HomeMy WebLinkAboutBuilding Permit #474 - 168 CAMPBELL ROAD 1/29/2008BUILDING PERMIT of t,�o ,Qgti
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ~
Permit NO:
Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
n�i
Addition
Two or more family
Industrial
Alter ion
No. of units:
Commercial
re iacemen
Assessory Bldg
Others:
Demolition
Other
c�.�a
s`I" 1Ya�ahar1 a. -Gfi as'6r�-0lY5-•T -S L3 .i {
RE �—`�`�`�I���.:
l'�`"_�•+- 't
?wVIZ S 23^'"' of
�
'��_t'a ',�.�,��-.—�"•c��
-,�l
r
s,�..r3 ����- � ��"3i
'e�ec�„�u ^+.�. �_r°�-s� � t,
m;������-��E�117.e7,;•- � .�
�� �_ x._�,�r..�:._s�� -�, ���'<. �._?,._.��s-;,--kA�
. __���sh_'�`'-a:�` ���_.�
DESCRIPTION OF WORK TO BE PREFORMED:
xCSTaRAT.r.wJ iGRoM / RdoM ,till aF- !'>A- A&:!4eQ /ICM e% R&C-.&1 6 -�
A1ejr- bc-c.KiAG . QCi�c e�.c'-',F- �It-pc�-c-� C¢) ppe-'2- 7 - 0 -*-V S . tW r r hcc.
.feral Raoy �� Ft tcc �G 5 " �N rc,e. A-rae�✓ Qest-/1 !� , R�� S's�••YGu-S. e.�
�� fzG'�. r e'er % /I✓l �[. �t ?.-moi f3 �.v cr/�wF-it O � �4-3 �!� /�`f %t w�i✓, �d S' x
AA�,W
Identification Please Type or Print Clearly)
OWNER: Name:'T�9WQIr- I-A-fcz, ccA- 4 DC91tA. 7 as„ubPhone:
Aririrocc-
-sr
ARCHITECT/ENGINEER b�'eraL "� �" Phone: q?8-2G3-7sdd
Address: %30'" M,41W +e7 -7,e A^^ ' Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000 0 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
ct Cost: �' '�32-a6 FEE:
Total Probe $ i
Check No.: -5^�� Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to th�4uaranty fund
�Ow
Zr
0
n
.•`
.,
M
n''�
s
NO
•�•
c�
V)
C,
o
o
c
O
ym
m aCL
O3.
-nCD
fC
4
0
3 - o
Z
'
30)
O
t
CD = M
-n �
�
a
'Ab"
ba
Z
-- c
N
W
�
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWER -AGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
3.
THE FOLLOWING SECTIONS WR'-.OFW&'U9Fc0jNLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
/
COMMENTS /---�
DATE REJECTED DATE APPROVED
C SERVATION
0 1 ww*% V 1- .'j 3
�z7nhl
mffN��%
C 4
1;y 5 "N
A
Jot
DATE REJECTED DATE APPROVED
HEALTH
COMMENTS
Q
i�- 2c" E •' r * - -
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Plannipg j"rd -,,t 1 Pn?.:,
�DQ Comments
Conservation Decision:
Comft-rts << V --) �' : • 'I'Nt'4'm
Water & Sewer Connection/signature & Date Driveway Permit
Located at 384 Os000d Street k t
KANAYO LALA, P.E.
BSCE, MASCE, M.NSPE, M.SEI, M.LE.(In&4 MAMWS, M.ACI
FOUR WEST ROAD
WEST ACTON, MA 01720
LIC.# 33710-C(MA), 9227(NI-I), 84611(1,� 32768(VA), 7736(VT)
hap://kanayo.home.att.net
January 27, 2008
Building Inspection and Zoning Department
1600 Osgood Street
North Andover, MA 01845
Re: 168 Campbell Road
I certify that I, or my authorized representative, have observed the work associated with the
damaged structural frame of the areas to be refurbished at 168 Campbell Road and that to the
best of my knowledge, the work is to be done in conformance with the permit and plans
approved by the Inspectional Services Department with the provisions of the Massachusetts
State Building Code and all other pertinent laws and the ordinances specifically to the four
rear roof rafter beams and the entire rear roof decking. The insulation above the roof
decking will be upgraded to meet current energy code.
r
*"n f�-N
i"J KAf'AAY(D 4G 1
Kanayo Lala '`'`` `- 33710-C
Engineer Mass reg. No.
