Loading...
HomeMy WebLinkAboutBuilding Permit # 6/22/2016 V%ORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION m � � a Permit No#: � � Y Date Received „,,,,�° ��.� � �q�aZarea ��CbOUS Date Issued. G' IMPORTANT:TAI° T: Applicant must complete all items on this page _ Wl- f r l, Al, r �,e, .. M rpt" ' ' LOCATION Y/ ��'"�" � � Prin PROPERTY OWNER 1r• Print 100 Year Gtr c re yes no f PARCEL: ^m MAP �m�� BONING DISTRICT: _Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential _ Non- Residential ❑ New Building K One family RAddition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial _ ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r "Al /io /„ S tNc„ ❑,Well ❑ Flood Iain q Wetlands ,,,,, p ❑ Watershed Dtstnct//i . ' . /f ri ;r r r / ! ,r r r r / DESCRIPTION OF WORK TO DE PERFORMED: Identification- Please'Type or Print Clearly OWNER: Name: ,., . . . � b ,G° µ � :: „ ; Phone: < m .. 14­. x Address: ! . .a�.,� ,w Contractor Name: Phone Email: Address .. L ` ` � 4 �� � � � 01,52 ! Supervisor's Construction License: 3 " k Exp. ��¢. .. Date: Horne Improvement License: i c;,) i t Exp. Date: ',zJ o)J ARCHITECT/ENGINEER w...°._........ Phone: _._._. Address: ° Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �:� � �.I M FEE: $ Check No.: _ /� Receipt No.: NOTE: Persons contracthii vitla unregistered rz � c�' rs do not haveccess o the guaranty fund f t antractar r ------------------------------- Plans Submitted Ll Plans Waived El Certified Plot Plan F1 Stamped Plans 0 TYPET ' or 'Pl� YPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art F1 Swiluming P0013 El W011 El Tobacco Sales ❑ Food Packaghig/Sales El Private(septic tardc,etc. E] Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ' PLANNING & DEVELOPMENT Reviewed On Signature_& X COMMENTS - ndc f�,enO 5_,KQ Al CONSERVATION Reviewed on Sigi nature A Aq-d' V V COMMENTS (',j 3 EALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No:_------_Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street EDE t t FIREr,'DEPARTMENT -Temp, Dumpster on s no , site yes Located at 1,24 Main'Street ir P Fire PDepaf"l"M'en't' sinature/date COMMENTS IAORTH Town ofq f ��' ndover ® ® h ver, Mass, 'je. CW ;I a 1 O LAIKII COCNICM@ WICx Q 0 �•9 °RArED S U BOARD OF HEALTH Food/Kitchen PF. �RMIT T LD Septic System THIS CERTIFIES THAT ... ® ® ,, ,,,,,, ,, ,,,, ,, BUILDING INSPECTOR .1.. ...... .... .... ....... .......... ...... ........ ........................ ......... .. ..... Foundation has permission to erect .......................... buildings on ......... ... ........................................ Rough to be occupied as ... . .......Ax.-R.0...... .. ,. . ... .. . .. ..®....,o........ ........... ....................... Chimney provided that the person accepting this permit shall in every respect conform to the arms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS .. . . ..... Rough Service .. . 4BUIiLD�71N��S�PEC�T&. Final GAS INSPECTOR Occupancy Permit Required t® Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. FRANCIS A. HEBB CONSTRUCTION CO.,, INC. DESIGN/BUILD CONTRACTOR CONSTRUCTION MANAGEMENT AND CONSULTING Residential,Commercial Building& Renovations Construction Supervisory License#033217 Home Improvement License#107916 CONTRACT TO BUILD 70 Lake Shore Road, Boxford, MA 01921-1115 Shop (978) 352-6123 Fax (978) 352-5068 Cell (978)423-6637 RESIDENTIAL CONTRACTING AGREEMENT Designated Registrant's Name: FRANCIS A.HEBB Registration Number: 107916 This agreement is made on_June 14, 2016`(date) between FRANCIS HEBB of 70 LAKE SHORE ROAD, BOXFORD, MA 01921 (978) 352-6123 hereinafter called "Contractor" and Alison Hayward and Michael Wadanoli (Owner) of 41 Ferncroft Circle, North Andover, MA 01845 hereinafter called "Owner". 