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Building Permit #431-15 - 127 Campion Road 11/4/2014
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 13)- 6 Date Received d �� Date Issued: l IMPORTANT:Applicant must complete all items on this page a LOCATION;z T ri t' ;'PROPERTY�OWNERt. 1�`t 1/ i �, u Pring1 o0�Year�Old Structure yes MAP=:NO Y PARCEL ZONING;DISTRICT° HistonDe stnct' ye§i YNlachineShop Village' yes; TYPE OF IMPROVEMENT PROPOSED USE .Residential Non- Residential -KNew Building K One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well �, , _ ❑'Floodplain ❑Wetlands µ =Watershed bistrict .« ', .. r r ater%Sewer DES RIPTION OF WORYO BE ERWRMED: ft44^ L-7 a Sal( Gar �e 'r i�r✓� � �'���r _ Be".1 7f_:O�J JV da, Identification Please T��YYpe or P ' Clearly) OWNER: Name: r�iT✓`ey Jeer S Phone: Address: ;CONTRACTOR`Name' r' Tli � /���i! fwd i��,gFPfione9 7 Vi777 t: .� � .. Address /byoh 7c)� 1de �$r k lkc .r ?G ;;"� : y s � `Trot#'.-. - ' Y?t k.ti:....hA ;Supervisor s Con_structlon License C�;S': ©St Z ��a. Exp��,Date 4 �i=7:�2� ,�'�-�3, 4 - 'x _ '" JT N •"}r+ -'F ij} f i w 75 M.. �� A„y Y ,� -eT.r Sf '..L {,i Y i ~.. Home improvement License ARCHITECT/ENGINEER �.� �� G S Phone.- (9-2� �� G�� - Z� J � Address:-S-? 9/q ?QA F"-�P V � ScirS" 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: $ S go, 000 ; FEE: $ lc� Check No.: Receipt Receipt No.: `�– ' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/OWner Signature of contractor Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans .:. Location-P f �9/�/ ./Ah 1 "` No. ./ Date ! f / f i f . . • TOWN OF NORTH ANDOVER 0 t 4 __ Certificate of Occupancy $ b Buildin /Frame Permit Fee $ - , `� _ � 3 Foundation Permit Fee $ ~I Other Permit Fee $ �; � " �.. TOTAL $ . :: I:.:: aft �, F:.. Check# L : I .I.... ..... .:: :.I...�,.��.a..- ,:�.::� :,.- �. -, ��41z:�� , ! . - Building Inspector .:. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/BodyArt ❑ 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 APP OVED CANNING & DEVELOPMENT ❑ VV ACOMMENTS 12ry v CONSERVATION Reviewed on 1 b N Si nature "�L- A COMMENTS /,-C- C �a HEALTH Reviewed on Signature COMMENTS +- cam- ,Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes `-f lanning Board Decision: Comments Conservation Decision: Comments - W t Water & Sevuer Connection/Si nature D`rive�w/ayPermit G' PW Towo ]Engineer: Signature: Located 384 Osgood Street FVRE DEPARTMENT - Temp Dumpster on site yeas no Lgcated at U4:Mairj Street Fire Depai�tmer #signature/date COMMENTS NORTfi Town of ndover O yr 0 No. 451 5 t - oL^K1 h ver, Mass, It4 [OCNK NlWKK �1. X1,95 RATED U BOARD OF HEALTH Food/Kitchen PERMIT T LDSeptic SystemJl/// THIS CERTIFIES THAT ............ -..�ki '� ........ 4/1..�.fiR.'. ....... ....... .,.,................ BUILDING INSPECTOIR has permission to erect ... V .. -5 /C,,,/ C " � p ....................... buildings on .I ........ 1!!!►. .r :�!1......... ...,....... /-1/7 Rough to be occupied a .. {,e/. �. ...... .*s ........an.. .�...�.... ... Chimney provided that the person accepting this permit shall in every respect conform to the terms a 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 MT ELECTRICAL INSPECTOR Colo C::w UNLESS CONSTRUCTI A 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. 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 D Notified for pickup - Date i Doe.Buildinab 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 o 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 DOTE: 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 ❑ Workers Comp Affidavit a 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) a Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: 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 NOTE: 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 app;al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm'Ated with the building application Doc: Doc.Bui!ding Permit Revised 2012 ACORD CERTIFICATE OF LIABILITY INSURANCE ioiii2o) PRODUCER (978)373-S623 FAX (978)S21-27S1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ANTHONY & MALCOLM INSURANCE AGCY., INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3 SO. CENTRAL ST. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR BRADFORD, MA 01835 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Century Builders, Inc. INSURERA Nautilus Insurance Company PO Box 907 INSURER& Acadia Insurance Methuen, MA 01844 msURERc: Western Surety Company INSURER D: Hanover Insurance INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !NSR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE PODATE(MMIDUM LICY EXPIRATION LIMITSGEKERAL LIABILmr NN419602 04/01/2014 04/01/201S EACH OCCURRENCE $ 1,00-0,000, X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S S0,0001 CLAIMS MADE FX OCCUR MED EXP(Any one person) $ S'Oool rA PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE 8 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s include POLICY I JECT LOC AUTOMOBILE LIABILITY AWN3298646 07/25/2014 07/25/2015 COMBINED SINGLE LIMIT 3 ANY AUTO (Ea accident) 11000,000 ALL OWNED AUTOS BODILY INJURY $ D X SCHEDULED AUTOS (Perperson) X HIREDAUTOS BODILY INJURY $ X NON OWNED AUTOS (Per accident) PROPERTY DAMAGE E (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSAJMBRELJA LIABILITY EACH OCCURRENCE S OCCUR FiCLAIMS MADE AGGREGATE $ S DEDUCTIBLE E RETENTION S S WORKERS COMPENSATION AND WC202000016806 08/16/2014 08/16/2015 X WAR sTATU- o R EMPLOYERS'LIABILITY E L EACH ACCIDENT S ZOO OOO B ANY PROPRIETORIPARTNEWEXECUTNE OFFeFttCEWMEMBEREXCLUDED? EL DISEASE-EA EMPLOYE $ 100,000 SPECIALdescribe PROVISIO S below E.L.DISEASE-POLICY LIMIT S S00,00 rtTr"EeRet opening Bond - 22168722 03/30/2014 03/30/2015 $S,000 Cwn of Methuen DESCRf ON OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS eneral Contracting CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of North Andover 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Building Department BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Osgood St. OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. No. Andover, MA 01845 AUTHORMDREPRESENTATIVE Frederick Malcolm 3r./JA ACORD 25(2001108) FAX: (978)688-9S42 ©ACORD CORPORATION 1988 j i' l Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-051254 srt GLENN T SABA 8 BRUSHWOOD DR ° Atkinson NH 038$1 r Expiration Commissioner 04/17/2015 " w 196.E W CP TOP FNDT. C ��g -179.0 35622. 3 a � LOT AREA ��, o m' o f 43,647 S.F. o' EXISTING ° FOUNDATION K 15265 ,��. J 20• o• ^w Hs?�oo h^ O S 268 �63o�S No/'38'O6"W '8' 111.11' 41 NA� — — \p•`fl -unuTY SENT 105.00 N87'38'06"W PROPOSED `Y0 4�6 00• DRIVEWAY EASEMENT .00' X47.12 1 HEREBY CERTIFY THAT THE LOCATION OF THE STRUCTURE SHOWN ON THIS PLAN WAS DETERMINED BY A FIELD SURVEY, CONFORMS TO THE SETBACK REQUIREMENTS OF THE ZONING REGULATIONS AND IS NOT LOCATED IN A FLOOD HAZARD AREA. REG. PROF. LAND SURVEYOR Of CERTIFICATION PLAN #107 CAMPION ROAPSD R D NORTH ANDOVER, MASS. /J\andover GOODWIN Prepared for consultants 90� 9°•48130 io F FG/STER� S� DIMITRIOS SARAGAS Inc. ss/ONg1LA�pS�Q SCALE: 1"=40' December 8, 2014 1 East River Place, Methuen, Mass. P:\10\10-03.1\DWG\CERT.DWG Scott A Kelloway, P.E. Professional Civil and Environmental Designs and Inspections. 148 North St. Andover,Ma. 01810 Phone: (978) 682-5054 Cell (978)479-5648 e-mail: skellowaype@yahoo.com Ma. Lisc #40122 October 30,2014 To whom this may concern, This letter is to confirm that applicant for the project located at 107 Champion Rd. in North Andover has retained my services as Erosion Control Monitor as required in the Order of Conditions Special Condition #46, +#47(DEP File No. NACC#126(local filing)). Please contact me at the numbers listed above with any questions or concerns. kincerely, way,PE �bl� The Commonwealth of Massachusetts - Department of IndustrialAccidents Office of Investigations IV 600 Washington Street Boston,MA.02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please /Print /Lep-ibly Name(Business/Organization/Individual): lJ/e.4A T, Address: Ao &Y, 9o--7 - City/State/Zip: o`-7City/State/Zip: !"l E'_`r�4 i.,st , Mi Q/NYPhone -70-2 ' Are you an employer?Check the appropriate box: Type of project(required): 1.