.519" 51.9% n/a 1 07-00-00 Span / Depth 14.4 n/a n/a 0 00-00-00 Bearing Supports Dim. (L x W) Value %Allow %AllowSupport Member Material BO Post 3-1/2" x 3-1/2" 3,991 lbs n/a 43.4% Unspecified B1 Post 3-1/2" x 3-1/2" 3,991 lbs n/a 43:4% Unspecified Notes Design meets Code minimum (U240) Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1 ") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the results. Page 1 of 2 StructuraalBDg & Sales 160�tgStreet 3 . ®Boise Cascade Double 1-3/4" x 11-1/4" VERSA -LAM® 2.0 2800 DF Floor Beam1F1307 BC CALL® Design Report1101-- Dry 11 span No cantilevers 0/12 slope Saturday, September 13, 2014 Build 3272 File Name: New Col_28x40 Job Name: New Colonial Home Description: Designs\FB07 Address: 79 Hewitt Ave. Specifier: Floor Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See Attic Floor Plan Connection Diagram Disclosure b d Completeness and accuracy of input must be verified by anyone who would rely on a • • • output as evidence of suitability for particular application. Output here based c on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood • • products must be in accordance with cM t II urf G 'd Page 2 of 2 ren ns a a ion ui a and applicable building codes. To obtain Installation Guide a minimum = 2" c = 7-1/4" or ask questions, please call b minimum = 3" d = 24" (800)232-0788 before installation.\n\nBC CALCO, BC FRAMER®, AJS-, Member has no side loads. ALLJOIST®, BC RIM BOARD- BCI®, Connectors are: 16d Sinker Nails BOISE GLULAM- SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUD® are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 . ®Boise Cascade Quadruple 1-3/4" x 11-1/4" VERSA -LAM@ 2.0 2800 DF Floor Beam1FB08 BC CALL® Design Report Dry 12 spans 1 No cantilevers 10/12 slope Saturday, September 13, 2014 Build 3272 File Name: New Col_28x40 Job Name: New Colonial Home Description: Designs1FB08 Address: 79 Hewitt Ave. Specifier: Floor/Roof Support Beam City State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See Attic Floor Plan BO 12-04-00 61 13-08-00 62 Total of Horizontal Design Spans = 26-00-00 Reaction Summary (Down / Uplift) ( lbs ) Bearing Live Dead Snow Wind Roof Live BO 4,185/766 1,022/0 B1 12,539/0 3,749/0 B2 4,570/508 1,215/0 Load Summary Live Dead Snow Wind Roof Live Trib. Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Attic Floor Load Unf. Area (Ib/ft^2) L 00-00-00 26-00-00 30 10 07-00-00 2 Roof Load Unf. Area (Ib/ft^2) L 00-00-00 26-00-00 40 10 14-00-00 Controls Summary Value %, Allowable Duration Case Location Pos. Moment 16,728 ft -lbs 48.2% 100% 3 20-02-07 Neg. Moment -21,297 ft -lbs 61.4% 100% 1 12-04-00 End Shear 4,774 lbs 31.9% 100% 3 13-05-00 Cont. Shear 7,301 lbs 48.8% 100% 1 13-05-00 Total Load Defl. U546 (0.3") 44% n/a 3 19-06-15 Live Load Defl. U655 (0.25") 54.9% n/a 6 19-06-15 Total Neg. Defl. U999 (-0.078") n/a n/a 3 07-11-09 Max Defl. 0.3" 30% n/a 3 19-06-15 Span / Depth 14.6 n/a n/a 0 00-00-00 Notes vesign meets c;oae minimum (U240) Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1") Maximum total load deflection criteria. Minimum bearing length for BO is 1-1/2". Minimum bearing length for B1 is 3-1/811 . Minimum bearing length for B2 is 1-1/2". Entered/Displayed Horizontal Span Length(s) 1/2 intermediate bearing Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the Page 1 of 2 Clear Span + 1/2 min. end bearing + results. OF BRIAN J. KAVANAUGH u STAuCTURAL IN. 41112 +� laTEr� Mcorle, LLC Structural Design & Sales 160 Sylvan Street Danvers, MA 01923 • ®Boise cascade Quadruple 1-3/4" x 11-1/4" VERSA-LAM®2.0 2800 DF Floor BeamIFB08 BC CALL® Design Report Dry 12 spans No cantilevers 10/12 slope Saturday, September 13, 2014 Build 3272 File Name: New Col 28x40 Job Name: New Colonial Home Description: Designs1FB08 Address: 79 Hewitt Ave. Specifier: Floor/Roof Support Beam City, State, Zip: North Andover, MA 01845 Designer: KK Customer: Company: KDK Design Code reports: ESR -1040 Misc: See Attic. Floor Plan Connection Diagram Disclosure b d Completeness and accuracy of input must a be verified by anyone who would rely on ut as evidence of for particularapplica on. Output suitability re based on building code -accepted design C properties and analysis. methods. Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide a minimum = 2" c = 7-1/4" or ask questions, please call (800)232-0788 before installationAn\nBC b minimum = 2-1/2" d 24" CALC®, BC FRAMER®, AJSTM', Beams 7 inches wide will be assumed to be either top -loaded only, ore equally loaded from ALLJOISTO , BC RIM BOARDTM BCI® , p Y. Q Y BOISE GLULAM , SIMPLE FRAMING each side. SYSTEM®, VERSA -LAM®, VERSA -RIM Bolts are assumed to be Grade A307 or Grade 2 or higher. PLUS®, VERSA -RIM®, Member has no side loads. VERSA -STRAND®, VERSA -STUD® are Connectors are: 1/2 in. Staggered Through Bolt trademarks of Boise Cascade wood Products L.L.C. Page 2 of 2