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Building Permit #505-13 - 12 ANDREW CIRCLE 1/8/2013
pORTH O�'t'eo 6AN BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION C6 Permit NO: Date Received i 7 �9 oRwTeD'PP��y Date Issued: SSgCHus� IMPORTANT: Applicant must complete all items on this page LOCATIONG � t PH PROPERTY OWNER.. :. Print MAP N0: PARCEL= ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential D New Building ❑ One family D(Addition Ulwo or more family E Industrial D Alteration No. of units: P _ D Commercial repair, replacement D Assessory Bldg D Others: D Demolition €-Other E Septic ,L1 We' ll D Floodplain Q Wetlands r� Watershed District Water/Sewer.,. Rt NAoUt= d Z� P �� �PI✓1v tZIL &ff;'Ie-vim ( tom X i D Identification Please Type or Print Clearly) OWNER: Nai 1e: 3"lt o �Q X1111 �_�, Phone.-q-7S 95D--7y 09 Address: CONTRACTOR Name: Phone: Address: Supervisor's Construction"License: Exp.. Date: Home Improieinent License: Exp. Date: ;I ARCHITECT/ENGINEER Phone: Address: Reg. No. e FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Co t. $ 1 00 FEE: $ -30 ' Check No.: ZA10 Receipt No.: 2 co a'i'l NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner k ,.�- -- Signature of contractor TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page -L®CATI®NL_ _, ___ - _ i �Pnrit� MAP NO' PARCEL m_.__ _. .-- ZONINGS®`IS,tTERICT: _ ___-_ HistOficIDstfcl yesr riot - r _ - i _ Machine,Shop)Vill4ge7 yes) nod TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -- -.-• _. piS_eptic3 ©tWelli { E1•Floodplain �iWetlandsy � Watershed!®istrict? t 0kWN ter/,,Sewerr DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: -QNTRACTO;R� :Name:. _ Phone:. fi . i Add:ress:. Supervisorrs3CorstructonrLcense - - I HomeImpCovement;Lcense iExpo. Date? _ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agentt/Ovvrier Sicinbture.6f.contractor. . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location '12 No. Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee " 0' Foundation Permit Fee $ �• Other Permit Fee $ t .; TOTAL $ Check#4 r 26077 / iuildin—ag Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art E] Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on ISi nature X �kd 0/�— COMMENTS I HEALTH Reviewed on Siqnature I 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 Os ood Street FIRE DEPARTMENT =,Temp Dumpster on site yes. no , . ,Located at-124,Main`;Street ` Fire'Departmentsignature/date ` COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use B Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits j i ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan a Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2012 NORTH Town of t E .F ndove' r O. No. 5D5 11) 4". rh _ ver, Mass, vA el , ?013 coc«ic"IWICK y1. �i9 A�R'�TEO 11V Cl S u BOARD OF HEALTH Food/Kitchen PERMI� T T LD Septic System f -THIS CERTIFIES THAT ...... ...�'���!.e........ 4. e_4.......................... ..................................... BUILDING INSPECTOR has permission to erect ..... buildings on �.�....� .. ,,,,,,,,,,,,,,,,,,,,,,,,,,, Foundation Q �ii .................................... Rough to be occupied as .....�... a I.rdve..........1.... .:.1`:"'...S,.% :�f`!.... :�4�!!:� Chimney provided that the person accepting this permit shall in every respect conform to the terms 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough ............ Service ................... ... .. ..................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 1/7/13 attachment(2592X1456} f fr k0t 4 , 3, .'' n "e+9' ..:_._---'-w_"-- ,._. 5f m» �..•n ii.£9'?%'. 4 '-- =,sem1:' , 3 x e i I - _ v 3 Z C y� t \ ,H. a � https://nail-attachment.googleusercontent.corrVattachment/?ui=2&ik=80cee4a82e&view=att&th=13cl57b9fc5l e570&attid=0.1&disp=inlin... 1/1 Tobut Of littletott 3d3J@ 5-13-I0 Typical Deck Details Package Based on the 8th Edition One and Two Family Dwelling Code guard decking ledger board fasteners existing house floor construction 0 guard post ledger board attachment attachement to existing house 0 rim joist joists O 0 beam post-to-beam connection (flush,tight bearing) footing joist-to-bearn post connection CONTENTS ........................................................................................................................................................... ........................................................................................................................................................... General Notes.................................................2 Ledger Attachment Requirements.................9 Introduction.....................................................2 Prohibited Ledger Attachments................... 11 Joist Sizes........................................................4 Ledger Board Fasteners 11 Beam Size and Assembly Requirements........5 Framing at Chimney or Bay Window.......... 13 Deck Framing Plan.........................................6 Free-Standing Decks.................................... 13 Joist to Beam Connection 7 Lateral Support of Free-Standing Decks ..... 13 Joist Hangers...................................................7 Attachment to House................................... 14 Post Requirements.......................................... 7 Guard Requirements.................................... 15 Rim Joist Requirements.................................. 8 Guard Post Attachments.............................. 16 Footings 8 Stair Requirements....................................... 