1. DETAILED DESCRIPTION OF WORD TO BE PERFORMED Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following: Build 20' x 20' 2-story addition with full basement and bulkhead. 2x6 frame construction, vinyl siding. First floor family room, 2nd floor master bedroom and walk-in closet. Hardwood floor on first floor, carpet on 2nd floor and the in bathroom. Install bath fixtures supplied by owner. Renovate existing bedroom to new master bathroom. New forced hot air furnace and a/c. New on-demand gas hot water heater. New electrical subpanel in new basement. New vinyl windows with exterior vinyl siding and asphalt shingle roof to match existing porch roofing. Electrical —Basement- 1 — l 00amp subpanel in basement; 2 lights in basement First Floor — 8 electrical outlets; 1 cable outlet; 1 ceiling light; I exterior door light; I exterior outlet; wire gas fireplace; 6 4"recessed lights and l dimmer switch Second Floor — 7 electrical outlets; 1 ceiling light; 1 closet light w/switch; 1 cable outlet; 5 4" recessed lights in bedroom and 2 4" recessed lights and 1 switch in closet Bathroom— I vanity location w/switch; 1 GFI outlet; 16"shower light w/wall switch; I Panasonic light fan unit w/wall timer Price does not include smoke detectors or transfer switch for generator. Price does not include any plumbing fixtures or parts for installation and painting. Price does not include gas fireplace or installation of fireplace. Price does not include permits, labor to obtain permits, and required Town inspections. These costs will be added to the next payment. II. PRICE Contractor agrees to do all work described in Section I for the total price $121,457.00. III. PAYMENT Payment will be made as follows: $17,800.00 due upon demo siding, dig foundation hole and pour foundation and install bulkhead, $18,400.00 due upon completion of deck frame; 1 st floor walls, 2nd floor deck, and foundation backfilled, $11,400.00 due upon completion of framing on 2"d floor walls, ceiling and roof, $11,700.00 due upon completion of roofing, windows installed and siding, $18,225.00 due upon completion of rough plumbing and electrical, $14,065.00 due upon completion of insulation,plaster, $15,520.00 due upon completion of interior finish, trim, tile floor, finish plumbing and electrical, $12,200.00 due upon completion of finish floor, hardwood and carpet, and the remaining $2,147.00 upon completion verification of the work by Owner and Contractor as having been satisfactorily completed, which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment (advance deposits) of more than one-third of the total contract price or the total amount of all deposit or payments which the contractor must make, in advance,to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is geater. IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified here in writing. Contractor will begin the work on June 15, 2016 and completion is scheduled for October 28, 2016. The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED The Contractor may not require payments to be made in advance of the times specified in Section III (Payment) above for the reason that he deems himself or the payments to be insecure. If, however,he deems himself to be insecure,he may require, as a prerequisite to continuing the work described herein, that the balance of the payments under this contract that are in the control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. VI. