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HomeMy WebLinkAboutBuilding Permit #802-13 - 15 WOOD AVENUE 5/23/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page Gtr © o I LO-CATH O-N L �� - } Pring 100Y, No" re; e , MA P, AO ZONI,NGDISTRICT Histonc�Distnct� yeas _ 'Machine'Shop}V LlageJ y_ §i1 n-0);-- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building a family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑Commercial ❑Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Other ❑iS_e tick Oy .,:_.._. _. ElDemolition p Vllell I �fFloodplaint ;W.etlands; 'Watershed�'Distnct L pWMer/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: -"2 c© ?�G✓ f�f//o Phone: �� J� Address: ,Address: +Supervi.§'0rrs4, nsttuctR niLib ense•:��s C- ��© /� E'-i Date: . me,l_mprgyement;License /G y00 s- Expo Oa_tei, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: Check No.: Jz- ds' Receipt No.: 0 ; NOTE: Persons contracting with unregistered contractors do not have access to Oe guaranty fund r `Signature.ofA ent/Owner . :. Signature of contractor 9 r r r_. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ S mped Plans i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Pians ❑ TYPE OF SEWERAGE.DISPOSAL t. Public Sewer ❑ Tanning/MassageBodyArt ❑. . ,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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS SZoning 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 s DPW Town ]Engineer: Signature: � Located 384 Osgood Street I `FIRE DEPARTM'i�T - Temp Dumpster on site yes no Located at 124 Main Street Fire Depaniert signature/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 I D Notified for pickup - Date . i E Doc.Building Permit Revised 2010 i l 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 o Copy of Contract o Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster.permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks I L3 Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 o Certified Proposed Plot Plan u 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 j Hydraulic Calculations (If Applicable) I j o Copy of Contract I o 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 npncal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application Doc: Doc.Bub ling permit Revised 2012 Location No. 5RO,--4- Date 3 ' TOWN OF NORTH ANDOVER s y��;ei;rlf xa;,c y • e ® Certificate of Occupancy $ Building/Frame Permit Fee $ '^ �r Foundation Permit Fee $ Other Permit Fee $ TOTAL Ch6 26433 Building Inspector ' A MA7000 COMPANY0111JJJ BLOW.=R 0 Q U I«<fffl INFRA-RED DOOR TEST SCANS • 110 PERIMETER ROAD,NASHUA,NH 03063 Insulation,Seamless Gutters,Waterproofing Shelving,Zero Clearance Fireplaces Blown-In Blanket System JOE RICARD LOCAL(603)889-6647 Sales Representative OUT OF STATE 800 256-1002 HOME(603)669-07B1 IN STATE 800 244-1841 CELL(603)860-2137 FAX(603)889-3385 AORTH Town of � � E :_ 6 ndover No. Z h ver, Mass, 0 � 1 CONIC Kl WICK 1• �.95 RATED LI BOARD OF HEALTH Food/Kitchen P. ERMIT T D Septic System THIS CERTIFIES THATV BUILDING INSPECTOR ...........�..PSCI............. ................................ .................................... i � Foundation has permission to erect.......................... buildings on ..I ... P ..... .................... Rough tobe occupied as .......... ...... ►.....................:..................................................... 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 CONSTRUCTION STS Rough fill 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 DATE(MM/DD(YYYY) CERTIFICATE OF LIABILITY INSURANCE r 05102,2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. N IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to thec°.LD certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 41 NAME: Ado Risk Services Central, Inc. PHOE Southfield MI Office (AIC NNo.Ext): (866) 283-7122 aC No.): 8O0-363-OTOS G1 3000 Town Center E-MAIL suite 3000 ADDRESS: O 0 Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC 4 INSURED INSURERA: Old Republic Ins Co 24147 Builder services Group, Inc. INSURER B: ACE American Insurance Company 22667 d/b/a Quality Insulation A Masco Corporation Company INSURER C: Indemnity Insurance co of North America 43575 110 Perimeter Road -- Nashua NH 03063-1301 