[0I am a employer with 3 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have Hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• F1 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition wonting for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised they 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill outthe section below showing their workers'compensation policy information. i'Homeowners who submit this affidavit indicating they 2're doing all work 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 of the sub-contractors and their workers'comp,policy information. lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. AcddL Insurance Company Name:. U ti( �1,S�lL(,fivtCC' Policy#or Self-ins.Lic.#: W C.2 (- 0 00 Q y 6 Expiration Date: Elal Z o 15— Job Site Address: n , 4" d�.ClJ City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert'under the pains and penalties of perjury that the information provided above is true and correct. Signafore: <)?,S ,.3-- �` Date: Phone#: 9.7 Y �t• — —26-7 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 ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. he affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of ladusWal Accidents Office of Investigation,,,, 600 Washington Street Boston,MA,021 It Tel.#617-7.27-4900 ext 406 or 1-$77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www mass,govld a r March 10, 2014 Mr. Gerald Brown, Building Commissioner Town of North Andover 1600 Osgood Street North Andover, MA 01845 Dear Mr. Brown: I am the owner of the property known as 107 Campion Road,North Andover, MA, Map 62, Parcel 89, as shown as Lot 12A on a Plan of Land entitled"Plan of Land located in North Andover, MA Prepared for Forbes Realty Trust," dated November 13, 1986 and recorded with the Essex North District Registry of Deeds as Plan No. 1-534. The land is also described in a QUITCLAIM DEED,recorded as Book 6848,page 163 in said Registry of Deeds. I have owned this property since May, 2002. I purchased the property as a single family house lot with the intent to build my home on it. Since I have owned the property the town has assessed it as a single family house lot and I have been paying the taxes on it. In June of 2003 at the request of the Town, I hired an attorney to do a title examination and give an opinion on the status of my lot. The lot was created in 1985 prior to the zone change of 1987 and has not been owned in combination with any contiguous lot since 1985. Although I started the process of pulling a building permit I decided not to build at that time. Last spring I applied for a building permit with the assistance of Glenn Saba from Century Builders, Inc. Once again I was asked by the town to hire an attorney to give an opinion on the status of the lot even though I had done this already. After I submitted my attorney's opinion, I was told that my lot now has a wetland on it. Since then we have had several meetings on the lot with Town representatives as well as my surveyors and wetland consultants. We have been in front of the Conservation Commission twice and now I am told we need to go in front of the Zoning Board of Appeals, Community Development and back in front of the Conservation Commission. I hereby authorize and designate Glenn Saba, Century Builders, Inc,to represent me as the"applicant"in all matters related to the permitting process for this lot. I understand and certify that all representations made by my designated applicant are considered to reflect my intent. imi ara fr y i J MASSACHUSETTS JURAT Commonwealth of Massachusetts County of Essex On this /D day of c/'c G, , 2014,before me, ,the undersigned Notary Public of Massachusetts,personally appeared proved to me through satisfactory evidence of identity, which was personally known to be the person whose name was signed on this document above in my presence, and who swore or affirmed to me that the contents of this document are truthful and accurate to the best of his knowledSp and belief. j� RONALD PAUL MARSAN Notary Public ignature of Notary Public UI) COMMONWEALTH OF MASSACHUSETTS My Commission Expues April 17, 2020 } Printed Name of Notary Public My Commission Expires: J " 'I`owta of North Andover ZONING BOARD OF"PEALS ". Cn P._C1nq-M_1 -Ckrwr�rvs Q� eiLORT#* s�co '4 Rufranl I.Bper4_F_• .C7erk 2 •'` ._.`*day of This is to certify that twenty(20)days D.Paul ci3 jr. F ..,.have elapsed from date of decision,filed 1lrar(xrr * i without filing of an appeal. �( P. Nischae3 Dafe-DtO�� T L'lx +� Joyce A.Bradshaw �" 9•nd n I.,S r»vs�fi Town Cterk Ikvch \lor�anriril r�R a c:t lirm_�41rnp Any appeal shall be fled within(20) Notice of Decision days after the date of filing of this Year 2014 notice in the office of the Town Clerk, er Mass. Gen.L.ch.40A 17 § Property at: 0 Campion Hall(Map 62 Parcel 89)North Andover,NIA 01845 NAME: Dimitrois Saragas HEARING(S): 13 May 2013 ADDRESS: 0 Campion Road(Map 62,Parcel 89), PETITION: 2014-004 North Andover,MA 01845 The North Andover Board of Appeals held a public hearing at the Town Hall, at 120 Main Street, North Andover, MA on Tuesday, May 13, 2013 at 7:30 PM on the application of Dimitrois Saragas, for property located at 0 Campion Road (Map 62 Parcel,.89 North Andover, 845. - Petitioner is requesting a Zoning Boa Variance g rd of Appeals for the R-I Zoning District under Section 4 g e from the .1�6 (3) of the Watershed Protection District i , (Building and Uses Permitted) �(c) (ii) n order to Construction a new Disturbance Zone"allowed by Special Permit by the to. Board only Permanent Structure within the "Non- Disturbance Board of g y after a Variance has been anted Zoning Appeals � by the Legal notices were sent to all the certified abutters provided by the Town of North Andover,Assessors Office,and were published in the Eagle-Tribune,a newspaper of general circulation in the Town of North Andover,on April 29 2014 and May 6,2014. The following regular voting members were present: Albert P.Manzi I1I, Ellen P.McIntyre,Richard J. Byers, D.Paul Koch and Allan Cuscia. The following Associate Members were present Michael Liporto,and Doug Ludgin. McIntyre made a motion to GRANT the Variance to allow Under Section 4.136, (Building and Uses Permitted) 3(c)(ii)(3)of the Watershed Protection District Bylaw, in order to Construct a new Permanent Structure within the "Non-Disturbance Zone" Koch second the motion to Grant the Variance All those in favor to Grant the Variance: Albert P. Manzi III,Ellen P.McIntyre,Richard J.Byers,D.Paul Koch, and Allan Cuscia 5-0 The Board finds that owing to circumstances relating to soil conditions, shape, or topography of the land or structures and especially affecting such land or structures but not affecting generally the zoning district in general, a literal enforcement of the provisions of the Bylaw will involve substantial hardship, financial or otherwe petitioner or applicant. The Board finds that desirable relief may be granted without substantial de in ise, to the ent to the public good and without nullifying or substantially derogating from the intent of the purpose of this bylaw. s The Board also finds that this use,.as developed by the building & site plans, is an appropriate location for such a use and will not adversely affect the neighborhood. There will be no nuisance or seriouhazard