Kanayo Lala, Professional Engineer
Company
Four West Road Acton, MA 01720
Address
978 337 5252
Telephone
PHONE (978) 337- L ALA kanayo a att.net
FAX (978) 263-1472
SUPPLE CONSTRUCTION, INCORPORATED
136 SUNSET ROAD CARLISLE, MA. 01741
PHONE (978) 369-7305
FAx (978) 371-3181
Mr. Robert A. Acciacca
Mrs. Debra J. Donald
168 Campbell Road
North Andover, MA 01845
Re; Fire Loss: 168 Campbell Road, North Andover, MA.
Removal and replacement of "Deck House" structural components associated with the
roof assembly and Removal and replacement of composition roofing, insulation, fascia,
and rakes.
We propose to furnish all labor, materials, debris disposal, and temporary protections of
existing finishes associated with the following scope of work:
Systematic removal of existing red cedar fascia & rake boards surrounding all roof area.
Systematic removal of existing structural, fur roof beams (4).
Removal of existing composition roofing, insulation, and drip edge.
Removal of existing skylight.
Erection of temporary supports and temporary protections of existing finishes & from
weather.
Systematic removal of structural red cedar T & G roof decking on front slope.
Installation of (4) laminated fur structural roof beams.
Installation of new structural red cedar T & G roof decking on front slope.
Installation of skylight curbing.
Installation of edge blocking and steel angles around perimeter of roof.
Installation of Ice and water shield membrane 60" from eves and around skylight.
Installation of 30 lb. felt paper, full coverage.
Installation of 5" (total thickness) of polyiso, foam insulation boards.
Installation of 1/2" plywood roof sheathing, full coverage.
Installation of (1) Velux fixed skylight.
Installation of Velux low slope flashing kit.
Installation of new metal drip edge around perimeter of roof.
Installation of 15 lb. felt paper, full coverage.
Installation of new pre primed, red cedar, two piece fascia & rake assembly.
Installation of new composition 50 yr. roofing shingles, full coverage.
All structural components to be "Deck House" specified and Massachusetts CMR Code
compliant.
All steel connectors and fasteners to be "Deck House" specified and Massachusetts CMR
Code compliant.
All insulation, and roofing materials to be "Deck House" specified and Massachusetts
CMR Code compliant (R 39.3).
All materials and components to be installed in strict accordance with manufacturer's
specifications, and Massachusetts CMR Code compliance.
All workmanship to be performed by qualified tradesmen during normal business hours.
All workmen on site to be covered by Liability and Massachusetts Workers
Compensation Insurances. Certificates of insurance are included within this contract.
All debris will be removed and properly disposed at approved facilities.
All Sales Taxes, freight and delivery charges are included.
Building Permit fee and attendance of all associated inspections is included.
No interior finishing of cedar ceiling is included in this contract.
No other work is included in this contract.
All workmanship is guaranteed for one year from installation.
All manufacturers' written warranties will be provided to client promptly upon
completion.
Total:
$84,432.00
Payment terms:
$50,000.00 Payment at delivery of "Deck House" Materials.
$25,000.00 Payment at completion of structural work.
$ 9,432.00 Payment at completion of roofing and debris removals.
Acceptance of t1X scQ Daterrtt�r�of this contract by:
Client
Z3',
Client- lJ Date:
✓'.S�rPat . �O t f-r,p1.rr /- ZN- or
Contractor: Unrestricted Builders Lie. # CS 057328 Date:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
9 '
' 600 Washington Street
.Boston, M4 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lelribly
Name (Business/Organization/Individual): $-V101011C C atjS 1 • /At C
Address: / 3 6- IvrJSE i �C n Ati `
City/State/Zip: AtA • pbnn'. 4. App'— 369- -7gof
Areyou an employer? Cheek the appropriate box:
1.0 I am a employer with ' 4. 0 I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2.19�I ama, sole proprietor or partner- listed on the attached sheet
ship and have no employees These sub -contractors have
working forme in any capacity. employees and have workers'
[No workers' comp. insurance comp• insurance.:'
required.] 5. 0
3.0 I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
We are a corporation and its
officers have exercised, their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required) -
6. ❑ New construction
7. Remodeling
8. 0 Demolition
9. [] Building. addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.X Roof repairs
13.1,%Othergve_-NAtlL
Any appacaa m mat cnecxs box 91 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
+Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp; policy number.