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself,his employees or his subcontracts in the performance of,or as a result of, the work under this Agreement. Contractor agrees to carry insurance to cover such damage or inj ury. VII. SUBCONTRACTING Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third party, Contractor is responsible to Owner for completion of all work described in a timely and worlunanlike manner. VIII. CONSTRUCTION RELATED PERMITS The following construction related permits will be necessary in order to complete the scope of work included in this Agreement: Building, Plumbing, Electrical and HVAC (Price does not include permits, labor to obtain permits and required inspections). The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. Notice: If the homeowner obtains his own construction related permits for the work described under this agreement, the homeowner is hereby advised that in the event of a dispute,judgment and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. IX. MODIFICATION This Agreement, including the provisions related to price (Section 11) and payment schedule (Section III) cannot be changed except by a written statement signed by both Contractor and Owner. X. CONSTRUCTION CHANGE ORDER Construction change orders will consist of any change to the original scope of work, such as hidden conditions and changes requested by Owner. These conditions may require adjustment in the overall price and time frame to complete the necessary work related to this Agreement. In such case the Contractor shall inform the Owner of such conditions forthwith and when necessary a written amendment to this Agreement will be negotiated and executed by the Contractor and Owner. XI. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of one year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct,replace, or cause to be remedied, repaired or replace such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed upon work. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment,which shall be and are hereby passed through directly to the Owner. Under such manufacturers'warranties,the Owner may be required to register or mail in a warranty card or other evidence of workmanship and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. This warranty gives the Owner specific legal rights, and Owner may also have other rights which vary from state to state. XII. COMPLETENESS OF AGREEMENT FOR EXECUTION The Owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. XIII. COPY OF AGREEMENT TO BE GIVEN TO OWNER It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time of execution. No work under this Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy thereof. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Owner Signature) >,� Date Signed C (Contractor's Signature) Date Signed (p 1 ���� Level,20'joil I plece(s)9 1/2" THO 230 @ 12" OC Overud Length,2W All locations are measured from the outside(ice of left support(or left cantilever end).All dimensions are horizontal. Design Resu _lts Actual @ Location Allowed Result LOP Load:(1,nintil nation(Pattern) Systern Floor Member Reaction(lbs) 416 @ 4 1/2" _1185-(350-) Passed(29/.) 501.0 L(All O D+ 1.0 Spans) Member Type joist Shear(lbs) 401 @ 5 1/2" 1330 Passed(3011/6) 1.00 1.0 D+ 1.0 L(All Spans) Building Use:Residential _� _ lvlornent(Ft-lbs) 1915 @ 10' 3330 Passed(58%) 1.00 1.0 D+ LO L(All Spans) Building Code:IBC 2009 Live Load Den.(in) 0A09 @ 10, 0.481 Passed(L/565.) 1.0 D+ 1.0 L(All Spans) Design Methodology ASD Total Load Dell.(in) 0.573 6q i7O 0.962 Passed(L/103) 1.0 D+ 1.0 L(All Spans) TI-Pro'"Rating 36 30 passed Deflection criteria:LL(L/480)and TL(L/240). Bracing(Lu):Ali compression edges(top and bottom)must be braced at 41 8 118"o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing Is required to achieve member stability. A structural analysis of the deck has not been performed. Deflection analysis is based on composite action with a single layer of 23/32"Panel(24"Span Ratting)that is glued and nailed down, Additional considerations for the TJ-Pro"'Rating include:1/2"Gypsum ceiling,1x4 Flat strapping. Roaring Length Loads to Supports(flus) Floor Supports Total Available