to vehicles or pedestrians,since there are provisions for the required off-street parking. Adequate and appropriate facilities will be provided for the proposed.single family dwelling. The Board finds that this Variance granted by the Board of Appeals will not.be substantially more detrimental to the neighborhood and that this use, is in harmony with the neighborhood and generAl?)ft�Tz;e and intent of this Bylaw, and the Board finds the neighborhood association is i favor of the petition. A True Copy n $owe Clerk Site: 0 Campion Road (Map 62, Parcel 89), North Andover, MA 01845 Under Section 4.136, (Building and Uses Permitted) 3(c)(ii) (3) of the Watershed Protection District Bylaw, The Construction of a new Permanent Structure within the "Non-Disturbance Zone" is allowed by Special Permit by the Planning Board only after a Variance has been granted by the Zoning Board of ' Appeals.R-1 Zoning District. Plan(s)Title: 1)"Plan of Land"containing one(1)sheet. Prepared by Andover Consultants Inc.,Dated March 3,2014 and revised March 12,2014 2)"Proposed House Plans of Front Elevation ,Rear Elevation,Left and right Elevation",containing one(1)sheet, "Proposed First Floor Plans"containing one(1)sheet. "Proposed Second floor Plans",containing one(1)sheet, "Proposed Foundation",containing one(1)all 4 sheets of Proposed House Plans Prepared by Century Builders Inc., 8 Brushwood Drive Atkinson NII 03811 Dated April 2013 Voting in favor to Grant Albert P. Manzi Ill, Ellen P.McIntyre,Richard J. Byers,D.Paul Koch Jr. the Variance: Allan Cuscia Voting in the Negative: 0 j The Board finds that the applicant has satisfied the provisions Under Section 4.136 to construct a new single family home in the Watershed Protection District for 0 Campion Road(Map 62,Parcel 89),North Andover, MA 01845 in the R-1 District. Notes: 1. This decision shall not be in effect until a copy of this decision is recorded at the Essex County Registry of Deeds,Northern District at the applicant's expense. 2. The granting of the Variance as requested by the applicant does not necessarily ensure the granting of a building permit as the applicant must abide by all applicable local,state,and federal building codes and regulations,prior to the issuance of a building permit as required by the Inspector of Buildings. 3. If the rights authorized by the Variance are not exercised within one(1)years of the date of the grant,it shall lapse,and may be re- established only after notice,and a new hearing. Northkndoverng B and of Appeals Alb , sq., Chairman Ellen P. McIntyre, Dice-Chairman Richard J. Byers, Esq., Clerk D. Paul Koch Jr. Allan Cuscia Decision 2014-004 Page 2 of 2 o0RT1� Town of ? y. : : ¢ ndover to No. t ""f*' oh ver, Mass, It4 cocMi:^"OKItwecK �1' D S U BOARD OF.,HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .............. ..S.�f.'1 '�. �?1��..�44W. BUILDING INSPECTOR V ..... ...... ....... .................... 03 A4 has permission to erect .......................... buildings on .I..0 Foundation Rough to be occupied a .. .�.. �j. .....6..0oV.4(*..71bn........0.n.. ....................... Chimney provided that the person accepting this permit shall in every respect conform to the terms a 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 IN6TA S ELECTRICAL INSPECTOR UNLESS CONSTRUCT I 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. 4 ENERGYSUSTAINABLE A N A LYT ICS I I +Proieot:Cont~ract Description: IECC 2012 VPP Support.With"Mass Save for-New Single Family SEA#2402 Residence Site Address: 107 Campion St,Andover,MA 01845 Date: 10/3/.2014 Number of Units: 1 Name: Century Builders, Inc same Contact: Glenn Saba Address: PO Box 907,Methuen,MA 01844 Email: nitsaba&out1ook.®om Phone: 978-815-7073 *ffered Services 1--istT_rice Contract:Price Units -Charge 1) N1A ResidentialNew Construction Program Support($750 refundable if successful—Tier III excluded) $1500.00 $1,000 1 $1,000 2) ENERGY STAR®Version 3.0 Certification $250.00 3) ENERGY STAR Certification Remediation Services $150.00/hr 4) Indoor airPLUS Air Quality Certification $250.00 5) Energy System Strategy Review/HVAC Sizing Analysis $750.00 6) Stretch Energy Code Support For'New Homes $500.00 7) Stretch Energy Code Support For Additions and Renovations $250.00 8) Building Envelope Infiltration Test $300.00 9) Duct System Compliance Test $250.00 $250.00 TBD 10) Duct System Leakage Remediation/Support $200.00 11) IECC 2009 Testing Package(Infiltration and Duct System) $500.00 12) Thermal Imaging Analysis $600.00 13) Additional consulting—Scope of Work $150.00/hr (Pre-approved by Client,Out-of-Pocket and Travel expenses billed separately) Applied Discounts Total<ontract Fees $1,000 *xpected Incentives/Subsidies(Not Guaranteed) - DeposiMequired $1;000 Pleaseremit payments to: Sustainable Energy Analytics,4Militia Drive,Suite 6, Lexington,MA 02421. This.proposal is valid for a period of 30 days from Proposal Date. Accepted by Client: Position: Date: �l'� Accepted By SEA: °7RI It Position: Managing Director Date: 10/3/2014 All services are complete"as is"when delivered. Sustainable Energy Analytics,LLC does not warrantee or guarantee the performance of any recommendation by SEA or any other product,or service provided by others as or referenced in its delivered documents. SEA is not a licensed professional engineer,electrician,or plumber and our recommendations should not be considered in lieu of their professional advice. Local building codes and ordinances take precedence over any SEA recommendation. SEA has made reasonable effort to ensure that all recommendations are consistent with state-of-the-art building practices. US A I ry 9 1�T NEW&- �` Description-6f Buildina•Servicesfirom-Sustainable Energy Analytes vIMAtResidentiail'NewfonsttruebioniiProgram-,$,1500/unit,$750vefunded;1if successfuiito Tier I=or T-ier41. This service includes two site visits;the first for the Thermal Enclosure System Rater Checklist and the second for the infiltration and duct system test. The builder needs to provide a set of floor plans,elevations,and specifications for all windows,doors,skylights,mechanical systems,etc.as required to develop a HERS score. Sustainable1nergyAnalytics will supply: A data request list at the beginning of the project. A program requirements specification organized by trade. A preliminary HERS score based on provided specifications. A set of recommendations to improve the HERS score,if needed. All required testing. Failure/retests and diagnostic testing are available as additional charges. Copies of all required documents. "Management of all rebates and incentives available to builders of new homes. -fNERGYSTAR Version 3.0,-Certification-$250 This service requires that the builder purchase the-MA Residential"New Construction Program as well. The benefit is that the builder.will be allowed to display and market the home as an ENERGY STAR home. `ENERGY-STARC-ertification,Remediation'Seruice-*$150/iir This service will provide all assessment and technical services required to remediate the minimum changes necessary for a house that has failed to achieve the ENERGY STAR label to receive certification. The initial consultation is free and an estimate of the required services will be provided before the service begins. • indoor airPLUS Air,Quality,Gertification-'$250 This service is only available for ENERGY STAR certified homes. The benefit is that the builder will be allowed to display and market the home as an Indoor airPLUS qualified home. :Energy-Systern Strategyfieuiew/.HVAC Sizing-Analysis-$750 This service provides accurate sizing of major HVAC equipment to`Nlanual J standard. -SustainablerfnerggAnalyticswill measure the house, perform the analysis and provide all necessary reports to the HVAC contractor. A 10%discount