17 THE USE OF THIS DECK PACKAGE IN LIEU OF SUBMITTED DRAWINGS APPLIES TO SIMPLE SPAN,SINGLE LEVEL,RESIDENTIAL DECKS ONLY. THIS PRESCRIPTIVE PACKAGE MUST BE SIGNED AND SUBMITTED BY THE PERMIT APPLICANT INDICATING ACCEPTANCE OF THE DETAILS CONTAINED HEREIN. A COPY OF THIS PACKAGE MUST BE ONSITE AND AVAILABLE TO THE INSPECTOR DURING THE INSPECTION. AN UNSIGNED DECK PACKAGE WILL RESULT INA PERMIT DENIAL. SIGNATURE OF PERMIT APPLICANT SIGNATURE OF BUILDING COMMISSIONER Pagel INTRODUCTION This package is provided as a supplement attachment to the permit application for a single story open deck in lieu of or in addition to the construction drawings. Before proceeding, always check with the Building Department for land use, zoning, or other regulations that may affect your deck project. When Do I Need A Permit For A Deck? A building permit is required for all decks that are intended to be used in connection with a single or two family dwelling or accessory structures and swimming pools. How Do I Use This Package To Get A Permit? To obtain a building permit for your deck, you will need to submit plans of sufficient detail to the building department as a permanent record of what you want to build. If you are not sure how to draw plans, this package can be submitted to the building department for the permit. You will, however, be required to follow the details as provided without any deviation. In addition, a certified site plan is required showing an outline of your property (property lines), the house, septic system and outline of where you will be locating the deck and how it will appear. Be sure to indicate any additional existing accessory buildings or structures (shed, pool, retaining walls, etc.). Fill out a Residential building permit application, and submit this package (along with your site plan). After the application is reviewed and approved, a permit to construct your deck will be issued. How Big Do The Footings, Beams, And Joists Need To Be? The detail in this package will help you determine how big the footings, beams, joists, posts, and ledgers need to be. Much of it depends on the size of the deck, what size beams and joists you want to use, and how far apart you want to place the beams, posts, and footings. It will help to highlight Tables in this package for later reference during construction. General Notes 1. All lumber shall be grade #2 Douglas-Fir, Hem-Fir, or better and shall be pressure treated (to resist insect and dry rot) in accordance with American Wood-Preservers' Association Standards. Decking material of redwood or cedar does not require pressure treatment as it has a natural resistance to decay. The pressure treatment category below must be identified on the lumber, usually in the form of a tag. The level of treatment depends on the use as follows: • Decking material, railings, joists, and beams must be treated to a Category UC3B. • Posts and other woods located on, in, or in contact with the ground must be a Category UC4B. • Any wood less than six inches above the ground or in contact with concrete must be a Category UC4A. 2. The level of preservative treatment is noted on the tags fixed to the ends of the wood members. Remember, any time you make a cut, treat the cut end of the wood with a paint-on preservative. Cut ends expose the inner untreated wood to potential moisture and insect damage. 3. All nails shall be "common" galvanized or better. 4. New pressure treatment methods use chemicals that will prematurely corrode standard fasteners, hardware, and flashing when in contact with pressure treated lumber; and as a result, fastener and hardware requirements have changed. Note the following: • All screws and nails shall be hot-dipped galvanized or stainless steel. • All hardware (joist hangers, cast-in-place post anchors, etc.) shall be galvanized with 1.85 oz/sf of zinc (G-185 coating) or shall be stainless steel. • Look for products such as "Zmax" from Simpson Strong-Tie or "Triple Zinc" from USP. Page 2 t i 5. Decks constructed according to this handout are not designed to support spas or hot tubs. Installation of spas or hot tubs will require additional structural supports. 6. Decks shall not be attached to house overhangs, bay windows, brick veneers, or chimneys. 7. Deck designs that deviate from the conditions of this handout will require a specific plan submission and may require engineering. 8. Inspections: . A footing, framing, and a final inspection are required on all decks. • 'Footings shall be a minimum depth of 48" on virgin undisturbed soil unless closer than 5 feet from the exterior of the existing house foundation, then the deck footing shall be the same depth as the house footing. Footing inspections are required PRIOR to the placement of concrete. At the time of the footing inspection, the ledger board must be attached to the existing house. Adequacy of connections will 'be verified by an inspector. If a ladder is required to access the ledger board, one must be provided. Framing and final inspections may be combined if all portions of the deck framing and mechanical attachments are at least four feet above grade. It is the responsibility of the permit holder or the permit holder's representative to notify the Building Department when stages of construction are reached that require an inspection. 9. All decking material shall be composed of 2x4, 2x6, or five quarter ("5/4") boards. Attach decking to each joist with two 10d nails or two #8 screws. Decking may be placed from an angle perpendicular to the joists to an angle of 45 degrees to the joists. Decking must have a span length such that each board bears on a minimum of two joists. 