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:58115:919414 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSLTR TYPE OF INSURANCE DD SUB POLICY NUMBER POL C MOL CY E P LIMITS INSR WVD MMIDD/VY1'V MMIDD/VWY B GENERAL LIABILITY MWZY 52512 EACH OCCURRENCE $2,000,000 Y COMMERCIALGENERALLIABILITY SIR applies per policy ter s & condi Tons AG O TED $2,000,000 PREMISES Ea occurrence CLAIMS-MADE MOCCUR - MED EXP(Any one person) S2S,000 PERSONAL B ADV INJURY $2,000,000 p GENERAL AGGREGATE $S,000, m0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S10,000,OOO 7 Y POLICY r PRG LOC o n B AUTOMOBILE LIABILITY MWTB 18398-12 06/30/2012 06/30/2013 COMBINED SINGLE LIMIT $5,000,000 N Ea accident YJANY AUTO BODILY INJURY(Per person) O ALL OWNED SCHEDULED Z AUTOS AUTOS BODILY INJURY(Per accident) y HIRED AUTOS Y NON-OWNED PROPERTY DAMAGE V AUT05 (Per accident) d UMBRELLA LIAB H OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION D WORKERS COMPENSATION AND WLRc46786385 06/30/2012'06/30/2013 WC STATU- OTH- EMPLOYERS'LIABILITY YIN LIMITS ER ANY PROPRIETOR I PARTNER I EXECUTIVE YIN Deductible - A05 C OFPICERIMEMBER EXCLUDED? NIA WLRC46786300 06/30/2012 06/30/2013 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) Ded - CA, MA E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT S1,000,000- C Excess WC WCUC46786269 06/30/2012106/30/20131 Deductible 52,000,000= Self-Insured States1-1m1t (1) Included SIR applies per policy terns & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) [Proj: RE: Project Name: HWAP-WAP Program] [AI: Greater Lawrence Community Action Council, Inc. and HWAP-WAP Program] are ncluded as Additional Tnsured with respect to the General Liability policy, as required by written contract. {. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Greater Lawrence Community Action AUTHORIZED REPRESENTATIVE Council, Inc. 305 Essex St. Lawrence MA 01840 USA �jy c/t^rcrG�iGt.4EL•f0 ����/dGLLa4 ✓nGt ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027887 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Central, Inc. Builder Services Group, Inc. POLICY NUMBER See Certificate Number: 570049808303 CARRIER -TIC CODE See Certificate Number: 570049808303 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDI7701NAL POLICIFS If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY fNSR ADDL SUBR EFFECTIVE EXPIRATION LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER LIMITS DATE DATE MM/UU/YY1'Y MM/DU/YYYY WORKERS COMPENSATION B N/A SCFc46786348 06/30/2012 06/30/2013 wi only C N/A WLRC46786427 06/30/2012 06/30/2013 Tx Only ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS OR ORGANIZATIONS (MASCO FORM RR) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Greater Lawrence Community Action Council, Inc. and HWAP-WAP Program WHO IS AN INSURED (SECTION II) is amended to include a person or organization as defined above. We shall indemnify the Additional Insured for all covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured. We shall further reimburse the Additional Insured for reasonable and necessary attorney's fees and litigation costs incurred in defending against covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured, except for those attorney's fees and litigation costs paid by another insurer. Our duty to indemnify and to reimburse attorneys' fees and litigation costs shall not exceed the product derived by multiplying the total dollar amount of liability for covered damages, or the total dollar amount of attorneys'fees and litigation cost, by that percentage of legal liability attributable to the Named Insured for covered damages as determined by a trier-of-fact in an arbitration or trial. GL 319 002 0609 Masco Corporation MWZY 55525-12 Policy Period: 06-30-12 to 06-30-13 The Commonwealth ofMassachusetts Department oflndustrurlAccidents Office of Investigations 600 Washington Street Boston,J A 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:BuilderslContractorslElectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatio0ndividual): ?z4a� Address: - CitylSfafe/Zip: Phone Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 4. Q I am a general contractor and I 6. E]Now construction employees(fall and/or part-time).* have liiredthe sub-contractors 2.0 1 am a soleproprietor orpartner- listed on the attached sheet. 