is provided if the customer provides all necessary information via construction plans and specifications. Pricing Wotes o All prices are subject to change,please contact us for current pricing. o Multi-unit discounts are available. o A 50%non-refundable deposit is required on acceptance and to begin work. Balance is due on the completion of the service. H q i i SUSTAINABLE ENERGY ANALYTICS 4ECC3OO9Perfarmance Path,'Stretch,Ode-and-Home Audit Services me Stretch!E-nergyrC-ode<.om.pfiancefor NewiHomes-$500/unit This is a complete service providing training,support,and HERS certification for your project as required by the Stretch Energy Code. The service includes an explanation of how the Stretch Code affects your project,technical advice on meeting the individual requirements, projected and final HERS scores,Thermal Bypass Insulation Inspection and documentation to provide your code officials certifying compliance-with the code. Required testing of duct systems and building envelope are not included in this service and must be purchased separately(see following services). Go Stretch EnergyrGode Compliancefor-Additions.and/or Renovations-$250/unit This is a complete service providing technical support and HERS certification for your project as required by the Stretch Energy Code. The service includes an explanation of how the Stretch Code affects.your project,technical advice on meeting the individual requirements, one site visit for the mandatory Thermal Bypass Insulation Inspection,and documentation to provide to your code officials certifying compliance with the code. Additional site visits and any required testing of duct systems and building envelope are not included in this service and must be purchased separately(see following services) V (Building'Enavelope Infiltration.Test-"$300 This service includes house set-up,testing,marking of all significant leakage points and documentation of results against the IECC 2009 standard for one house. ',Duct'SYstem Test-$25Operfurnace/air#aandler The base service includes house set-up,testing of one duct system (i.e.air handler)in the home. It includes test results for both total leakage and leakage to the outside of the thermal envelope. Appropriate documentation of results against the IECC 2009 standard is included. If the system fails there is an additional charge per system to diagnose leakage points(See Duct System Leakage Remediation/Support). Ouct'Systezn 1.eakage,Remediation/Support-$200-per;furnace/ailT bandler This service provides one hour of troubleshooting support for duct systems that fail compliance. Additional time spent beyond the first hour.will be billed at the additional consulting rate. The HVAC company is highly recommended to be on site during troubleshooting. 11ECC2009 Testing'Package-'$500,plus'$350,for.additionalfu mace/air-handler The test package includes the Building Envelope Infiltration Test and the Duct System Test during the same visit on the same house at a discount. Thermal Imaging-Analysis-$600 3ustaindble4EnergyAnolytics will perform an infrared analysis of the home and provide a report detailing all issues related to the thermal performance of the building envelope. The customer must be able to maintain the home at a temperature difference greater than±10°F from the current outside temperature. -Pricing Wo o All prices are subject to change,please contact us for current pricing. o 'Multi-unit discounts are available. o A 50%non-refundable deposit is required on acceptance and to begin work. Balance is due on the completion of the service. i l F� i Sustainable Energy Analytics,LLC 41'ilitia Drive, Suite 6 InvWxce Phone# (781)652-8282 Date Invoice# 10/3/2014 2014-502 Bill To Century Builders Inc PO Box 907 Methuen,MA 01844 P.O."No. Terms Project Due on receiptSEA2402- 107 Campion St... Quantity Description Rate Amount IECC 2012,program and Rebate Support for New Residential Construction in 500.00 500.00 MA.-Deposit Make checks payable to"Sustainable Energy Analytics"OR"SEA" Send Payments to: Payments/Credits $0.00 Sustainable Energy Analytics 4 Militia Drive,Suite 6 Lexington,MA,02421 $ela7.lCe Due $500.00 f SUSTAINABLE ENERGY ANALYTICS k: October 21,2014 Dear Glenn, Thank you for choosing us as your HERS rater,we appreciate the business and look forward to wor-king.with you on the 107 Campion Road project. The projected HERS rating for this house is-1 The maximum allowed score is 65 for IECC 2012. This number is based on the drawings;certain project assumptions provided by you;and defaults.we use when generating the projected model when specifics are not available.,Jf.you,inreraditotmaike.any.changes;to,thezfi4dllowing assumptiens#lease caf msltoieview;the implications.and maintain•,conformance;to:guilding�Code and orincentive1programs. The assumptions used are the following, IECC 2012 and'Mass Save specific requirements are highlighted: General Fuel type is Natural Gas Code insulation R values throughout the house Two HVAC systems, location basement and attic Window specs:_U-Factor 0.30,SHGC 0.28 • �iflYle�h�rii�I�V,enfil�,tion:;gl��1111sr.��ciire#9��� i �1gf19�bifi�h�"ifiryilj�t3tm�ii�n�t�lled((i�aL�r,i{��crrll�� �1I�XtrolPyho�EtnfiC[i►�i:Fin�rt_�i;i4'1;}i�.TaD[P��(i�x�IlnwedC{ECL�03�j `+S,.u�.t��temilxi�1lt��k�gae:4���(r���ilnser��n � Basement Unconditioned 96AFUE Furnace 1.5 ton SEER 13 Air Conditioner DHW 75 Gallon, EF 0.65 Attic Unconditioned,vented 96 AFUE Furnace 2 ton SEER 13 Air Conditioner Insulation flat across ceiling(Blown-in insulation highly recommended,batts create issues due to the strapping on the ceiling),and in the roof rafters at cathedral ceiling locations. '*Note: You have a 5 point cushion on the HERS rating. Please give us a call at your convenience to discuss options to reduce building costs. For your review,please find the following documents attached to the email -Projected:flERC-C,etbfficate: Include this with-your permit application. -Equip.ment'Sizing•Sammi Generated by our REM model,for you and.your HVAC subcontractor. While this does not serve as an HVAC design document, it can be useful to your HVAC contractor in pricing the work and checking their equipment load calculations. •-HVAC,CChed dist: For the HVAC contractor. Please forward this checklist to your HVAC sub. It must be returned to us by the beginning of ductwork rough-in. ThellE{C3012 and Therma]IEnclosure,C-beckfists: Summaries of what is required for IECC 2012 code compliance. cPan.asoniclsprogrammahle;8athsEan=c�at`Sheet: "Mechanical ventilation is a requirement for IECC 2012 and for the-Mass Save program. We highly recommend using a model listed on this cut sheet,one on each floor with living space for this project. The next milestonewill be the midpoint(insulation) inspection,;please understand and remeniber,that.wemust visit!themihouselo inspect insalation.an,d-air sealing;before.wallboard,isanstalled. As always,please feel free to contact us.with any questions or concerns. I Regards, SEA Team Reg nom !Ener Rating C e if ca a RatingiJungMu try ID mber SEA2402P Certified Energy Rater Jang Yoon AO s 107 Campion Road Rating Date 10/20/2014 Andover,MA 01845 !