10. Plastic or composite decking products may be used as a substitute for conventional wood decking, but installation and span lengths of the substituted material must be in strict conformance with the product listing and the manufacturer's installation instructions. Copies of the manufacturer's installation instructions must be submitted with this handout and permit application. 11. Inspections are required by law. Failure to receive any and all inspections can result in the issuance of violation notices which may lead to legal action. 12. The minimum uniformly distributed live load is 40 pounds per square foot (Massachusetts State Building Code §5301.5) Page 3 1 JOIST SIZE The span of a joist is measured from the centerline of bearing at one end of the joist to the centerline of bearing at the other end of the joist and does not include the length of the overhangs. Joist may overhang up to one-forth of the actual joist span Lj. Use TABLE 1 and TABLE 2 to determine joist span and overhang based on lumber size and joist spacing. See Figure 1, 2 and 3 for joist span types. optional.overhang existing wall --�•-� rim joist joist`hanger beam (flush, ledger beard tight bearing) joist Post ,foist Sparc(Li) TABLE 2 Figure 1: Joist Span —Deck Attached at House and Bearing Over Beam joist existing wall beam" joist hanger joist hanger -4 `Note: beam depth must be equal to or greater than joist ledger board depth if joist hangers are used post Joist Span U Figure 2: Joist Span —Joists Attached at House and to Side of Beam optional overhang optional overhang rim joist rim joist A- beam beam (flush, tight joist (flush, tight bearing) post bearing) post Joist Span (Li)TABLE 2 TABLE 2 Figure 3: Joist Span—Free Standing Deck Page 4 TABLE 1: MAXIMUM JOIST SPAN LENGTH Lj Joist Without Cantilever Joist With Cantilever Joist Joist spacing, on center Joist spacing, on center Size 12" 16" 24" 12" 16" 24" 2 x 8 13'-8" 12'-5" 10'-2" 10'-6" 10'-6" 10'-2" 2 x 10 17'-5" 15-10" 13'-1" 15'-2" 15'-2" 13'-1" 2 x 12 18'-0" 18'-0" 15'-5" 18'-0" 18'-0" 15'-5" Spans are based on 40 PSF live load, 10 PSF dead load, southern yellow pine#2 or better, normal,loading duration, wet service conditions and deflection: D=060 for simple span and t/180 for cantilever TABLE 2: MAXIMUM JOIST CANTILEVER Member Maximum Cantilever Span Size Spacing (Uplift Force at Backspan Support in Lbs.) 2x8 12" 39" (156) 2x8 16" 34" (171) 2x10 12" 57" (189) 2x10 16" 49" (208) 2x10 24" 40" (241) 2x12 16" 67" (260) 2x12 24" 54" (319) BEAM SIZE AND ASSEMBLY REQUIREMENTS Beam size is determined using TABLE 3. Beams may overhang up to one-fourth of the actual beam span between supports as shown in Figure 4 joists above options overhang may occur at each end) ivi ivi ivi w� IAI IAI IAI IAI beam beam splices at interior post, typical post locations Le/4 max. beam span (Ls) beam span (Le) Ls/4 max. overhang overhang Figure 4: Beam Span Types Page 5 TABLE 3: MINIMUM BEAM SIZE Spans are based on 40 PSF live load, 10 PSF dead load, southern yellow pine#2 or better, normal,loading duration, wet service conditions and deflection:A=4360 for simple span and 080 for cantilever with a 230 lb point load. Beam Size Joist Span (2)2x6 (2)2x8 (2)2x10 (2)2x12 (3)2x6 (3)2x8 (3)2x10 (3)2x12 0-6'-0" 7'-1" 9'-2" 11'-10" 13'-11" 8'-7" 11'-4" 14'-5" 17'-5" 6'-1" -8'-0" 6'-2" 7'-11" 10-'-3" 12'-0" 7'-8" 9'-11" 12'-1-" 15-1" 8'-1" - 10'-0" 5'-6" 7'-1" 9'-2" 10'-9" 6-11" 8'-11" 11'-6" 13'-6" 10'-1" - 12'-0" 5'-0" 6'-6" 8'-5" 9'-10" 6'-3" 8'-1" 10'-6" 12'-4" 12'-1" - 14'-0" 4'-8" 6'-0" 7'-9" 9'-1" 5'-10" 7'-6" 9'-9" 11'-5" 14'-1" - 16'-0" 4'-4" 6'-0" 7'-9" 9'-1" 5'-10" 7'-6" 9'-9" 11'-5" 16-1" - 18'-0" 4'-1" 5'-3" 6'-10" 8'-0" 5'-2" 6'-7" 8'-7" 10'-1" The beam is assembled by attaching the members identified in TABLE 3 in accordance with Figure 5. If a beam is constructed with 3-members, attach each outside member to the inside as shown herein --------------------------------- 1611 --------------------- ---------- 16„ I I typical I 10d common nail or 2 common nails or screws at each #10 wood screw; end and at each end of splices; J/1 staggered in 2 rows splices shall be located at interior posts only; see Figure 4 Figure 5: Beam Assembly Detail DECK FRAMING PLANS A framing plan shows the joist and beam layout; the location of the ledger board, posts, and footings, and the type, size, and spacing of the ledger board fasteners. See Figure 6 for an example of a typical deck framing plan. -r r r r r r [ledger board with bolts/saewslanchors Figure 20 J C joist hanger a �po t 2)or 2x joists �3)or [.12x_ beam See Table 1 ~. a, £ 2x rim joist a 0 round or square footing max.L,/4 beam span, Table 3 max.t-s/4 overhan overhan Figure 6: Typical Deck Framing Plan Page 6 JOIST TO BEAM CONNECTION Each joist shall be attached to the beam as shown in Figure 7. Use Option 1 or Option 2 when joists bear on or overhang past the beam; see Figure 1 and Figure 3. Use Option 3 when joists attach to the side of the beam; see Figure 2. Mechanical fasteners or hurricane clips used in Option 2 shall have a minimum capacity of 100 lbs in both uplift and lateral load directions. See manufacturer's recommendations for additional requirements. OPTION 1* OPTION 2 OPTION 3 (3) 8d toe nailed mechanical (2 on one side, fastener or top of beam and joist 1 on the other) hurricane clip �O1St must be at same hanger elevation 00 O O O O 0o O O beam d *Option 1 is prohibited on free-standing decks Figure 7: Joist-To-Beam Detail JOIST HANGERS Joist hangers, as shown in Figure 8, shall have a minimum capacity of 600 lbs for 2x8s, 700 lbs for 2x1 Os joist hanger with inside flanges and 800 lbs for 2x1 2s. The depth and width of the joist hanger shall equal the