Required Dead L Total Accessories 1-Stud wall-SPF 5.501, 4.25" 11751, 120 300 420 1 1/4'Rim Board 2-Stud%vall-SPF 120 - 300 420 1 1/4"Rini Board -Rini Board is assumed to carry all loads applied directly above it,bypassing the member being designed. Dead d Floor Live Loads Location(Side) spicing (0.90) (1.00) Comments I-Uniform(PSF) a to 20, 121, 1210 30.0 Residential-Living -Areas o' G r J�r"d J Weyerhaeuser Notes Weyerhaeuser warrants that the sizing of Its products will be in accordance with Weyerhaeuser product design criteria and published design values. Weyerhaeumar expressly disclaims any other warranties related to the software,Refer to current Weyerhaeuser literature for installation details. (wwY;,wood1bywy.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction,The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project,Products manufactured at Weyerhaeuser facilities are third.-party certified to sustainable forestry standards,Weyerhaeuser Engineered Lumber Products have been evaluated by ICC ES under technical reports ESR-1153 and ESR-1387 and/or tested in accordance will)applicable ASTM standards. For cut-rent code evaluation reports refer to I)ttp://www,woocibywy.com/service,,/s_CodeR(?I)orts,;)Spx. The product application,Input design loads,dimensions and support Information have been provided by Forte Software Operator ;'A'NW, v! 6-13-16 rt°"Y iu e i REScheck Software Vers.or�i 4°5.0 m������� 0��� ��� ������ ��`��m��������������� n�+��� � � ��� ��� � ����� �m�m��� �L� � ����� �Lm�� Project Energy Code: 2009 1ECC Location: North Andover, Massachusetts Construction Type: Single-family Project Type: Addition Climate Zone: 5 (6322 1-111313) Permit Date: Permit Number: Construction Site: Owner/Agent: Des|gneil[ontracLur: «l FerncmftCi/z|o Michael VVadanp|iAlison Haywood Francis Hebb North Andover, MA 01845 41 FemcmftO/c|a FA Hebb Const. Co.. Inc. North Andover, MA 01845 70 Lake Shore Rd 978-314-5I54 Boxford, MAOl92z 978-423'0637 pmncisHebb@gmaiicom C-111 11. 179F!' The%Better orWorse Than Code Index reflects how close mcompliance the house/°based"ncode trade-off rules. uDOES NOT provide"oestimate o/memvuse"'cost relative m°mm/m"w-c^uehvme. Ceiling 1- Flat Ceiling Or Scissor Truss 400 38.0 0.0 0.030 12 Wall z: VVuoa Frame. /5^ nz. 1.005 21.0 0.0 0.057 46 Window I: Vinyl Frame:oouWePane with Low-E 157 0300 47 Door I: Glass 33 0300 lU Floor z: All-Wood jnisVTmss:OverUnconditioned Space 400 38.0 0.8 0.826 zU Compliance Statement: The proposedbuilding design described his consistentwith the bUilding plans, specifications, and other calculations submitted with the permit application,The proposed building has been designed k`meet the ZVo9 |ECCrequirements in REScheokVersion 4.5.8and tocomply with the mandatory requirements listed inthe nE5checkInspection Checklist, C 0� REScheck, Software Verslori 4.5.0 Inspectmon Checki "st Energy Code: 2009 IECC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the User in the REScheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. a►iVe i 'F"Ield'Verified # re-Inspection/p a I W PI" s I► Valti I►ec V comr)IIes'? Comments/Assumptions & ReqAD s(;ai6W P I I Revie 103.2 Construction drawings and ElComplies [PR1]1 documentation demonstrate E)Does Not 4 energy code compliance for the E]Not Observable building envelope. E]Not Applicable 103.2, Construction drawings and ElComplies 403.7 documentation demonstrate E]Does Not [PR31' energy code compliance for EINot Obsery,able lighting and mechanical systems. Systems serving multiple E]Not Applicable dwelling units Must demonstrate compliance with the commercial code. 403,6 Heating and cooling equipment is Heating: Heating: ElComplies [PR2J2 sized per ACCA Manual S based Btu/hr Btu/hr— E]Does Not on loads per ACCA Manual J or E]Not Observable