I am. an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company N
Policy # or Self -ins. Lic. #:
Job Site Address: 16 A'A'A' ?A CU,
Expiration Date:
City/State/Zip: Am- .401-9 VIX O 1p yr -
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure. to secure coverage as required under 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 certify U d pains 'and penalties of perjury that the information provided above is true and correct
Si atur`e: Date: */A
9/ate
Phone 1#: 9 Ff - P r- V 26 9 C 971—
not write in this area, to be completed by city or town official
City or Town:
Issuing Authority (circle one):
Permit/License #
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." r
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 m6ti.fl an 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. ofsiich,empioOA 6t 7deerned to be an employer."
MGL chapter IA1§25C(6f ,W6 states'tilat "ever state or locaf &nsing aged shall'withhold the issuance or
renewal of a Iicense or permit to,bperste-a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of cornpiiance with the insurance coverage required."
Additionally, MGL chapter 1.52, §25C(7) states "'Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for. the performance of public work until acceptable evidence of compliance with the insurance �:•
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(g) along with their certificate(s) of
insurance. Limited Liability Oompanies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
member$;grpprtners, are not'required to carry workers' compensation insurance. If an LLC or LLP does have
+.aF,mployees;'alp4 y is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Ac6 98�ts*14if confirrnation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if youare 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 givensygar,`need only slxl#rfiitltke iffi&Vt indicating current
Z'pdlidy infat%ft 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 perinits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's addr8k, tef6pAoAe and fax number:
The Commonwealth of M � husdtfst �3
Departrnent of fndzstral Accidents
Office of Investigations
604 Washington Street
Boston, MA 02.111
Tel. # 617-727-4900 ext.4.06 or 1-877-MASSAFE
` Fax # 617-727-7749
Revised 1122-06 www.mass-gov/dia-
O
FM4
W
x
o
o
cn
v
u"
u
i.
O
w
e
v
v
cn
Cd
v
R-,
�
z
q
.a
a
O
w
m
O
rx
v
-C
U
Cd
C
w
a
w
m
O
w
G
u,
x
w
w
"�
w
ono
O
u
�
G
U
`
xoo
O
G
ZWo
�
P-4
w
a
w
v
as
z
cn
v
0
a,
-"
cn
W
3
YZ D
J= F
u Q
��O
0 CO
tj
cm
y A
•mm
O ' 3H m
:m�
_c c
� m
CO2Cc
cc
Z:L
- a m 412.
�L O
O C
Q
C Z
• m O'L
to
C:j
' c � o
CL
Q � e c
= m : 'COL.
m
o
~ � hmoF-
W
UJ C�
H •y CLC
ev c
LLJ Co., -z m
V c
Lr E
C.3 CD
O CL ti K m� O�
z = W .m 0 y
CL
N
O
h
cc
c
O
ea
CD
cm
32C
m
0
ea
c
'c
N
m
r
0
Z
5
O
M
U)
O
u
U)
O
O
O
O
v
Z °D
O.
O h
D �
a� cm
I Cm
W W
CL
CD
O
O G O
i
� O �
CL o�Q
c
C C
O ea
CJCO2 J •O
C Z ts
CD
0 CL
U VD
O C
_
C_
C
CO2
LU
0
U)
U)
ce
W
19
ujW
CA
ID c
c w
O `
C H
O
C
w
v
c
.env
ev
m c
p i
tEa
v
m c
�ts
w
CD
:on
h
E c
CL
N
O
h
cc
c
O
ea
CD
cm
32C
m
0
ea
c
'c
N
m
r
0
Z
5
O
M
U)
O
u
U)
O
O
O
O
v
Z °D
O.