dimensions of the member it is carrying. Joist hangers shall be galvanized per the ° requirements on Page 2. ° ° Use joist hangers with inside flanges when clearances to ° ° ° ° ° the edge of the beam or ledger board dictate. ° ° ° Do not use clip angles or brackets to support ° framing members. Do not bend hanger flanges to ° ° ° accommodate field conditions. Use only galvanized ° nails or equal as prescribed by the foist hanger manufacturer. Figure 8: Typical Joist Hangers POST REQUIREMENTS All deck posts shall be 6x6 with a maximum height of 14'-0" measured from the top of the footing to the underside of the beam. The beam shall be attached to the post by one of the two — methods shown in Figure 10. Attachment of the beam to the side of the post without notching is prohibited; see Figure 9 The post cap shown in Figure 10, Option 2, shall be specifically designed for(2) 2x or(3) 2x beams and 6x6 posts with a minimum downward allowable load capacity of 5,000 lbs. Attachment shall be per manufacturer's instructions. Post caps shall be galvanized per the requirements on page 2. Cut ends of posts shall be field treated with a wood preservative containing copper naphthenate. Such products can be found in Figure 9: Prohibited Post-To- most hardware or home center stores in the paint department. Beam Attachment Condition Page 7 3-member beams must use post cap post cap; attachment, option (2)2x beam; fasteners per manu- p3ohibedamd from facturer's instructions Option 1 (2)Z'diameter through-bolts 0 JAM beam must bear kith washers o on 6x6 notch 6x6 post; maximum 6x6 post height= 14'-0"; notch post to measure to provide beam underside of beam with flush and to top of footing tight bearing OPTION 1 OPTION 2 Figure 10: Post-To-Beam Connection Options RIM JOIST REQUIREMENTS Attach a continuous rim joist to the ends of joists as shown in Figure 11. Attach decking to the rim joist as shown in Figure 11. For more decking attachment requirements, see DECKING REQUIREMENTS on page 2. secure decking to top of rim joist with joists #10 x 3"minimum wood screw @ 6"o.c.; NAILS NOT PERMITTED • attach rim joist to end of each joist with(5)#10 x 3" minimum wood screws; NAILS NOT PERMITTED;the number of screws may be reduced to 3 if there is no guard D or,when a guard post is installed, its connection is per rim joist Option 1 in the GUARD POST ATTACHMENT details Figure 11: Rim Joist Connection Detail FOOTINGS The concrete for all footings shall have a minimum compressive strength of 2,500 PSI concrete. See TABLE 4 for footing size and footing thickness; see Figure 12 for post attachment options and requirements. Post anchors shall be galvanized per the requirements on page 2. All footings shall bear on solid undisturbed ground; bearing conditions shall be verified in the field by the Building Commissioner prior to placement of concrete. DECK FOOTINGS CLOSER THAN 5'-0"TO AN EXISTING EXTERIOR HOUSE WALL MUST BEAR AT THE SAME ELEVATION AS THE EXISTING HOUSE FOOTINGS. Do not construct footings over utility lines of any kind. Call DIG-SAFE 1-888-344-7233 before you dig Page 8 y TABLE 4: FOOTING SIZE Beam Joist Span, L, Footin Size Minimum Span, LB Square Round Thickness* 0 - 10'-0" 16" 18" 8" 0 - 8'-0" 10'-1" - 14'-0" 16" 18" 8" 14'-1" - 18'-0" 18" 20" 10" 0 - 10'-0" 16" 18" 8" 10'-1" - 14'-0" 22" 24" 10" 12 -0 14'-1" - 18'-0" 22" 24" 10" 0 - 10'-0" 22" 24" 10" 17'-5" 10'-1" - 14'-0" 24" 26" 1 12" I posts must be centered on footing grade � E 1I E ;" footings must bear ~ ' 9 cLU rs on solid round - iv E n T� frost dept . • e • .. per Table 4 pre-manufactured post base with cast-in-place post anchor Figure 12: Post-To-Beam Connection Options LEDGER ATTACHMENT REQUIREMENTS GENERAL: Attach the ledger board, which shall be greater than or equal to the joist depth, to the existing exterior wall in accordance with Figure 14 through Figure 16. When attachments are made to the existing house band board, the band board shall be capable of supporting the new deck. If this cannot be verified or conditions at the existing house differ from the details herein, then a free-standing deck is required. See FREE-STANDING DECKS on page 13. YOU MUST VERIFY THE EXISTING CONDITIONS IN THE FIELD PRIOR TO APPLYING FOR A BUILDING PERMIT. COMPLIANCE WITH ALL THE REQUIREMENTS HEREIN IS CRITICAL TO ENSURE THE STRUCTURAL STABILITY OF YOUR DECK AND THE SAFETY OF YOU AND YOUR FAMILY. SIDING AND FLASHING: House siding, or the exterior finish system, must be removed prior to the installation of the ledger board. Flashing is required at any ledger board connection to a wall of wood framed construction and shall be composed of copper(attached using copper nails), stainless steel, UV resistant plastic or galvanized steel coated with 1.85 oz/sf of zinc (G-185 coating). See Figure 14 for continuous flashing with drip edge. The threshold shall be carefully flashed and caulked to prevent water intrusion due to splashing from the deck or melting snow and ice. WOOD I-JOISTS: Many new homes constructed with wood I-joists, see Figure 13, have a 1" or thicker manufactured engineered wood product(EWP) as the band board that can support the attachment of a deck; see Figure 14. However, older homes constructed with wood (- joists may not have a bandboard capable of supporting a deck. Some may have plywood band boards with a thickness of less than 1". Others may have an I-joist as the band board. In these cases a free-standing deck is required. See FREE-STANDING DECKS on page 13. Figure 13: Wood I-Joist Profile Page 9 exterior sheathing existing house remove siding at ledger stud wall prior to installation continuous flashing With drip edge existing 2x or 1" deck joist minimum EWP band board 2'diameter lag screws or through-bolts with washers, or 2x floor joist •• joist hanger approved wood screws or wood Foist • • a existing 2x ledger board; must be greater foundation wall than or equal to the size of the joist Figure 14: Attachment Of Ledger Board-To-Band Board embed anchors 21' minimum to resist corrosion and decay, this area should • be caulked existing concrete deck joist or solid masonry •' ' wall .