Conlin g: g:Coolin other approved methods. Btu/hr Btu/hr E]Not Applicable Additional Comments/Assumptions: 1 (High impact(Tier 1) 12 Medium Impact(Tier 2) 3 Low impact(Tier 3) Project Title: Report date: 06/09/1.6 Data filename: Untitled.rck Page 2 of 8 12.009 IEC".:C". f'ouinIdation In I-peactioul C Cornine*nts/Assurription 11 303.2.1 A protective covering is installed to OComplies [FO11]2 protect exposed exterior insulation Oboes Not and extends a minimum of 6 in. below []Not Observable grade. ONot Applicable 403.18 Snow-and ice-melting system controls OComplies [FO1212 installed, ODoes Not ONot Observable ONot Applicable Additional Corrnments/Assumptio"S: 1 �I-Iigh Impact(Tier 1) 1 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Report date: 06/09/16 Data filename: Untitled.rck Page 3 of 8 1 1 11-ligh Impact (Tier 1) 2 I Medium Impact(Tier 2) 13 1 Low Impact(Tier 3) Project Title: Report date: 06/09/16 Data filename: Untitled.rck Page 5 of 8 Section plans Ver value ifieci Fra1ir71✓erifieri Insolation Inspection Complies? C:ontmetits/Ass ttrnp�tions t� Fkc�ci.ii) 1✓altre 303,1 All installed insulation is labeled ❑Complies [IN13)2 or the installed R-values ❑Does Not A, provided, ❑Not Observable ❑Not Applicable 402.1.1, Floor,insulation R-value. R- R- ❑Complies See the Envelope Assemblies 402.2.5, ❑ Wood ❑ Wood ❑Does Not table for values. 402.2,6 ❑ Steel ❑ Steel ❑Nat Observable [IN1]1 ❑Nat Applicable 303.2, Floor insulation installed per ❑Complies 402.2.6 manufacturer's instructions, and ❑Does Not [IN2]1 in substantial contact with the kA) underside of the subfloor. ❑Not Observable ❑Nat Applicable 402.1.1, Wall insulation R-value. If this is a R- R- ❑Complies See the Envelope Assemblies 402.2.4, mass wall with at least 1/1 of the E1 Wood (.J Woad ❑Does Not table for values. 402,2.5 wall insulation on the wall ❑ puss ❑ Mass [IN3]1 exterior, the exterior insulation ❑Not Observable 0 Steel E] Steel ❑Not Applicable requirement applies. pp 303.2 Wall insulation is installed per ❑Complies [IN4]1 manufacturer's instructions. ❑Does Not ❑Nat Observable ❑Not Applicable 402.2.11 Sunroom wall insulation has a R- R- ❑Complies [IN8)1 minimum R-value of R-13. New ❑Does Not if , walls separating the sunroorY7 from conditioned space must ❑Not Observable meet code requirements. ❑Not Applicable 303.2 Sunroom wail insulation installed ❑Complies [IN9]1 per manufacturer's Instructions. ❑Does Not ❑Not Observable ❑Not Applicable 402.2.11 Sunroom ceiling minimum R- R- ❑Complies [IN10]1 insulation R-value of R-19 in ❑Does Not Climate Zones 1-4, and R-24 in ❑Not Observable Climate Zones 5-8, ❑Nat Applicable 303,2 Sunroom ceiling insulation is ❑Complies [IN11]1 installed per manufacturer's ❑Does Not instructions. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 1High Impact(Tier 1) 2 (Medium irrrpact(Tier 2) 3 (Low Impact(Tier 3) Project Title: Report date: 06/09/7.6 Data filenarne: Untitled.rck Page 6 of 8 _ _.. .. ' r"t orfr p➢ar far°ifi r� fBia lcl VerrfiecR # final Inspection Provrs�ions Complies? + ��rr�rrrer�t�/Assr�r�r ticar�s & Reg.1D 1/altr¢ _ �Jaltre 402.1.1, Ceiling insulation R-value. Where R- R- ❑Complies See the Envelope Assemblies 402.2.1, > R-30 is required, R-30 can be ❑ Wood [] Wood ❑Does Not table for values. 402.2.2 used if insulation is not Steel ❑ Steel ❑Not Observable [Fill' compressed at eaves, R-30 may be used for 500 ft2 or 20'/0 ❑Not Applicable (whichever is less) where sufficient space is not available. 303.1.1.1, Ceiling insulation installed per ❑Complies 303.2 manufacturer's instructions. ❑Does Not [FI21' Blown insulation marked every 300 ft' ❑Not Observable ❑Not Applicable 402.2.3 Attic access hatch and door R-__ R-_ ❑Complies [F131' insulation >_R-value of the ❑Does Not Q, adjacent assembly. ❑Not Observable ❑Not Applicable 402.4.2, Building envelope tightness ACH 50 _ACH 50 ❑Complies 402.4.2.1 verified by blower door test result ❑Does Not [F1171' of<7 ACH at 50 Pa.This �r requirement may instead be met ❑Nat Observable via visual inspection, in which ❑Not Applicable case verification may need to occur during Insulation Inspection. 