Paper Tools has been tested with several Avid CNC machines connected to Mach 4 version 2.0.5036 or Centroid with CNC12.
To be sure your graphics system is capable of running Paper Tools, open Google Chrome and navigate to this URL: chrome://gpu/
You should see Hardware Accelerated for most status. If not, Paper Tools may not work correctly.
You also need a video camera, extension cable and some way to mount it facing downward so it moves along with your CNC spindle.
A working printer is helpful to print your paper tools, but not necessary.