7• E]Remodeling ship and'have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. workers'comp.insurance. 9. 1uilding addition [No workers'comp.insurance 5. Q We are a corporation and its lo.0 Electrical repairs or additions required.] officers have exercised their 3.0 I am a homeowner'doing allwork right of exemption per MGL 11.0 Plumbingrepairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.QRoofrepairs insurance r required.] employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box#1 must also Ell outthesection bel6wshowingtheirworkers'compensationpolicyinformation. T Homeowners who submit this affidavit indicating they tie doing all work and then hire outside contractors must submit anew affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and thek workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is ihepolicy and job site information. Insurance Company Name: Policy#or S elf-ins.Lic.0: 7 U C )e Z:D _F_ Expiration Date: Job Site Address: ,�qi 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 MCL o.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 DTA for insurance coverage verification. I do hereby cert jo us d penalties ofperjury that the information provided above is trueandcorrect Simature: Date: Phone It: 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.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other - - - Contact Person: Phone M Information and InstructRons . 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 ofhire,- express or implied,oral or.written." An emproyer 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 bean.employes." 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),addresses)and phonenumber(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. 13 a 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 retumed 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 hasprovided 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 pemut/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(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may beprovided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be fulled out each year.Where a homeowner or citizen is obtaining a license o permit not related to any business or commercial venture (i.e.a dog license orperrnit to bum leaves etc)said person is NOTrequired 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 Com- caoRWDalth ofmassarhwe"tts Aepart>aleat ofJadusWal Acexdo is OfAce ofI1westigWo.m 600 Waftgtoa Street Boston MA 02111 TO,#617-727-4900 ext406 or 1-87MASS.AFE Revised 5-26-05 Fay,*617-727-7749 _ . r Office of Consumer Affairs and Business Regulation 10 Paris Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Coactor Registration Registration: 164005 — - Type: Private Corporation Expiratlon: 8M 112013 TO 215145 MASCO HOME SERVICES, INC. iul LUCAS BENSON - 2339 BEVILLE RD DAYTONA BEACH, FL 32119 'o�MUpdate Address and return card.Mark reason for change• SCA7 6 2(1AMSI11 t Address [j Renewal 0 Employment f7Lost Card (92.1 QJp711Ulll0mm"44 f �'f IJJJII N.kd�fJ OMce of Consamcr ARalm&Business Regulalien Litense or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to.- 910911110n: o:9lstratl0n: 164005 Typos Ofilee of Consumer Affairs and Business Regulation xplraUon:;Bit 112013 Private Corporstioa 10 Park Plaza-Suite$170 , t y Boston,MA 02116 MASCO HOME SERVICES,INC. tNELI.HOME LUCAS BENSON ' 2339 BEVILLE RD DAYTONA.BEACH,FL 32t19' Uaderaecreury �i—utgftNotvad� . �� Job Number 4596 DATE 17-May-13 Client ROSE VENTRILLO 978-683-3789 address 15 WOOD AVE city i town NORTH ANDOVER MA contractor (QUALITY 1.11NEATHERSTRIPPINGICAULKING QUANTITY TOTAL AUDITOR NOTES Door Kits Q-Lon or Equiv. 