���Rating Ordered For Century Builders ma-y,ed Czft E Q �` Use 1AMBtu Cost Percent 5 Stars Plus 9 'i Heating 114.3 $1893 46% ' Projected Rating Tr,•a HERS Index'60 Cooling 4.0 $174 4% Efficient_.Home Comparison:40%Better Hot Water 22.7 $358 9% Projected R ung: ,Based on Plans •-Field Zanfrmation'Required. Lights/Appliances 36.0 $1486 GVERrA Photovoltaics -0.0 $-0 -0% Conditioned Area 4362 sq.ft. House Type Single-family detached Service Charges $196 5% Conditioned Volume 39786 cubic ft. Foundation Unconditioned basement Total 176.9 $4107 100% Bedrooms 4 Aed.Wd_1Mfl!S3WMTM fmaftrms This home meets or exceeds the minimum criteria for the following: Heating: Fuel-fired air distribution,Natural gas,96.0 AFUE. 2009 International Energy Conservation Code Heating: Fuel-fired air distribution,Natural gas,96.0 AFUE. Massachusetts Stretch Energy Code Cooling: Air conditioner,Electric,13.0 SEER. Compliance with criteria for this program is Duct Leakage to Outside 174.00 CFM25. determined by the rater. Ventilation System Exhaust Only:81 cfm,20.0 watts. Programmable Thermostat Heat=Yes;Cool=Yes Ceiling Flat R-38.0 Slab None Seated Attic NA Exposed Floor R-30.0 Vaulted Ceiling R-37.8 Window Type U-Vatue:0.300,SHGC:0.280 Rating Team Above Grade Watts R-21.0 Infiltration Rate Htg:3.00 Clg:3.00 ACH50 Sustainable Energy Analytics Foundation Watts R-0.0 Method Blower door test 4 Militia Drive,Suite 6 Lexington,MA.02421 781-652-8282 Percent Interior Lighting 80.00 Range/Oven Fuel Natural gas t7LLA1 IjI Energystar@sea.us.com Percent Garage Lighting 0.00 Clothes Dryer Fuel Electric Refrigerator(kWh/yr) 709.00 Clothes Dryer EF 3.01 Dishwasher Energy Factor 0.46 Ceiling Fan(cfm/Watt) 0.00 Certified Energy Rater: 4� ;REWI..Rate•-:Resideritial fErteiWIAnalysiswnd Rating Software;v14. .1 This information does not constitute any warranty of energy cost or savings.©1985-2014 Architectural Energy Corporation,Boulder,Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. CS IECC 20:2 R4O2.4.1.1ERater Verifilcat�ion�Checkl st 'Home a4ddress: City: -state: '117JA II flEBwi hr r Air barrier and thermal A continuous air barrier shall be installed in the building envelope. barrier Exterior thermal envelope contains a continuous air barrier. Breaks or joints in the air barrier shall be sealed. Air-permeable insulation shall not be used as a sealing material. Ceiling/attic The air barrier in any dropped ceiling/soffit shall be aligned with the insulation and any gaps in the air barrier sealed. Access openings,drop down stair or knee wall doors to unconditioned attic spaces shall be sealed. W's — •att¢arn�r� �tar$ t _1'l _ l �a '41h��g�urfie�n_ :y a�mimn ]It t�itY;i l cazaiA nicnsJIjj aTit atrrtbarrier_ "T�CTs�€ lls`�f�ilP;bP . Windows,skylights and doors The space between window/doorjambs and framing and skylights and framing shall be sealed. rmJOM& > midi t 11 ri 1�i Tia3T liir l �cr rri Floors(including above- Insulation shall be installed to maintain permanent contact.with underside of garage and cantilevered subfloor decking. floors) The air barrier shall be installed at any exposed edge of insulation. Crawl space-walls .Where provided in lieu of floor insulation,insulation shall be permanently attached to the crawlspace-walls. Exposed earth in unvented crawl spaces shall be covered-with a Class I vapor retarder..with overlapping joints taped. Shafts,penetrations Duct shafts,utility penetrations,and flue shafts opening to exterior or unconditioned space shall be sealed. Narrow cavities Batts in narrow cavities shall be cut to fit,or narrow cavities shall be filled by insulation that on installation readily conforms to the available cavity space. Garage separation Air sealing shall be provided between the garage and conditioned spaces. Recessed lighting Recessed light fixtures installed in the building thermal envelope shall be air tight, IC rated,and sealed to the drywall. Plumbing and wiring Batt insulation shall be cut neatly to fit around wiring and plumbing in exterior walls,or insulation that on installation readily conforms to available space shall extend behind piping and wiring. Shower/tub on exterior wall Exterior walls adjacent to showers and tubs shall be insulated and the air barrier installed separating them from the showers and tubs. J!� eaaiT - HVAC register boots HVAC register boots that penetrate building thermal envelope shall be sealed to the subfloor or drywall. Fireplace An air barrier shall be installed on fireplace.walls. Fireplaces shall have gasketed doors. Rater Inspection Date: Builder Inspection Date: Home Energy Rater Company:Sustainable Energy Analytics Builder Company Name: Home Energy Rating Provider: PSD, Ithaca,-NY 14850 Home Energy Rater Signature: Builder Employee Signature: Equtpment Sizing Property Organization yERS Century Builders Sustainable Energy Analytics Projected Rating 107 Campion Road 781-652-8282 10/20/2014 Andover,-MA 01845 Jang Yoon AO Rating No:SEA2402P RaterID:5240057 f Weather:Andover,AAA Builder ` 107 Campion Road Glenn Saba SEA2402P - 107 Campion Road Andover.big t`eating iaftEm 5-7 FqEi9 M MIM Cq.PM3_WffF)) Gaoling CAMAIdEd 3l3 Sffmftble 31-9 Udbaril 4A VW m..9 Sffmg sir loam GmiIgEOPMOR 7 UR J TDIAll 3i TMW 42M o o5v (BE Ir�,9�a>�Je 3i1(I. %ffnJ IJe 3 �a?M�a HA Laffm Z-AD 1REWRate• Residentiai"Energy:Analysis and Rating Software v14.5�1 This information does not constitute any warranty of energy cost or savings. ©1985-2014 Architectural Energy Corporation, Boulder, Colorado. f (p�` A ` �it , PAIVASONTIC 1�Vf -1SPERGREE:N `:SELECT Panasonic's WhisperGreen Select is a customizable,all-in-one fan and fan/LED light combination for your IAQ solution.The Vin'iaws new Pick-A-Flow technology gives you the ability to select Fan Housing: your required air flow with just the flip of a switch. 10 114"x 10 114"x 7 3/8" �. Grille: Feu- ene y' '-s.°•+ �•1,,�� 13"x 13" Pick-A-Flow speed selector Ease of selection for required air flow Plug'N Play modules 3 value added features for further customizaton SmartFlow"rm technology Constant CFM performance Best in class LED light engine ,r Long Life-40,000 hours, no maintenance Flex-Z FastTm bracket z Flexible fast and secure installation GUMEaa:IU« OWA WV45. TWTES s r Dud @Rr-ie Multi-Speed Ran OA Il ' 5505.401 FV-05-11VKS1 -M-111M z Berra Ught if 5505.404 FV-05-11VKSL1 M--11110 M—ffiD—`(rITI�D JITQ —m#II Sra-1(11(i_1�tmd, 4" 2 1�, Motion Sensor Condensation ` Sensor 4 NiteGlo LED 0 - -- - - — - - - night light 7"- C a I I =- -Call now at _ ; to place your order or for more information efi.org/wholesale I wholesale@efi.org k11 •�VYYfl?'{R'n+L,x,:+i9y.aFatiGy ' flVAGC-ooling System Sizing Contractor Verification form Program requirements: 1. All cooling equipment must be sized according to the latest editions of ACCAT7lanuals 1 and S,ASHRAE 2001 Handbook of Fundamentals,or an equivalent computation procedure.The maximum over sizing limit for air conditioners is 15%,25%for heat pumps. Documentation must-be provided to the HERS Rater. The interior design temperatures used for heating and cooling load calculations shall be a maximum of 72°F(22°C)for heating and a minimum of 747(24°C)for cooling. The maximum over-sizing limit for the Program is 15%for air conditioners,and 25%for heat pumps. This should be calculated by multiplying the overall load(in Btu)by 1.15 for air conditioners,or 1.25 for heat pumps,then choosing the next available size. Cooling systemsmAth.uariatile speed cornpressors.are-exempt ifromithis:requiremernt. 2. A Thermal Expansion Valve(T-XV)or Electronic Expansion Valve(EXV)is required on all cooling systems. 3. [Performance[Paft Homes with HVAC ducted systems have a leakage rate at or below six(6)CFM to outdoors per 100 sq.ft.of conditioned floor area. Testing is required on ALL ducted systems,including systems with all the ductwork located within conditioned space. 