� 2"diameter expansion • anchors with washers •. joist hanger 2x ledger board; must be greater than or equal to the size of the joist Figure 15: Attachment Of Ledger Board To Foundation Wall (Concrete or Solid Masonry) embed anchors 3 ' minimum to resist corrosion and • decay, this area should ,• be caulked deck joist existing hollowdiameter masonry wall approved epoxy anchors with washers joist hanger 8" block wall 2x ledger board; must be greater minimum than or equal to the size of the joist Figure 16: Attachment Of Ledger Board To Foundation Wall (Hollow Masonry) Page 10 PROHIBITED LEDGER ATTACHMENTS Attachments to the ends of pre-manufactured open web joists, to brick veneers or chimneys, and to house overhangs or bay windows are strictly prohibited; see Figure 17 through Figure 19. In such cases the deck shall be free-standing. See FREE-STANDING DECKS on page 13. house floor trusses deck deck lad foist rick veneeror overhang masonry or hY chimney window Figure 17: No Attachment Figure 18: No Attachment Figure 19: No Attachment To Open Web Trusses To Or Through Brick Veneer To House Overhang LEDGER BOARD FASTENERS Ledger board fasteners shall be installed in accordance with Figure 20 and the spacing in TABLE 5. Only those fastener types noted herein are approved for use; LEAD ANCHORS ARE STRICTLY PROHIBITED. Adequacy of connections will be verified by the inspector typical spaang E S NO LEAN ANCHORS 0 0 0 5-5" min_ for 2x8 min. 6 5" min_ for 2x10 7-5" min. for 2x1 2 0 0 0 o approved fasteners; stagger in 2 roars Figure 20: Ledger Board Fastener Spacing And Clearances TABLE 5: LEDGER BOARD FASTENER SPACING Joist Span Band Board 0 W-1" 8-1' 10'-1" 12'-1" 14'-1" 16'-1" Fastener 2 to to u to to to to Material 6•-0" 8'-0" 10' 0" 12'-0" 14'-0" 16'-0" 18'-0" Spacina of Fasteners on center 1" EWP 24" 18" 14" 12" 10" 9" 8" Lag Screws 1-1/8'EWP 28" 21" 16" 14" 12" 10" 9" 2x lumber 30" 23" 18" 15" 13" 11" 10" 1" EWP 24" 18" 14" 12" 10" 9" 8" Through Bolts 1-1/ "EWP 28" 21" 16" 14" 12" 10" 9" 2x lumber 36" 36" 34" 29" 24" 21" 19" 1" EWP 18" 13" 11" 9" 8" 7" 6" Approved Wood Screws 1-1/8'EWP 21" 15" 12" 10" 9" 7" 7" 2x lumber 19" 14" 11" 9" 8" 7" 6" Expansion Anchors 36" 36" 34" 29" 24" 21" 19" Approved Epoxy Anchors 32" 32" 32" 24" 24" 16" 16" 'See Sheet 11 for fastener specifications. ZEWP=manufactured engineered wood product;see Sheet 8.for more information. Page 11 Through-Bolts ` Through-bolts shall have a minimum diameter of 1/2". Pilot holes for through-bolts shall be 17/32" to 9/16" in diameter. Through-bolts must be equipped with washers at the bolt head and nut. Expansion Anchors Use expansion anchors when attaching a ledger board to a concrete or solid masonry wall as shown in Figure 15. Bolt diameters of the anchors shall be a minimum of 1/2"; in some cases, this may require an anchor size of 5/8". Minimum embedment length shall be 2-1/2". Expansion anchors must have washers. Approved epoxy anchors may be substituted for expansion anchors; see below for minimum requirements. Epoxy Anchors When attaching to hollow masonry, use one of the approved epoxy anchors listed in TABLE 6 and install as shown in Figure 16. Epoxy anchors shall have a minimum diameter of 1/2" and minimum embedment length of 3-1/2". Installation shall be in strict conformance to the manufacturer's instructions. Epoxy anchors must have washers. Lap Screws Lag screws shall have a minimum diameter of 1/2" and shall be hot-dipped galvanized or stainless steel. Lag screws may be used only when the field conditions match those shown in Figure 14. See Figure 21 for lag screw length and shank requirements. All lag screws shall be installed with washers. Wood Screws The approved wood screws listed in TABLE 7 are similar to lag screws and have an integrated washer. However, no pilot holes are required for installation. The screws shall have a minimum diameter not less than 1/4" and shall be of sufficient length to fully penetrate the existing house band board. Installation shall be in strict conformance with the manufacturer's instructions. TABLE 6: APPROVED EPDXY ANCHORS TABLE 7: APPROVED WOOD SCREWS Manufacturer Product Manufacturer Product ITW Ramset/Red Head Epcon Acrylic 7 FastenMaster Ledgerl-ok Hilti HY-20 Simpson Strong-Tie Strong-Drive Screw (SDS) lag screws must be hot- dipped galvanized or stainless steel only N r screw must penetrate 1-112"shank length must extend through beyond band board a minimum of 1/2" (no threads) existing band board Figure 21: Lag Screw Requirements LAG SCREW INSTALLATION REQUIREMENTS Each lag screw shall have pilot holes drilled as follows: 1) Drill a 1/2" diameter hole in the ledger board, 2) Drill a 5/16" diameter hole into the solid connection material of the existing house. DO NOT DRILL A 1/2" DIAMETER HOLE INTO THE SOLID CONNECTION MATERIAL. 