402.4.3 Wood-burning fireplaces have ❑Complies [F1812 Basketed doors and outdoor ❑Does Not combustion air. ❑Nat Observable ❑Not Applicable 403,2.2 Post construction duct tightness cfm cfm ❑Complies [F141' test result of{58 cfm to outdoors, []Does Not or-12 cfm across systems,Or, rough-in test result of 56 cfm ❑Not Observable across systems or:s4 cfm El Not Applicable without air handler. Rough-in test verification may need to occur during Framing Inspection. 403.1.1 Programmable thermostats ❑Complies [Flg]' installed on forced air furnaces. ❑Does Not uk' ❑Not Observable ❑Not Applicable 403.1.2 Fleat pump thermostat installed ❑Complies [FI1012 ort heat pumps. ❑Does Not a, ❑Not Observable ❑Not Applicable 403.4 Circulating service hot water ❑Complies [Flll.]2 systems have automatic or L1 Does Not accessible manual controls. []Not Observable ❑Not Applicable 403.9.1 Readily accessible switch on ❑Complies [171121' heaters for swimming pools, ❑Does Not ❑Not Observable ❑Nat Applicable 403.9.2 Timer switches on pool heaters ❑Complies [Fllg]3 and pumps are present. (_]Does Not ❑Nat Observable ❑Not Applicable 1 1 Fligh Impact(Tier 1) � 2 Medium Impact('T'ier 2) � 3 1 Low Impact(Tier 3) Project Title; _._Report date; 06/09/16 Data filename; Untitled.rck Page 7 of 8 _ f t�larry Ir�cafreei ... aelcl/ave,lrrefie, .. Ccarw7plies: Ccsr�rnrs,r�t*s/A,,... �...... ......._. sucficrw ## Final ins ect1on Pr vi siot ssurr� t �sr�s kSa F'Cec.if) 403.9.3 Heated swimming pools have a ❑Complus [F120]3 cover. Covers on pools heated ❑Does Not over 90"F are insulated to R-12, ❑Not Observable ❑Not Applicable 404.1 50%of lamps in permanent ❑Complies [F16]1 fixtures are high efficacy lamps. ❑Does Not , ❑Not Observable ❑Nat Applicable 401.3 Compliance certificate posted. ❑Complies [FI7]2 ❑Does Not ❑Not Observable ❑Not Applicable 3033 Manufacturer manuals for ❑Complies [F118]3 mechanical and water heating ❑Does Not equipment have been provided. ❑Not Observable ❑Not Applicable AdditionalComments/Assumptions: 1 (High Impact (Tier 1) 2 �Mediurn Impact(Tier 2) 3 Low Impact(Tier 3) Project Tilde: Report date: 06/09/:16 Data filename: Untitled.rck Page 8 of 8 " 01"Y) IECC Energy E ff il d C e rti'�f'I c a t e MCIMMIMENIMMOMMUMM Wall 21.00 Floor 38.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): Window 0.30 Door 0.30 CCEM M:. MOM Heating System: Cooling System: Water Heater: INEMMIMMMMINIMMEMINIMM Name: Date: Comments The Commonwealth of masssachusetts Department of Industrial Accidents X Congress Street,Suite 100 =' F Boston,MA 02114-2017 www.rnass.gov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electridans/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name ominess/Organization&dividual): ri�,, Com)'� Address: `UD City/State/Zip: a > Phone,l#: q Tk-$2.y,-- Gto 3'7 Are you an employer?Check tfie aj proprlate box: Type o£project(7;equired): 1.41 am a employer with employees(full and/or part-time).* 7. E]New construction 2.[]1 am a sole proprietor or partnership and have no employees working for me in 8. [1 Rema deliti g any capacity.LNo workers'comp,insurance required] 3.Q I am a homeowner doing all work myself(No workers'comp.Jusurance required.]t §. 0 Demolitiom 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 n Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 1 .Q Plumbing repairs or additions S.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.tJ Roof repairs These sitb-contractors have employees and hava workers'comp.insurance. 