4. Projects that apply for Cool Smart and Gas-Networks CANNOT participate in the program. i Home Address: City: State: Whole Home: Design Total Heat Gain: BTUh Design Total Heat Loss: BTUh (for heat pumps) HVAC Company-Name: HVAC ContractorName: HVAC Contractor Signature: Date: The Block load calculations for the home listed above have been completed in compliance with the requirements _listed on„pa.ge 1 of this form. i 1 i ANERGY STAR Certified ,Homes., .Version 3 {(Rev. ,07) t her: l al Endl:osure System Rater Checklist Home Address: City: State: Zip Code: u' imust 331rimer €hater 1..3�rg'ttiP:erfi�rma�e"Fenes�fii� VA 1.1 Prescriptive Path:Fenestration shall meet or exceed ENERGY STAR requirements ❑ ❑ ❑ ❑ 1.2 Performance Path:Fenestration shall meet or exceed 2009 IECC requirements 2 ❑ ❑ ❑ ❑ :DAh-7i2y-4ns1 aTM 3ms�11ffDn11 2.1 Ceiling,wall,floor,and slab insulation levels shall comply with one of the following options: 2.1.1 "Meet or exceed 2009 IECC levels 3,4,5,OR; ❑ ❑ ❑ ❑ 2.1.2 Achieve<_133%of the total UA resulting from the U-factors in 2009 IECC Table 402.1.3, excluding fenestration and per guidance in Footnote 3d,AND home shall achieve<_50%of the ❑ ❑ ❑ ❑ infiltration rate in Exhibit 1 of the-National Program Requirements 4,5 2.2 All ceiling,wall,floor,and slab insulation shall achieve RESNET-defined Grade I installation or, alternatively,Grade II for surfaces that contain a layer of continuous,air impermeable insulation>_R-3 ❑ ❑ ❑ ❑ in Climate Zones 1 to 4, >_R-5 in Climate Zones 5 to 8 RtalA�lirrer�AtrBerrier At each insulated location noted below,a complete air barrier shall be provided that is fully aligned with the insulation as follows: •At interior or exterior surface of ceilings in Climate Zones 1-3;at interior surface of ceilings in Climate Zones 4-8.Also, include barrier at interior edge of attic eave in all climate zones using a wind baffle that extends to the full height of the insulation. Include a baffle in every bay or a tabbed baffle in each bay with a soffit vent that will also prevent wind washing of insulation in adjacent bays At exterior surface of walls in all climate zones;and also at interior surface of walls for Climate Zones 4-8 7 At interior surface of floors in all climate zones,including supports to ensure permanent contact and blocking at exposed edge 8.9 3.1 Walls 10 3.1.1 Walls behind showers and tubs ❑ ❑ ❑ ❑ 3.1.2 Walls behind fireplaces ❑ ❑ ❑ ❑ 3.1.3 Attic knee walls 11 ❑ ❑ ❑ ❑ 3.1.4 Skylight shaft walls ❑ ❑ ❑ ❑ 3.1.5 Wall adjoining porch roof ❑ ❑ ❑ ❑ 3.1.6 Staircase walls ❑ ❑ ❑ ❑ 3.1.7 Double walls ❑ ❑ ❑ ❑ 3.1.8 Garage rim/band joist adjoining conditioned space ❑ ❑ ❑ ❑ 3.1.9 All other exterior walls ❑ ❑ ❑ ❑ 3.2 Floors 3.2.1 Floor above garage ❑ ❑ ❑ ❑ 3.2.2 Cantilevered floor ❑ ❑ ❑ ❑ 3.2.3 Floor above unconditioned basement or unconditioned crawlspace ❑ ❑ ❑ ❑ 3.3 Ceilings 10 3.3.1 Dropped ceiling/soffit below unconditioned attic ❑ ❑ ❑ ❑ 3.3.2 All other ceilings J ❑ ❑ ❑ J ❑ 4.iReBumritl 7#Errrn7 BnWmg 4.1 Forinsulated face of the exteriongs lr wall below tattic space bove theseLlevels:CZ 1h5:� IR 21)CZ 6 -8:,Grade 12!R-30 12 on extends to the ❑ ❑ ❑ ❑ 4.2 For slabs on grade in CZ 4 and higher, 100%of slab edge insulated to:?R-5 at the depth specified by ❑ ❑ ❑ ❑ the 2009 IECC and aligned with thermal boundary of the walls 4.3 Insulation beneath attic platforms(e-g.,HVAC platforms,walkways)>_R-21 in CZ 1-5;>_R-30 in CZ 6-8 ❑ ❑ ❑ ❑ 4.4 Reduced thermal bridging at above-grade walls separating conditioned from unconditioned space(rim/band joists exempted)using one of the following options:1 3 4.4.1 Continuous rigid insulation,insulated siding,or combination of the two; >_R-3 in Climate Zones 1 to 4,>R-5 in Climate Zones 5 to 8 14,15,15,OR; ❑ ❑ ❑ ❑ 4.4.2 Structural Insulated Panels(SIPs)14,OR; ❑ ❑ ❑ ❑ 4.4.3 Insulated Concrete Forms(ICFs)14,,OR; ❑ ❑ ❑ ❑ 4.4.4 Double-wall framing 14,17 OR; ❑ ❑ ❑ ❑ 4.4.5 Advanced framing, including all of the items below: 4.4.5a All corners insulated>_R-6 to edge 18,AND; ❑ ❑ ❑ ❑ 4.4.5b All headers above windows&doors insulated>_R-3 for 2x4 framing or equivalent cavity width,and>_R-5 for all other assemblies(e.g.,with 2x6 framing)19,AND; 11 El 11 11 4.4.5c Framing limited at all windows&doors to one pair of king studs,plus one pair of jack studs per window opening to support the header and sill 20,AN'D; ❑ ❑ ❑ ❑ 4.4.5d All interior/exterior wall intersections insulated to the same R-value as the rest of the exterior wall 21,AND; ❑ ❑ ❑ ❑ 4.4.5e`Minimum stud spacing of 16 in.o.c.for 2x4 framing in all Climate Zones and,in Climate El ❑ ❑ Zones 5 through 8,24 in.o.c.for 2x6 framing Effective for homes permitted starting 8/01/2013 Revised 6/01/2013 Page 3 of 16 ENFRGY ,STAR Gerfified `Homes, Version 3 (Rev. 07) Thermal Enclosure System- Rater G:he&list ..?fir afn� l tNlrst II fiffid rn APIA 1 17�nf� [V"'Tfw.,d��J 5.1 Penetrations to unconditioned space fully sealed with solid blocking or flashing as needed and gaps sealed with caulk or foam 5.1-1 Duct/flue shaft ❑ ❑ ❑ p 5.1.2 Plumbing/piping . ❑ ❑ ❑ ❑ 5.1.3 Electrical wiring ❑ ❑ ❑ ❑ 5.1.4 Bathroom and kitchen exhaust fans ❑ ❑ ❑ ❑ 5.1.5 Recessed lighting fixtures adjacent to unconditioned space ICAT labeled and fully gasketed. Also,if in insulated ceiling without attic above, exterior surface of fixture insulated to>_R-10 in ❑ ❑ ❑ ❑ CZ 4 and higher to minimize condensation potential. 5.1.6 Light tubes adjacent to unconditioned space include lens separating unconditioned and conditioned space and are fully gasketed 23 ❑ ❑ ❑ ❑ 5.2 Cracks in the building envelope fully sealed 5.2.1 All above-grade sill plates adjacent to conditioned space sealed to foundation or sub-floor with caulk,foam,or equivalent material.Foam gasket also placed beneath above-grade sill plate if ❑ ❑ ❑ ❑ resting atop concrete or masonry and adjacent to conditioned space 24,25 5.2.2 At top of walls adjoining unconditioned spaces,continuous top plates or sealed blocking using ❑ ❑ ❑ ❑ caulk,foam,or equivalent material 5.2.3 Drywall sealed to top plate at all unconditioned attic/wall interfaces using caulk,foam,drywall adhesive(but not other construction adhesives),or equivalent material.Either apply sealant ❑ ❑ ❑ ❑ directly between drywall and top plate or to the seam between the two from the attic above. 5.2.4 Rough opening around windows&exterior doors sealed.with caulk or foam 26 ❑ ❑ ❑ ❑ 5.2.5'Marriage joints between modular home modules at all exterior boundary conditions fully sealed ❑ ❑ ❑ ❑ with gasket and foam 5.2.6 All seams between Structural Insulated Panels(SIPs)foamed and/or taped per ❑ ❑ ❑ ❑ manufacturer's instructions 5.2.7 In multifamily buildings,the gap between the common wall(e.g.the drywall shaft wall)and the ❑ ❑ ❑ ❑ structural framing between units fully sealed at all exterior boundaries 5.3 Other openings 5.3.1 Doors adjacent to unconditioned space(e.g.,attics,garages, basements)or ambient conditions ❑ ❑ ❑ ❑ made substantially air-tight with weatherstripping or equivalent gasket 5.3.2 Attic access panels and drop-down stairs equipped with a durable>-R-10 insulated cover that is gasketed(i.e.,not caulked)to produce continuous air seal when occupant is not accessing the ❑ ❑ ❑ ❑ attic 27 5.3.3 Whole-house fans equipped with a durable?R-10 insulated cover that is gasketed and either installed on the house side or mechanically operated 27 ❑ ❑ ❑ ❑ Rater Name: Rater Pre-Drywall Inspection Date: Rater Initials: Rater Name: Rater Final Inspection Date: Rater Initials: Builder Employee: Builder Inspection Date: Builder Initials: Notes: 1. At the discretion of the Rater, the builder may verify up to eight items specified in this Checklist. When exercised, the builder's responsibility will be formally acknowledged by the builder signing off on the checklist for the item(s)that they verified. 