O h
D �
a� cm
I Cm
W W
CL
CD
O
O G O
i
� O �
CL o�Q
c
C C
O ea
CJCO2 J •O
C Z ts
CD
0 CL
U VD
O C
_
C_
C
CO2
LU
0
U)
U)
ce
W
19
ujW
CA
Kanayo Lala, P.E. . ............ 01/25t2008
PROJECT: Accciacca Residence
168 Campbell Road, No Andover, MA
DESIGN FOR - GIRDERSMOISTS /RAFTERS- Roof Rafter / Beam
At Master Bedroom
LOADS: DEAD LOAD
12.00 PSF
96 PLF
Ce-- 1
CF= 1.00
SNOW LOAD
35.00 PSF
288.62 PLF
Cq= 0.9
Cs=
LIVE LOAD
PSF
0 PLF
qs= 21
Cd=1.15
TOTAL LOAD
384.62 PLF
1= 1
Cm=1
WIND SPEED
100 MPH p
18.9 PSF
POINT LOAD
LB a=
FT
Ra=
0 LB
2884.63
TRIBUTARY WIDTH
8 LF
E= 1800000 PSI
JOIST/GIRDER SPAN
15 LF
Fb=
2400 PSI
WIDTH- IN 3.125 GLAM 11.25"
IN
= d Fv=
190 PSI
ROOF PITCH - N :12 =
3
Fc=
1900 PSI
Fcp=
650 PSI
MOMENT=
10817 LB -FT
MOMENT2=
0 LB -FT
66 =S provided OK
S=
47 IN"3
371 =1
Deflection =
0.66 IN =L/
274
274 For Total Load
Required U240
Deflection2 =
0.00 IN =L/
ERR
365 For Live Load
Required U360
Fcp'=
284 PSI
OK
3.25 In Bearing Length
FV=
123 PSI
OK
REPLACE EXISTING DAMAGED ROOF RAFTERS/BEAM WITH FIR GLUELAMS 3 1/8"X11 1/4" OR LARGER
AND REPLACE THE STRUCTURAL DECKING WITH 3" THICK RED CEDAR LAMINATED DECK FOR 8 FEET SPAN ROOF.
THE SECTION DETAIL DESCRIBES THE RIGID INSULATION AND REQUIRES NO VENTING AS PER STATE CODE CMR 780.
DAP FOR STRAP
21/2 "WIDEx#'LONGx3/16" DEEP
All
PG. F2-1
BEAN STRA.F (585 STR^-.F) (]id N.AIL5)
RAFTER A5 FER FLAN
(2) NETAr BEAN STRA.FS (51218
�i (12GA)) ONE EA. `IDE. ATTAC!-!ED
\ WIN lOd GALV. NAILS EA. 50E.
RABBET TED F05T
45 FER FLAN
DOUBLE PARER TO FOST DETAIL
SCALE: 1 1/2" = 1'-0" i
CK\Manual, Current\F_Roofbm\F2-1
ECK HOUSE, LLC STANDARD DETAIL
!fain Street, Acta, Mass. Phone (617) 259-9450
1 1 J
s<at�S
COPYRIGHT
�� TE
6y DECK HOUSE. LLC
These plans may not
Ae used in any way
Gated
without the written
Pnnnission of the
2-3-04
copyright owner.
==-5� -1
RAFTER
PG. F1-1
/ —CUT AT DECKING
1 3"xIe," PRE -GUT BUTYL TAPE
51TE APPLIED FULL DEPT!
OF BEAM, TRIM AT DECKING
OR WRAP ONTO TOP OF BEAM
(SINGLE LAYER) BEFORE
DECKING 15 INSTALLED.
BEAM 5 T RAP 1<5T-210 EA.
SIDE FASTENED W/ (22) 10ol
GALV. NAILS.
DAP FOR STRAP:
2'/2"WIDEx6'/2"LONGx3/1(o"DEE
POST RABBETTED 45
PER PLAN
F1 fRAFTER TO FOST, 5TANIDARE) 1.