3) The threaded portion of the lag screw shall be inserted into the pilot hole by turning. DO NOT DRIVE WITH A HAMMER. Use soap or a wood-compatible lubricant as required to facilitate tightening. Each lag screw shall be thoroughly tightened snug, but shall not be overly tightened so as to cause wood damage. Page 12 FRAMING AT CHIMNEY OR BAY WINDOW All members at a chimney or bay window shall be framed in accordance with Figure 22. Headers may span a maximum of 6'-0". When a chimney or bay window is wider than 6-0", one or more 6x6 posts may be added to reduce header spans to less than 6-0". In such cases, the post footing must meet the requirements on page 8. Headers with a span length greater than 6'-0" require a plan submission. 1.�V-0"maximum.! decking may extend I I 6"maximum moble joist chimneeyY or / chimnVey bay vrufdow or ane • • Titdger Ward X X ledger Ward double joist, d1le joist double header (2)ledger board fasteners each side hanger,typacal PLAN VIEW SECTION Figure 22: Requirements For Framing At Chimney Or Bay Window FREE-STANDING DECKS Decks which are free-standing do not utilize the exterior wall of the existing house to support vertical loads; instead, an additional beam with posts is provided at or offset from the existing house. THE ASSOCIATED DECK POST FOOTINGS SHALL BE PLACED AT THE SAME ELEVATION AS THE EXISTING HOUSE FOOTING. See Figure 3 and Figure 23. Beam size is determined by TABLE 3. rim joist 001< rim joist joist overhang existing house beam,-- foundation gall posts joists deck footings must be at same elevation as dagional existing house footing bracing Figure 23: Free-Standing Deck LATERAL SUPPORT OF FREE-STANDING DECKS Free standing decks greater than 2 feet above grade shall resist lateral loading and horizontal movement by providing diagonal bracing or by attaching the deck to the exterior wall of the house. Page 13 DIAGONAL BRACING Provide diagonal bracing both parallel and perpendicular to the beam at each post as shown in Figure 24. When parallel to the beam, the bracing shall be bolted to the post at one end and beam at the other. When perpendicular to the beam, the bracing shall be bolted to the post at one end and a joist at the other. When a joist does not align with the bracing location, provide blocking between the next adjacent joists; attach as noted in the figure. provide blocking when joists do no align with posts; attach blocking to joist with 10d nails top and bottom, RM each side; attach diagional bracing to blocking with 3-10d toe nails N N beam 21 beam E L2' joist at post E 2x4,typical (1)3/8"diameter locations through-bolt with washers,typical v _T H H H LJ L BRACING PARALLEL TO BEAM BRACING PERPENDICULAR TO BEAM Figure 24: Diagonal Bracing Requirements ATTACHMENT TO HOUSE Attach the deck rim joist to the existing house exterior wall as shown in Figure 25. The wall must be sheathed with a minimum 3/8" structural panel sheathing. Use lag screws or through-bolts when fastening to an existing band board or wall stud; use expansion anchors or epoxy anchors when fastening to concrete or masonry. LEAD ANCHORS ARE STRICTLY PROHIBITED. DO NOT USE THIS ATTACHMENT METHOD IF A BRICK VENEER IS PRESENT. YOU MUST VERIFY THIS CONDITION IN THE FIELD PRIOR TO UTILIZING THIS METHOD. Fasteners shall be 16" on center and staggered in 2 rows. Flashing over the rim joist is required and must be installed in accordance with the flashing provisions on page 9. exterior sheathing; remove siding at rim joist location prior to installation minimum thickness= ' continuous flashing existing wall stud,band with drip edge board,or concrete or masonry foundation wall fasteners @ 16"o.c. staggered \-2xrimjoist post and beam Figure 25: Attachment To House Lateral Support Page 14 GUARD REQUIREMENTS All decks greater than 30" above grade are required to have a guard. If you are providing a guard when one is not required, it must meet these requirements. All guards shall be constructed in strict conformance with the details herein; any deviations require a plan submission. See Figure 26. 6'-0" maximum spacing so 2x2 pickets; may be placed on 4x4 post,typical rail cap:2x6, 514 board or approved either side of guard DO NOT NOTCH manufactured material 36" - 2x4 top and bottom; minimum may be placed on either side of guard post;attach to post with(2)8d ring-shank nails or(2)#8 wood ® ® screws (2)'"diameter openings shall not allow t e attach pickets at top and through=bolts and passage of a 4"diameter bottom with(1)#8 wood screw washers sphere;wet lumber must be or(2)8d ring-shank nails with a spaced such that when 0.135"nominal diameter shrinkage occurs,the maximum opening is maintained Figure 26: Typical Guard Detail The guardrail shall be designed to withstand a concentrated load of 200 pounds anywhere along its length, and the infill area is designed to withstand a load of 50 pounds on a square foot area. The guard cap may be composed of an approved foreign lumber, plastic or composite material provided the product has an approved evaluation report from an accredited testing laboratory which has listed the product. For a list of approved materials, go to the website below. The evaluation report must be on the jobsite and available to the inspector during the inspection process. Guard post shall not be notched. See Figure 27. do not notch 9 post ost at deck connection Any guard wholly comprised of a pre-fabricated wood, plastic, composite or manufactured guard system purchased from a home center store, lumber company or similar will require a plan submission. ONLY THOSE SYSTEMS LISTED BY AN ACCREDITED TESTING AGENCY SUCH AS ICC-ES EVALUATION REPORT ARE APPROVED FOR USE IN LITTLETON MASSACHUSETTS. For a list of approved products, go visit the website below. Figure 27: Prohibited http://www.icc-es.org/ Notching At Guard Post Page 15 centerline of guard post i2"minimum , (2)2"diameter through-bolts and I c washers E CV , outside joist or rim oist 2"minimum Figure 28: Guard Post Attachment Detail GUARD POST ATTACHMENTS Guard posts may be attached to the inside or outside face of the rim joist. See Figure 28 for attachment detail. Guard posts forwards which run parallel to the deck ioists (side of deck) Shall be attached to the outside-joist shown in Figure 29. However, in this condition, and in addition to the attachment requirements shown in Figure 11, the rim joist must be fastened to the next adjacent joists with 20 gage stud tie plates attached per the manufacturer's instructions with hot-dipped galvanized or stainless steel fasteners. Stud tie plates must be galvanized with 1.85 oz/sf of zinc (G-185 coating) or shall be stainless steel. Look for model number SP1 in a Zmax coating from Simpson Strong-Tie or model number SPT22 in a Triple Zinc coating from USP. i at first interior bay, ;provide 2x blocking a guard posts;toe nail with 10d nails top and bottom, each side i stud tie-plate guard post outside-joist guard stud tie- post plates outside-joist SECTION blocking PLAN VIEW Figure 29: Guard Post To Outside Joist Detail Guard posts for guards which run perpendicular to the deck ioists (rim ioist) Use one of the options shown in Figure 30 and Figure 31 to attach a guard post to a rim joist. See Figure 11 for rim joist-to-deck joist and decking-to-rim joist attachment requirements. Page 16 r I guard post I stud tie plate stud tie plate guard post 1 joist I *; rim joist rim joist joists SECTION PLAN VIEW Figure 30: Guard Post To Rim Joist Detail, Option 1 attach 2x4 to post with 2-8d nails or 2-#8 wood 4--fl,I screws, typ. attach blocking to joist wit I 6-#10x3" min.wood screws at each end I 2-1/2"rN attach per bolts 2x blocking rimjoist details rim joist rim joist joist beyond SECTION PLAN Figure 31: Guard Post To Rim Joist Detail, Option 2 STAIR REQUIREMENTS STAIR GEOMETRY: Stairs shall be a minimum of 36" in width as shown in Figure 40. Tread, riser and nosing dimensions, opening limitations and tolerance minimums shall meet the requirements shown in Figure 32. Treads may be framed with 2x lumber or 5/4 board. An approved manufactured material may be substituted provided the construction is within the product limitations listed in its evaluation report. See Decking Requirements on page 2 and Evaluation Report on page 15 for more information. Risers may be framed with 1x lumber minimum. STAIR STRINGERS: Stringers shall be 2x12s cut to meet the stair geometry requirements shown in Figure 32 and Figure 33. Solid 2x1 2s stringers may be substituted, but for 36" wide stairs only. All stair stringers shall be spaced a maximum of 18" on center, as shown in Figure 34. Stairs that are equal to 36" in width and have 2x tread material may be framed with two stringers, either sawn or solid. Page 17 riser may be open, but S hall not allow the passage of a 4" diameter 9" minimum sphere tread width i 84" maximum riser; height f shall not deviate from one another by more than 8" riser tread 33" - 1d" nosing; nosing shall not deviate from one another by more than$" Figure 32: Tread And Riser Detail All stringers shall not exceed the horizontal span length shown in Figure 33. If the stringer span exceeds the maximum limit, a 4x4 post may be provided to support the stringer and shorten its span length. The 44 post shall be notched and bolted to the stringer with (2) 1/2" diameter through-bolts with washers per Figure 10, Option 1. The post shall be centered on a 12" diameter or 10" square, 4"thick footing. The footing shall bear 24" below grade, and the post shall be attached to the footing per Figure 12. An intermediate landing may also be provided to shorten the stringer span; see page 18 STAIR LANDINGS. s C=3 V-----J ------J maximum span= $"-6" maximum span = 16'-6" SAWN STRINGER SOLID STRINGER Figure 33: Stair Stringer Requirements STAIR LANDINGS: If the total vertical height of a stairway exceeds 12'-0", then an intermediate landing will be required. All intermediate stair landings shall be designed and constructed as a free-standing deck using the details herein. The width of each landing shall not be less than the width of the stairway served. Every landing shall have a minimum dimension of 36" measured in the direction of travel and not less than the width of the stairway served. Page 18 attach tread material with(2)#8 screws or,(2) 8d nails per board at each stringer or ledger 36"only tread tread stringer stringer---w- N (�18"max. 18"max. I 2x4 ledger, each side,full depth of tread;attach with (4) 10d nails or#8 wood screws SAWN STRINGER SOLID STRINGER Figure 34: Tread Connection Requirements 6'-0"maximum between posts stair guard is required for stairs with a total rise more than 30"or more;see GUARD REQUIREMENTS guard post for more information stair guard height: . , provide blocking between stair 34"measure from i stringers at guard post nosing of step locations,toe nail with 10d nails top and bottom,each side o triangular opening shall not permit the passage of a 6" diameter sphere Figure 35: Stair Guard Requirements sloped joist hanger; see ,701ST HANGERS for more requirements Figure 36: Stair Stringer Attachment Detail Page 19 i i i s��i i 11fiR•�iR1�i!�1 1�i 1iY� • •. •• • RfifiOf�1f1 a�i s sfi i i��•i Rei P•iQ t•{••••1s••1{1t•t•atlt• ♦t1.1.1.♦♦.f{!•!.♦f.YR•.1 ♦••.••��a l.lMlii1f1Y11l11. s 1 • 'i iii•Y i•10i sfiii i 1�00�..... 9 .•.•.••••a••11sY•••. 4111�iiii.lf l••f•l11....•.1.♦ :�•.:•�ti••1111•R1.11l1tf.1 ♦111.1RR1•.•1.1.•YY♦ 1 `1 � rti;���a i�iiiiiis iiiii•'�OiiiO 40 O:�f'! 