2. For Prescriptive Path: All windows, doors, and skylights shall meet or exceed ENERGY STAR Program Requirements for Residential Windows, Doors,and Skylights-Version 5.0 as outlined atm_ _For Performance Path:All windows,doors and skylights shall meet or exceed the component U-factor and SHGC requirements specified in the 2009 IECC-Table 402.1.1. If no'NFRC rating is noted on the window or in product literature(e.g.,for site-built fenestration), select the U-factor and SHGC value from Tables 4 and 14, respectively, in 2005 ASHRAE Fundamentals, Chapter 31. Select the highest U-factor and SHGC value among the values listed for the known window characteristics (e.g., frame type, number of panes, glass color, and presence of low-e coating). Note that the U- factor requirement applies to all fenestration while the SHGC only applies to the glazed portion.The following exceptions apply: a. An area-weighted average of fenestration products shall be permitted to satisfy the U-factor requirements; b. An area-weighted average of fenestration products>_50%glazed shall be permitted to satisfy the SHGC requirements; c. 15 square feet of glazed fenestration per dwelling unit shall be exempt from the U-factor and SHGC requirements, and shall be excluded from area-weighted averages calculated using a)and b),above; d. One side-hinged opaque door assembly up to 24 square feet in area shall be exempt from the U-factor requirements and shall be excluded from area-weighted averages calculated using a)and b),above; e. Fenestration utilized as part of a passive solar design shall be exempt from the U-factor and SHGC requirements, and shall be excluded from area-weighted averages calculated using a) and b), above. Exempt windows shall be facing within 45 degrees of true South and directly coupled to thermal storage mass that has a heat capacity>20 btu/ft3x°F and provided in a ratio of at least 3 sq.ft.per sq.ft.of South facing fenestration.Generally,thermal mass materials will be at least 2 in.thick. Effective for homes permitted starting 8/01/2013 Revised 6/01/2013 Page 4 of 16 ENERGY `STAR lCeffif ed Homes, version .3 ,.(Rev. "07) 'Therma-IlEn,closure S,Ysfem RaterChecklist 3. Insulation levels in a home shall meet or exceed the component insulation requirements in the 2009 IECC-Table 402.1.1.The following exceptions apply: I a. Steel-frame ceilings,walls,and floors shall meet the insulation requirements of the 2009 IECC—Table 402.2.5. In CZ 1 and 2,the continuous insulation requirements in this table shall be permitted to be reduced to R-3 for steel-frame wall assemblies with studs spaced at 24 in.on center.This exception shall not apply if the alternative calculations in d)are used; b. For ceilings with attic spaces, R-30 shall satisfy the requirement for R-38 and R-38 shall satisfy the requirement for R-49 wherever the full height of uncompressed insulation at the lower R-value extends over the wall top plate at the eaves. This exemption shall not apply if the alternative calculations in d)are used; c. For ceilings without attic spaces, R-30 shall satisfy the requirement for any required value above R-30 if the design of the roof/ ceiling assembly does not provide sufficient space for the required insulation value.This exemption shall be limited to 500 sq.ft.or 20% of the total insulated ceiling area, whichever is less. This exemption shall not apply if the alternative calculations in d) are used; d. An alternative equivalent U-factor or total UA calculation may also be used to demonstrate compliance,as follows: An assembly with a U-factor equal or less than specified in 2009 IECC Table 402.1.3 complies_ A total building thermal envelope UA that is less than or equal to the total UA resulting from the U-factors in Table 402.1.3 also complies.The insulation levels of all non-fenestration components(i.e.,ceilings,-walls,floors,and slabs)can be traded off using the UA approach under both the Prescriptive and the Performance Path. Note that fenestration products (i.e., windows, skylights, doors) shall not be included in this calculation. Also, note that while ceiling and slab insulation can be included in trade-off calculations, Items 4.1 through 4.3 of the Checklist shall be met regardless of the UA tradeoffs calculated_The UA calculation shall be done using a method consistent with the ASHRAE Handbook of Fundamentals and shall include the thermal bridging effects of framing materials.The calculation for a steel-frame envelope assembly shall use the ASHRAE zone method or a method providing equivalent results,and not a series-parallel path calculation method. 4. Consistent with the 2009 IECC,slab edge insulation is only required for slab-on-grade floors with a floor surface less than 12 inches below grade_Slab insulation shall extend to the top of the slab to provide a complete thermal break. If the top edge of the insulation is installed between the exterior wall and the edge of the interior slab, it shall be permitted to be cut at a 45-degree angle away from the exterior wall. Alternatively,the thermal break is permitted to be created using>_R-3 rigid insulation on top of an existing slab(e.g.,in a home undergoing a gut rehabilitation). In such cases, up to 10% of the slab surface is permitted to not be insulated (e.g., for sleepers, for sill plates). Insulation installed on top of slab shall be covered by a durable floor surface(e.g.,hardwood,tile,carpet). 5. Where an insulated wall separates a garage, patio, porch, or other unconditioned space from the conditioned space of the house, slab insulation shall also be installed at this interface to provide a thermal break between the conditioned and unconditioned slab. Where specific details cannot meet this requirement, partners shall provide the detail to EPA to request an exemption prior to the home's certification. EPA will compile exempted details and work with industry to develop feasible details for use in future revisions to the program. A list of currently exempted details is available at:yywwAnamws%w_wy//skbBdk 6. For purposes of this Checklist, an air barrier is defined as any durable solid material that blocks air flow between conditioned space and unconditioned space, including necessary sealing to block excessive air flow at edges and seams and adequate support to resist positive and negative pressures without displacement or damage. EPA recommends,but does not require, rigid air barriers. Open-cell or closed-cell foam shall have a finished thickness >_ 5.5 in. or 1.5 in., respectively, to qualify as an air barrier unless the manufacturer indicates otherwise. If flexible air barriers such as house wrap are used,they shall be fully sealed at all seams and edges and supported using fasteners with caps or heads >_ 1 in. diameter unless otherwise indicated by the manufacturer. Flexible air barriers shall not be made of kraft paper, paper-based products,or other materials that are easily torn. If polyethylene is used,its thickness shall be>_6 mil. 7. EPA highly recommends,but does not require, inclusion of an interior air barrier at rim/band joists in Climate Zones 4 through 8. 8. Examples of supports necessary for permanent contact include staves for batt insulation or netting for blown-in insulation_ Alternatively, batts that completely fill floor cavities enclosed on all six sides may be used to meet Items 2.2 and 3.2, even when compression occurs due to excess insulation, as long as the R-value of the batts has been appropriately assessed based on manufacturer guidance and the only defect preventing the insulation from achieving the required installation grade is the compression caused by the excess insulation. 9. Fully-aligned air barriers may be installed at the exterior surface of the floor cavity in all Climate Zones if the insulation is installed in contact with this exterior air barrier and the perimeter rim and band joists of the floor cavity are also sealed and insulated to comply with the fully-aligned air barrier requirements for walls. 10. All insulated vertical surfaces are considered walls (e.g., above and below grade exterior walls, knee walls)and must meet the air barrier requirements for walls,with the exception of adiabatic walls in multifamily dwellings.All insulated ceiling surfaces,regardless of slope(e.g., cathedral ceilings,tray ceilings,conditioned attic roof decks,flat ceilings,sloped ceilings),must meet the requirements for ceilings. 