NO SCALE
.' A ..j�
I
ECK\Manual, Current\F—Roofbm\F1-1 I'
SeaA� NOTED COPYRIGHT ` I
DECK HOUSE, LLC DECK HOUSE, LLC
STA VDAfRE) Th I
These plans m¢y not 1
6e used in any way
[DETAIL
Dnted wilhout the vrritten
10 Main Sireet, Acton Mass. Phone (617 259-9450 permissiowner.
of the
t 2 — J - 04 copyrightwner.
f ��
PG.
EACH INDIVIDUAL PLANK MUST BEAR ON AT LEAST ONE SUPPORTING MEMBER. ALL JOINTS SHA
BE END MATCHED AND ALL PLANKS SHALL BE NA' -ED TOGETHER WITHIN ONE FOOT OF EACH
OF THE END JOINT, END JOINTS IN ADJACENT PLANKS SHALL BE ATLEAST TWO FEET APART, ANI
END JOINTS IN ALTERNATE PLANKS SHALL BE - IORE THAN ONE FOOT APART WHEN MEASURED
ALONG THE SPAN OF THE DECKING. ELIMINATE END JOINTS IN 1/3 OF THE END SPAN C;; )RSE.
USE THE NAILING- PATTERN ILLUSTRATED FOR BOTH ROOF AND FLOOR DECKING (IF AFFLICABL
NAIL EACH 3X/o COURSE TO BEAM SUPPORTS WITH (2) 206 NAILS PER COURSE. BETWEEN SUFF(
TOE NAIL EACH COURSE TO TON' :.UE OF ADJACENT COURSE USING Sd NAILS AT 45° a 30" O.G.
STAGGER ADJACENT ROU) OF. NAILS 15". USE ADDITIONAL NAILS 12" TO EACH SIDE OF END ,JOINT
NOTE:
THAT DECKING SHOULD NOT BE HANDLED WITH DIRTY
OR OILY HANDS TO AVOID SMUDGES ON FACE SURFACE.' ;d
N,
LAMINATED
�r.r���c; 'fit✓'
LAMINATED DECKIN ;,- L
F NAILING DIAGRAM ��,....�.t TQC;:; r1 ,
Lr> ,
DECK\Manual, Current\F—Roofbm\F-1
i
LCK HOUSE, LLC
fain Street, Acton bfass. Phone (617) 259-9450
L—
sate:
COPYRI
011
LAMINATED DECKING
by DECK 1101
NAILING DIAGRAMbe
These plans
used in c
without the
Dated
2-3-04
permission o
copyright ou
METAL DRIP EDGE
ICE & WATER SHIELD (FIRST 5'-0")
1/16 OSB.: STAGGER JOINTS OVER INSULATION.
LAYER OF 2" RIGID INSUL.
[0)
o�AGGERED SEAMS RIGID INSUL
S
2X6 BLOCKING
SITE APPLIED
P
MI=
CLIP e 24" O.C.
IIYII
I
11/1C " X -1 1/4" PRIMED CEDAR TRIM
11/16" X 5 1/2" PRIMED CEDAR TRIM
,f
EAVE: 1/211 UNVENTED
�1
15 lb FEL
l 1/2" SCREWS
a 12" O.C. VERT.
e 16" O.G. I-IRZ,
BEAM
OVERHANG
ROOF PITCH
"'I "
: OVEfR ANIG
3 IN 12
2'-2
1/2"
4 IN 12
2'-2
1/2"
5 IN 12
11-11
1/4"
-1 1/2 IN
12
1'-4
1/2"
<\Manua1,Current\R\ R5.5-1
JMPYIRV1EAN VE5A1UN1/ENTED
NTE RNA TIONAL, LLC.
Matin Street, Acton Mass. Phone (978) 263-7000 INSULATION
30 Ib FELT ABOVE'
3XC LAMINATED
DECKING
ROOF BEAM
TOP OF POST
POST
* REDUCE STAGING
TO 8" O_C. AT FIRST
4' FROM EAVES AND
RIDG-ES.
R = 39.3
,. 01
*.�.
,}j.
_ !'?