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The light switch shall be operated from inside the house. However, motion detected or timed switches are acceptable. w � L handrail all stairs and landings handrail shall must be illuminated, return at each J see STAIR LIGHTING end REQUIREMENTS 6"min.stair width Figure 40: Miscellaneous Stair Requirements Page 21 STAIR FOOTING REQUIREMENTS: Where the stairway meets grade the stair stringers shall bear on a 4" concrete pad minimum or attach to 44 posts as shown in FIGURE 42. The pad shall be sized such that all stringers have complete bearing on concrete and do not come in contact with the ground. cut post at bottom tread elevation when no stair guard is required stair stringers shall bear on — stair concrete pad and not come stringer 2- 112" diameter in contact with the ground through-bolts 0 with washers 44 post 4 ;11 ;;r 4"concrete 10"square or pad minimum 12"' round,4"' frost depth OPTION 1 thick footing OPTION 2 Figure 41: Stair Stringer Bearing At Grade It is the responsibility of the permit holder or the permit holder's representative to notify the inspector when the stages of construction are reached that require an inspection. Inspection requests may be made using one of the methods listed below; please have your permit number available when scheduling an inspection. Page 22 1/7/13 Gmail-Fwd: Fwd: Fwd: Message from Scan from Konica 360 s ; Fwd: Fwd: Fwd: Message from Scan from Konica 360 Matt Dick <madick@comcast.net> Sun, Jan 6, 2013 at 11:59 AM To: Roland Bernier<zoningzar.rjb@gmail.com> Cc: Danielle Bernier<dbemier450@gmail.com>, Alexis Winnell <awinnell@yahoo.com>, Rahat Mama <rahatmama@gmail.com>, David Chavous <david.chavous@wilmerhale.com> Hi Roland, The Board has reviewed your plan (attached) and confirmed it does not go against the continuity of the back of the units and is allowable based on our review of the Association documents. Please consider this email as our approval to remove the existing 8 X 8 deck and build the replacement 10 X 10 deck. Per our conversation, you plan to put up a mock up of the new railing design, please let us know when you have this so we can view it and provide feedback. Thanks, Matt ----- Original Message ------ Subject:Fwd: Message from Scan from Konica 360 Date:Tue, 20 Nov 2012 09:47:15 -0500 From:Danielle <dbemier450 cr gmail.com> To:Madick@comcast.net Hi Matt, Here are the plans my dad drew up for my new deck. Thank you. Danielle Sent from my iPhone Begin forwarded message: From: Roland Bernier<zoningzar.rjb@gmail.com> Date: November 20, 2012, 7:13:42 AM EST https://mail.google.com/mail/?ui=2&ik=80cee4a82e&view=pt&search=inbox&th=l3c1OcdbOe9beb23 1/3 3= µoar a,doAVN OF NOR TO T$ANDOVER - ° OFFICE OF s BUILDING DEPARTMENT 600 Osgood Street Building 20,-Suite 2-36 y,�SsHus�c�5 North Andover,Massachusetts 01845 Gerald A.Brown Inspector ofBuildings Telephone(97e)688-9545 HOMEOWNER-LTCENSE EXENlpTION Fax (978)688-9542 BUIDING PERMIT•APPLICATION Please print - DATE- :JOB ATE_JOB LOCATION: 01 �r�c� �1 Number Street Address Map)'Lot oMEOWNER • r �- Name. Home Phone ���� ' • Work Phone PRESENT MAILING ADDRESS Zip Code aThe current exemption for thomeowners"was extended to h-lclude owner-occdpied dwellings to t4vo units or less and allow such homeo�vers to engage an individual-for hire who does not possess a license,provided That the owner acts as supervisor). State Building (Code Section 108.3.5.1) DEFINITION OF HOMEOWNER Persons)who Qwas a parcel of land on which he/she resides or intends to reside,on which(here is,oris intended to be,a one or two family structures. A person who constructs more that one home in a which there Orio-d shall not e considered a homeowner. The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other Applicable codes,by-laws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Forth Andover Building Department minimum inspection procedures and requirements and that he/she will comply with,said procedures and requirements, HOMEOWNERS SIGNATURE APPROVAL,OF BUILDING OFFICIAL, Revised 7.2009 Form Homeowners Exemption BOARD OF APPEALS 689-9541 CONTSERVATION 688-9530r' HEALTH 688-9540 PLANNING 688-953i 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 V f' n Please Print Le0b Xly Name (Business/Organization/Individual): , ban[f,1LP_ &eriq(-r Address: City/State/Zip: >0i M4 OW 5Phone#: ,X 9'7'�7- �8 5 a - :]qD Are you an employer?Check the appropriate box: Type of project(required): .❑ I am a employer with 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors El am a sole proprietor or partner- listed on the attached sheet. ? E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. Y p t3'• 9. uilding addition [No workers'comp.insurance 5. ElWe are a corporation and its required.] officers have exercised their 10. Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions. yself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other .ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. im an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site formation. surance Company Name: dicy#or Self-ins.Lid.#: &-::_ Expiration Date: b Site Address:_ City/State/Zip: "- fach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a LC 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ✓estigations of the DIA for insurance coverage verification. 'o hereby certt&under the pains �andpenaltiess ofpnerjury that the information provided /above is true and correct. .nature: Date: one#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 (N tic 2 DN��t I E LLE SE4:?.'N 2xg i a F.TI O l .ST TI', AD ! `r 1:)EGk LESS I-O?E'v--A � �o FRofi� GSR D� Y ` l/�L _P' 't" toast ?`Y 4 � 6 x�o F`�T-•RIE V5ED t-P GUA RI-77R.-P,I L -SEE __ .. 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