6.Q We are a corporation and ifs officers have exercised their right of exemption per MGI,e. 14.0 Other 152,§1(4),and Wo have naqgplayees.[No vrorkers'comp,insurance requited.] *.Any applicant that checks b6x4l must also fill out the section below showing their workers'compensation policy information. t Homeowners who sfibraif Jl is affidavit indicating they are doing all work and than hire outside contractors iAust submit anew affidavit indicating such. tContractors that check this box must•aWhed an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-conlraciors Piave employees,%ey must provide their workerscgmp.po4c.y number. I'ain an employer that is p' vidlhg works rs'compensation insurance for my employees.'-below Is the policy and job site information. Insurance Company Name: T6 - Policy##or S elf-ins,Lie.#: N-. - (65 7 Expiration Date: 'Z lzrkc, Job Site Address: 41 T7-- City/State/Zip: ► xA-, Apic6-+,� vt1,, OLSs�� Attach a copy of the workers'cbmpe:psation 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 tine 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 DTA,for insurance coverage verification. X do hereby certyy under thepains andpenaldes ofpeijury that the information provided above is true and correct Signature• /l. Ila Date: e.1111W Phone#: 9Z&-423--6(o 3-1 Of,octal use only. Do not sprite 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 fnspector 6.Other Contact Person: Phone#: AC R © TI LIABILITY'a tl INSURANCE DATE(MMIDDIYYYY) i06/09/2016 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 pollcy(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 04298-001 Branch 4298-1 BKM Inc dba Cross Insurance Peabody -A1C,Wo.Ext): (978)532-5445- ------- 139 Lynnfield Street Ste 210 EEMAIL -- _ _ Peabody, MA 01960 ADDRESS:_— -------_- -- -- -_- --- ------ —.T r INSURER A• /a.LM. MUtuai InSUrance Company i 33758 NSURED (Francis A Hebb Construction Inc ITISI�[tER C:----- ----- 70 Lake Shore Rd INSURER D_ Boxford, NIA 01921-1115 ----------------_.__ _II—^ INSURER E:--- -- —---------- -�----- - -------- 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. Ng pp Lg�g --- pLL'' yy Pp��cy�p LTR — TYPE OFINSURANCE_.- - IN�f2IINS POLICY NUMBER IMM/DDN :.(FAM/DDIYY_YYl LIMITS — -- - GENERAL LIABILITY i EACH OCCURRENCE $ DAMAGElORENTED' -----. _ COMMERCIAL GENERAL LIABILITY j I $ . I - I CLAIMS-MADE f OCCUR i I j MED EXP(Any one person) $ PERSONAL RADV INJURY GENERAL AGGREGATE ;$ SENI AGGREGATE LIMIT APPLIES PER: I PRODUCTS COMP/OP AGG $ -- RO- _ - -- -- -- POLICY pr LOC AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT- $ ANY AUTO f BODILY INJURY(Per person) S ALL OWNED SCHEDULED - — - — -- - AUTOS AUTOS BODILY INJURY(Per accident)I$ HIRED AUTOS NON-OWNED i j j PROPEf2YY DAMAGE AUTOS I {Perccidentj $ UMBRELLA LIAB i OCCUR 'EACH OCCURRENCE S EXCESS LIAB CLAIMSMADE I AGGREGATE g i DED C - RETENTION $ -- gANNyD ERM�PPLRO�Y�ErRpS�P`�IpIgAaBTILNQETRY/ E Y I N A OFFICERRNEMBER EXCLURED? CUTIVE -N NIA) AWC-400-7006999-2016A 7/2812016 71261201 S E L EACH ACCIDENT i$ 1 ------.CO- (Mandatory in NH) ..I E.L.DISEASE I!i - ---- -E- A EMPLOYEEr;$ - 100000.00 DCsRIs [ON uOer 1 OPERATIONS below E L DISEASE POLICY LIMIT ------ 600,000.00 - 1 -----. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover 1600 Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE North Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety. Board of Building Regulations and Standards License: CS-033217 Construction Supervisor � FRANCIS A HEBB 70 LAKE SHORE ROAD j BOXFORD MA 01921 nn ,, l� ' �,,,� Expiration: Commissioner 03/26/2018 a\ Office of consumer Affairs&Business Regulation DOME IMPROVEMENT CONTRACTOR Type — egistration: 107916 private Corporation x p i rati o n: 8/10/2016 FRANCIS HEBB CONSTRUCTION Francis Hebb U 70 Lake Shore Rd Boxford,MA 01921 Undersecretary