'i
seafe:
COPYRIGHT
by EAfPYP.EAV
INTERNATIONAL, LLC.
These pians may not
Dated
be used in any way
ten
without the written
5-22-0
permission of the
copyright owner.
4 k
METAL DRIP EDGE
15 Ib FELT
1/16 OSB.: STAGGER JOINTS
OVER INSULATION.
2x6 BLOCKING
SITE APPLIED
v -
m
1'-0I'
OR AS PER PLAN
11/16X1 1/4 PRIMED CEDAR TRIM
11/16X5 1/4 PRIMED CEDAR TRIM
PG. R5-3
I
I
-1 1/2" SCREWc.- I
�8" D.C. VERT. E 10" O.G. ='�L.
(1) LAYER 2" E 3 11/2" RIGID
INSULATION (STAG-G-ERED SEAMS)
30 Ib FELT ABOVE
F 3X6 LAMINATED DEC<ING--
RA<E: 5 1/2" UNVENTED ROOF
ECK\Manua1,Current\R\R5.5-3
ROOF BEAM OR
EXT. BEARING- PAN -=L
K
V
CI''� FIs e.r'i, �Cr7
t 7
✓ Y
— .• -ter" __-� ; t
i
T
RA <E 5 1 /2
Scale:
3 _ -moi"
COPYRIGHT
F.,ifP
I \!1�
1
E M P Y R� A�
.
INTERNATTONA LLC.
ns m
These plans may not
he
1`y
I N& U L A T I ON
t a in any way
y
INTERNATIONAL, LLC.
Dated
without the written
hour
930 Main Street, Acton Mass. Phone (978) 263-7000
9 -1- 05
c yr ght owner—.1
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
Doc.Buildin; Permit Revised 2007
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
Building Permit Application
- El Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
❑ Floor Plan Or Proposed Interior Work
4.�ngineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
a Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2007
Date ...... zf� -,
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ........1k) L` 541 t 7-.,/ C-1-E�r'a (a. n
.........................................................................
has permission to perform....................... ...
...................................... a ........ ..........................
CC f4�c�
wiringin the building of...................................................................................
at Z.....C'!9�? ��, North Andover, Mass.
...........................................................
Fee..................... Lic. No.............. ................... �........... .....
... .... ......... ...
ELECTRICAL INSPECTOR i
Check # -7-3Z'
s��
Commonwealth of Massachusetts
TElm Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. YCO 3
Occupancy and Fee Checked
1ev.1/07] (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 0—/9- o c -
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to erform the electrical work described below.
Location (Street & Number) to C fi- j+, -p rj /Ji r
Owner or Tenant Q C e C', Telephone No.
Owner's Address
Is this permit in conjunction with a uilding permit? Yes [Z No ❑ (Check Appropriate Box)
Purpose of Building Fe S, r e n j; q Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work: 2 /��'
CJvt To �'�-e P �= �ec7—c,'C;�J i�v,�r,'nq lK f3�rn.,
G,� e o ✓?leT 13 ,`n� c�,� �p oc code
No. of Recessed Luminaires
No. of Ceil: Susp. (Paddle) Fans
uum mu ue walvea oy Ine llu ector of wires.
No• of Total
Transformers KVA
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In ❑
rid. rnd.
o. o Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
No. of Zones
No. of Switches
No. of Gas Burners
No. of Detection and
tiatin Devices
No. of Ranges
No. of Air Cond. Tns
TottDetection/Alerting
Alerting Devices
No. of Waste Disposers .
Heat Pump
Totals:
Number
Tons
KWSelf-Contained
Devices
No. of Dishwashers
Space/Area Heating KW
oca❑ Municipal ❑ Other
Connection
No. of Dryers
No. of WHof eaters KW
Heating Appliances KW
No. of al
Ball
Signs Ballasts .
Security Systems:*
No. of Devices or Equivalent
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
TelecommunicationsWiring:
No. of Devices or E uivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of Wires.
Estimated Value of Electrical Work: o d (When required by municipal policy.)