6 273.00 _ Door Sweeps(Regular) 6 94.50 Door Sweeps(Automatic) 0.00 Reglaze Windows An.inch 0.00 Window.Weathstr Schlegal per side 0.00 Tenmat Recessed Can Cover 0.00 Attic air sealing per man/hr 3.5 262.50 A/S SOME AREAS BEFORE BLOWING FLAT basement and living space air sealing 2 150.00 L� SUBTOTALS 780.00 2A,INFILTRATION/INSULATION AUDITOR NOTES Domestic pipe Hot Water Tank 1st 6' 0.00 i Sill Insulation R-19 CF 0.03 Sill Two Pan Foam w/Fiberglass Latt 1 2.23 Drape Perimeter R-5 Anch.Sq.ft. 0.00 _ Perimeter 2"T-max or equivalent foam hoard sq.ft. 0.00 Drape DOOR 1-Z-5 or T-rnax or equivalent on door. 1 51.00 Tape Joints(Aluma Grip only)per hr. 2 130.00 Duct Insulation&Tape sq.ft.R-5 180 558.03 THIS IS BASE ON A 1`0Iv1ULA NOT BY ROLL Rigid Foam Boaro Anch. 1"per board 0.00 Hydronic pipe'nsjiation to 1"R-5 0.00 Hydronic pipe ins.1.25"-1.5"R-5 0.03 Steampipe Iris.to 1.25"iron pipe R-5 0.03 Steampipe Ins. 1 5"-T`su(i pipe R-5 0,00 Steampipe;.a.3"iron pipe F:-5 0.00 Air Conditioner Idaeting r�aif Air Conditioner Cover 0.00 Air Conditioner Cover Specie!Order 0.00 _w SUBTOTALS 741.20 2B.INSULATIUN AUDITOR NOTES Open Unrestricted R 49 0.00 Open Unrest';ic:tud R 38 663 974.31 d 156'FLAT ROOF 507 MAIN ROOF- �! Open Unrest;i;wd P,30 0.0) 1 Open Unrestr;ct6u R 20 470 606.30 Open Unrestricte-'R 10 0.0� Restrict FU'Sloped R 30 0.03 Restricted FL/Sloped R 4:J 0.00 _ Restrict FL/Sloped R 10 0.03 _ - R-19 FGB open rafters/wallslkneewalls 0.00 R-1 1 00R-11 F3B upen rafters/wails/kneevdalls 0.00 Attic Stairs(64....ell&common wall; 0.03 Cover Pull Dori,Stairs.her rnadorna 0-0) Site bu'.It pull au w stairs 2"Town box 0.03 �A AUDIT OR NOTES Attic/Kneewal Floor Transition.Dense pack cellulose 94 236.88 W.S.Hatch Q-Lon or equal 0.00 W.S.&bat Hatch R-30/C-Lon cu= 0.00 Kneewall R-12 cell behind Per Memb 0.00 _ Open Rafter R-20 Cell./w poly 0.00 Open Rafter R-30 Cell.hr poly 0.00 _ Basement Overhead R-19 fiberglass 0.00 Basement Overhead R-30 fiberglass 0.00 Crawlpace Overhead<4'high F'19 0.00 Crawlpace Overhead<4'high R30 0,00 Garage Ceiling cavity filled wl cellulus 0.0U ~' _ Wood,Shake,Cli;board,;:"hinglec Vinyl 296 529.64 WOOD SHINGLES _ Asbestos(siryle nail)i Asphalt 0.00 _ Asbestos(doub.Nail),'Aiuminur.i 992 2291.52 ALUMINUM SIDING Brick/Stucco 0.00 _ Vinyl over Asbestos 0.00 ma -^ Multi-layered 3 or;-oore kiyers 0.00 ` Drill rough plaster or fniso woad h:ug 0.00 Drill finish p1as+Er 0.00 Test Drli Walls ksil 4) 0,00 SUBTOTALS 4639.15 2.INSULA110N I'OTAL 2A.+,I~, 5380.35 3.STORM WINLOWS o JCADUrFs AUDITC7'1 RCTES Plexiglass up to 88 u.i. 0.00 Additional per U,over 88" 0,00 Other(Negotiatso?rica) O,OO SUBTOTALS 0.00 S.OTHER MATILLVA'. ^�AUDITO'+NOTES Ridge vent hi it. p.O Vents GaL•la ;octar,gwa. Varipitch Vent 0.00 Vent Roof I sq fi r4r V)�arye 0.00 Vent Roof 8c 5;.;sq ft NFV)Small 5 400.00 SEE NOTES Vent Saffil Turbine;Vere, AL O.UO Stack Vent 0.00 Props Vent 0.00 Permaafe vV ap 0.00 Vapor:rarri0.0 Energy Star R.,:bgiu di ryi Repl 94-101 U.I. O.GO SUBTOTAL;; 400.00 6.17.E.C.rdIAT.ERLAULAEOR 6660.35 Pt.'3e 3 8a. HEALTH& ;r'k: i' AUDITOR:NOTES l Vent Bath I Kitchen Fan 0.00 NO BATH FAi_�R_TO VENT Dryer vent w/exhaust du,t Heartland 1 89.00 ^ Dryer Transition Duct only 0.00 Blower Door Test Pre-___ Post_ 1 45.00 L ALWAYSACLUDE PRE.ANC POST` ALWAYS TAKE PICs`OF READINGS SUBTOTALS 134.00 _ 8b.REPAIR MATERIALILABOR AUDITOR_NOTES Basement outside door only 0.00 _ A' Basement outside door wl jambs 0.00 Door Repl pre hung 32-35"Steel-w!Lite 0-00 Door Ropl interior soli)core 28-32" 0.01) Door Repl pre rang 32- woac' K I Lite U.UU Window Repiacerrient vd SIR less than 1 0.00 I _ Basement Wtrrcuw Repl.Awning'Hopper 0.00 Basement Window Repl.With a frame 0.00 _ - Lcckset(door)Schlage cr equal U.00 _ Repair/ReYit iooi 0.00 Replace Side Stop 0.00 Replace Casing 0.00 Glass Replacarm;nt to Eti uJ 0.00 Glass P.eptacaMent par UJ.ovar 34 0.00 Sash =eF.iacEii:er1C 0.00 Threshald 0-00 -- Threshold(ArUiiLriUrrt) 0.00 �- Slide Bolts 0.00 Plug Plate Cover 0.00 Cut/Wish atltc-kneewail access 4 420.00 3 KW ACCESS t F=OR ATTIC BLOW Cut/close a;];u-0eew211 access 0.00 close off fascie rear of the house 0.00 _ Labor Rate I-luu- 0.00 Labor f:atE I-;uw8 0 00 -• _______._.___w_ _,_ _ Labor d;atEr,oa.s O.OU Labor fate r;vurc 0.00 Permits!Fuss(Vllap on,y) 0.0? SUBTOTALS 420.40 TOTAL RES Alk+HEALTH&SAFETY 554.00 GRAND TUdw�1VO RK LARDER# (A) 4596 7414.35 Any aliaratiu­ar deviations from the above specifications involving extra costs aiu!t be cleared in writing before installation The Wark Lu ;omplete within 15 working days from acceptance date bEtow: CONTRAG i ORiCOMPAN"i. QUALITY ACCE'TAId C:iori unJ.U:r,i,actor AUTHORIZED SIGNAL URE: DatE AGENCY AK,;kCIVALS: CTI Authorized Signature. Y _ Date.-____ GLCA0 Auu,�;,zed Signawrz< _ Date_.______ Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supcnisor Specialtc License: CSSL-100189 5 _r I THEODOREJPLONA ; IS THAYER AVF AUBURN MA 01501 Expiration commissioner 09/13/2014 i