11. Exterior air barriers are not required for attic knee walls that are<_24 in. in height if an interior air barrier is provided and insulation extends in all directions from the top of this interior air barrier into unconditioned space at the following levels:CZ 1-5:>R-21;CZ 6-8:>_R-30. 12. The minimum designated R-values must be achieved regardless of the trade-offs determined using an equivalent U-factor or UA alternative calculation,with the following exception: For homes permitted through 12/31/2012: CZ 1-5: For spaces that provide less than 5.5 in. of clearance, R-15 Grade I insulation is permitted. CZ 6-8:For spaces that provide less than 7.0 in.of clearance, R-21 Grade I insulation is permitted. For homes permitted on or after 01/01/2013:Homes shall achieve Item 4.1 without exception. Note that if the minimum designated values are used,then higher insulation values may be needed elsewhere to meet Item 2.1.Also,note that these requirements can be met by using any available strategy,such as a raised-heel truss,alternate framing that provides adequate space,and/or high-density insulation. 13. Mass walls utilized as the thermal mass component of a passive solar design (e.g., a Trombe wall) are exempt from this Item. To be eligible for this exemption, the passive solar design shall be comprised of the following five components: an aperture or collector, an absorber,thermal mass,a distribution system,and a control system.For more information,see: Effective for homes permitted starting 8/01/2013 Revised 6/01/2013 Page 5 of 16 ENERGY :STAR Gertiried °Homes., Version :3 :(:Rev, +07) Thermal Enclosure 'System Rater {Ghecklist �a8>DtsJ/il�r nt� M.�€t %r��/f€leskk�uri to paswe sallar ht a m, deshatLipffl. 'Mass walls that are not part of a passive solar design(e.g.,CMU block or log home enclosure)shall either utilize the strategies outlined in Item 4.4 or the pathway in the assembly.with the least thermal resistance, as determined using a method consistent with the 2009 ASHRAE Handbook of Fundamentals, shall provide >_ 50% of the applicable assembly resistance, defined as the reciprocal of the mass wall equivalent U-factor in the 2009 IECC—Table 402.1.3.Documentation identifying the pathway with the least thermal resistance and its resistance value shall be collected by the Rater and any Builder Verified or Rater Verified box under Item 4.4 shall be checked. 14. Up to 10%of the total exterior wall surface area is exempted from the reduced thermal bridging requirements to accommodate intentional designed details (e.g., architectural details such as thermal fins, wing walls, or masonry fireplaces; structural details, such as steel columns). It shall be apparent to the Rater that the exempted areas are intentional designed details or the exempted area shall be documented in a plan provided by the builder,architect,designer,or engineer.The Rater need not evaluate the necessity of the designed detail to certify the home. 15. If used, insulated siding shall be attached directly over a water-resistive barrier and sheathing. In addition, it shall provide the required R- value as demonstrated through either testing in accordance with ASTM C 1363 or by attaining the required R-value at its minimum thickness. Insulated sheathing rated for water protection can be used as a water resistant barrier if all seams are taped and sealed. If non- insulated structural sheathing is used at corners,advanced framing details listed under Item 4.4.5 shall be met for those wall sections. 16. Steel framing shall meet the reduced thermal bridging requirements by complying with Item 4.4.1 of the Checklist. 17. Double-wall framing is defined as any framing method that ensures a continuous layer of insulation covering the studs.to at least the R- value required in Item 4.4.1 of the Checklist, such as offset double-stud walls, aligned double-stud walls with continuous insulation between the adjacent stud faces,or single-stud walls with 2x2 or 2x3 cross-framing. In all cases, insulation shall fill the entire wall cavity from the interior to exterior sheathing except at windows,doors and other penetrations. 18. All exterior corners shall be constructed to allow access for the installation of>_ R-6 insulation that extends to the exterior wall sheathing. Examples of compliance options include standard-density insulation with alternative framing techniques, such as using three studs per corner,or high-density insulation(e.g.,spray foam)with standard framing techniques. 19. Compliance options include continuous rigid insulation sheathing, SIP headers, other prefabricated insulated headers, single-member or two-member headers with insulation either in between or on one side,or an equivalent assembly,except where a framing plan provided by the builder, architect, designer, or engineer indicates that full-depth solid headers are to be used. The Rater need not evaluate the structural necessity of the details in the framing plan to certify the home. Also, the framing plan need only encompass the details in question and not necessarily the entire home. R-value requirement refers to manufacturer's nominal insulation value. 20. Additional jack studs shall be used only as needed for structural support and cripple studs only as needed to maintain on-center spacing of studs. 21. Insulation shall run behind interior/exterior wall intersections using ladder blocking, full length 2x6 or 1x6 furring behind the first partition stud,drywall clips,or other equivalent alternative. 22. In Climate Zones 5-8, a minimum stud spacing of 16 in. o.c. is permitted to be used with 2x6 framing if>_R-20.0.wall cavity insulation is achieved. Regardless, all vertical framing members shall either be on-center or have an alternative structural purpose (e.g., framing members at the edge of pre-fabricated panels) that is apparent to the Rater or documented in a framing plan that encompasses that member and is provided by the builder, architect, designer, or engineer. The Rater need not evaluate the structural necessity of the framing plan to certify the home. However, all 2x6 framing with stud spacing of 16 in. o.c. in Climate Zones 5- 8 shall have? R-20.0 wall cavity insulation installed regardless of any framing plan or alternative equivalent total UA calculation. 23. Light tubes that do not include a gasketed lens are required to be sealed and insulated>_R-6 for the length of the tube. 24. Existing sill plates(e.g., in a home undergoing a gut rehabilitation)on the interior side of structural masonry or monolithic walls are exempt from this Item. In addition, other existing sill plates resting atop concrete or masonry and adjacent to conditioned space are permitted, in lieu of using a gasket,to be sealed with caulk,foam,or equivalent material at both the interior seam between the sill plate and the subfloor and the seam between the top of the sill plate and the sheathing. 25. In Climate Zones 1 through 3, a continuous stucco cladding system adjacent to sill and bottom plates is permitted to be used in lieu of sealing plates to foundation or sub-floor with caulk,foam,or equivalent material. 26. In Climate Zones 1 through 3,a continuous stucco cladding system sealed to windows and doors is permitted to be used in lieu of sealing rough openings with caulk or foam. 27. Examples of durable covers include, but are not limited to, pre-fabricated covers with integral insulation, rigid foam adhered to cover with adhesive,or batt insulation mechanically fastened to the cover(e.g.,using bolts, metal.wire,or metal strapping). Effective for homes permitted starting 8/01/2013 Revised 6/01/2013 Page 6 of 16