Work to Start: 2 - a U - D 2- Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE [g BOND ❑ OTHER ❑ (Specify:)
I certify, under the pains and penalties of perjury, that the information on this application is true and complete -
FIRM NAME: Lt/. . J e CTs . C as I LIC. NO.: 1S619� 4
Licensee: WA- j T r 3,AA !!%Ii Signature ti LIC. NO.:
(If applicable, enter "exempt " i��jythe license numbe line. n Bus. Tel No.: % i `✓ 57 3 ' G/��
Address: _ % �/ /ih h f A r` r r� /21 , -�C) r Gf Q Alt. Tel. No.: 3,9' 6 3 Y- 1-/27 F -
*Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
10
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
•t°;t, i
Boston, BMA 02111
www.mass.gov/dia .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Alaalicant Information Please Print Legibly
Naive (Business/Organization/individual): t s {� , I /L' (c (:j t' , C rg
Address: / /4n r
City/State/Zip:_ & /-9dr J VO y4 p ?5 % Phone #:. % 7t - !� 73 D /7-6
Are you an employer? Check the appropriate box:
Type of project (required):
1. ❑ I am a employer with
4, Q I am a general contractor and I
6. Q New construction
employees (full and/or part-time).*
2. R I am a.sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet. I
7. ❑ Remodeling
ship and have no employees
These subcontractors have
S. Q Demolition
working for me .in any capacity,
[No workers' comp. insurance
workers' comp. insurance.
5. ❑ We are a corporation and its
q, Q Building addition
required.]
officers have exercised their
10. Electrical repairs or ad>>Ss
ep
3. ❑ I am a homeowner doing all work
right of exemption per MGL
1111 Plumbing repairs or additions
myself [No -workers' comp,
c. 1.52, § 1(4),' and we have no
12.1 Roof repairs
insurance required.] t
employees. [No workers'
13.1 Other
comp. insurance required..]
'Any appttcant that checks bob # t must also fill out the section below showing their workers' compensation policy information.
t homeowners who submit this affidavit indicating they are daring all work and then hire outside contractors must submit a new affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing• the name of the sub -contractors and their workers' comp. policy information.
I ant an employer that is providing workers' compensation ivancefor my eploeeBelw itepinformation. micy andjob site
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: 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 required under 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 certo under pal nd pent ftk�s f perjury that the information provided above is true and correct.
Signature: �J2%I Date-
Phone #: % 7 y 173 — D / �O
Official' use only. Do not write in this area, to be completed by city or town ofciaL
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
LL& Other
Contact Person: Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the'foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. 'However the
owner, of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence.of compliance with the insurance' coverage required."
Additionally, MGL chapter 152, §25C(7) states' Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation. affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -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 may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage.. Also be sure to sign and Hate the affidavit. The affidavit should,
be returned to the city or town that the application for the permit or license is being requested, not -the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. in addition, an applicant
that must submit multiple permit/license applications in any given year, need. only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to 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 industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 eat 406 or 1-8.77-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
4
IL
•
T .. COMMONWEALTH OF MASSACHUSETTS
OF ELECTRICIANS
REGISTREDSMASTER EN ECoTRICIAN
E
WALTER, L SMITH
19 BL1ANCRARiD RD
M"A 01757-2458
MILFORD
07/31/10.. 302152,
15668 A • •
Fold, Then Detach AlOn g All Perforations
CONTROL # E 3 8 714 9
IMPORTANT
If this license is lost or destroyed, notify your Hoard at the:
Division of Professional Licensure, 239 Causeway St.,
5th Floor, Boston, MA 02114.
If your name or address shown 's changed, notify your c-oard
of correct name or address to insure proper mail rg of next
Renewal Application. Always refer to your license number.
This license is subject to the provisions of the General Laws
as amended. It is a personal privilege, and must not be ioaned
or assigned to any other person. Keep this license on your
person or posted as required by law.
COMMONWEALTH OF MASSACHUSETTS
CTRICIANS
AS A REG .JOURNEYMAN ELECTRICIAN
OF ELE
ISSUES THIS LICENSE
WALTER L SMITH`
19 BLANCH'ARD RD
MA 01757-2458
MILFORD 302151 .
36126 E. 07%31710. •
Fold, Then Detach Along All Perforations
CONTROL # E 3 8 (fin 4 8
IMPORTANT
If this license is lost or destroyed, notify your Board at the:
Division of Professional Licensure, 233 Causeway St.;
5th Floor, Boston, MA 02114.
If your name or address shown is changed, notify your board
of correct name or address to insure proper mailing of next
Renewal Application. Always refer to your license number.
This license is subject to tf e provisions of the General Laws
as amended. It is a personal privilege, and must not be !caned
or assigned to any other person. Keep this license .in your
person or posted as required by law.
Fold. Then betach Along All Perforations
Fold, Then Detach Along All Perforations
N
N2
IV
Date .... !:/....C/
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ....... ............. C—--*--***
has permission to perform ....... TA�
.t..'q ....... .......
wiring in the building of...... 471 .... ......
....... .—e, North Andover, Masse
F,f e ..... ...................... 0..
. ..... ..........
Z/—ELEcrRICAL INSPEC-MR
/le/'/
qLj,&/04/cn 11:35 50-00 PAID
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
THE09A MONWF.ALTHOFMASSACffL5= Office Use only %
DEPARTAfYl0FPUBLICS4= Permit No. { /
UV
BOARD OFFIREPREfiF. M0NREGMTI0NSV7CMR 12DO
Occupancy & Fees Checked
APPLICATION FOR PERMff TO PERFORM ELECTRICAL WORK
ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 G ��
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date o
Town of North Andover
The undersigned applies for a permit to perform the electrical work described below.
Location (Street &Number) 14157 ,_ I _ d wlh ,
Owner or Tenant i17 LL,7/ 2L1an987LJ-/—
Owner's Address 6L j-`� Aff4 i.-11 Brl.
Is this permit in conjunction with a building permit: Yes M No
Purpose of Building
Existing Service Amps / Volts
New Service ,� Amps/,iO /d OVo]ts
To the Inspector of Wires:
Ll
(Check Appropriate Box)
Utility Authorization No. /G3 4-R 7
Overhead M Underground M
Overhead Underground M
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Meters
No. of Meters �l —
No of Lighting Outlets
No. of Hot Tubs
No. of Transformers
Total
KVA
Mo. of Lighting Fixtures
Swimming Pool Above
Below
Generators
KVA
and 1:1round
No. of Receptacle Outlets
No. of Oil Burners
No. of Emergency Lighting Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS
No. of Zones
No. of Ranges
No. of Air Cond. Total
Tons
No. of Detection and
No. of Disposals
No. of Heat Total Total
Pumps
Tons
KW
WtiatingDevices
No. of Sounding Devices
No. of Dishwashers
Space Area Heating KW
No. of Self Contained
Detection/Sounding Devices
Local Municipal
Other
No. of Dryers
Heating Devices KW
0 Connections
No. of Water Heaters KW
No. of No. of
e
Signs
Bailasis
No. Hydro Massage Tubs
No. of Motors
Total HP
OTHER
irmra=Cotiea Lam
Iha�eaamatLi�blityhatm=PbticymaxhlgCcr�CowdWcritsst lec�� YES NO
IhaN-esrhxrtdvalidprnofofsarretotheOffim YES F-1 If} uhmduJAYES, *ase indicAethetpeof6magebydakirgthe
1NSVR6,NCE [D/BOND F-1 OTHM F-1 (Ps mSpeffy)
Esttr i*d Vah�eo Ekftical work $
wodk�slazt 8- fnspe�crtDa�Rd Rotgh F'a>al
Sigrtad M±M Fedtie5 k£pajt sy
FIRM NAME VRAJI-5—//,1O AJ
Irxr>see (/r(�/'c
Stgtmae No
�- Business TeL -
` a r Al TeL Na f2
OWNER'S MJRANCEWANER;tamawaredrattheI.ioaisedomnot l r+edrtr m=a a-tsakWnrtialc4mkrtasm*medby&tmmd 3cosCtnaaiLaws
and dvtmysigviuncnd%pwn appfiCatiatwai�esf asralttism=
(Please check one) Owner a Agent o I ,I d
Telephone No. PERMIT FEE $ '(J
�aLb -1-11