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HomeMy WebLinkAboutBuilding Permit #769 - 170 HICKORY HILL ROAD 5/22/2007L BUILDING PERMIT o* "° oT 6'�ti TOWN OF NORTH ANDOVER*° APPLICATION FOR PLAN EXAMINATIO2(1 q *y Permit N0: Date Received SSACHUS� Date Issued: - TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ,'Addition ❑ Two or more family ❑ Industrial 9 Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other n Septic A�i,VVe� ❑ Floopl ©W�tlads,� Q "rsfie�istrrc 14 DESCRIPTION OF WORK TO BE PREFORMED: R&n0V,r �xls���� s �•n�2s l�2c�/. �'v,�sr2ucr �'x zZ' J%�vb� S ; aRZ /fib b i 10IJ 70 1�5a I -rlA* holn Identification Please Type or Print Clearly) OWNER: Name: 'r>4vl.D Go.ubuxE fCci Phone: Address: 176 TAf IqtiDavf-2 '414. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $,.=- : - ����'1Z909EE: $ /Oc�o— Check No.: Receipt No.: -- NOTE: Persons contracting with unregistered contractors do not have access to the guar nd Signatureof Agentlwneg ;l ignnatureofY corittactorP_ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ 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 LANNING & DEVELOPMENT COMMENTS 01 DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED CONSERVATIO �`2C2 COMMENTS HEALTH COMMENTS a I' u DATE REJECTED DATE APPROVED Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street Dimension Number of Stories Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop ectVires approval of Electrical Inspector Yes No � C DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use - Alz�' ❑ Notified for pickup - Date Doc.Building 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 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ opy of Contract ❑ loor Plan Or Proposed Interior Work ❑ ngineering Affidavits for Engineered products NOTE: All d mpster permits require sign off from Fire Department prior to issuance of Bldg Permit Additilon Or Decks Z Building Permit Application aK Certified Surveyed Plot Plan 31 Workers Comp Affidavit a' Photo Copy of H.I.C. And C.S.L. Licenses ae' 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 Location-/lo Ad ae No. Date HORT" TOWN OF NORTH ANDOVER Oft«•° •�'% Certificate of Occupancy $ b",••° ''<<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # fa f 2G239 �B4O6�inglnsp�ector REPORT: May, 2007 Lary Palmisano; Contractor 508.509.7593 Prepared for: Condurelli Residence 170 Hickory Rd. N. Andover, MA 01845 Phone DANIEL L. _ _ _ _ Fax o GELINAS — — — — STRUCTURAL q No.33994 Contact: _ _ _ 9 c. Prepared bv: Gens Structural �rqneerinq I LC Daniel L. Gelinas, P.E. 579A North End Blvd. Salisbury, MA 01952-1738 Phone 978.465.6436 Fax 978.465.5160 Email: dant eli as@comcast.net andaol.com rroo- I im LL 3966 lbs LL 2219 lbs DL 3909 lbs OL 3188 lbs SL 4830 lbs SL 4830 lbs Total Horizontal Product Length a 14-00-00 LOW Tag Summary Description Load Type Ref. --a$E" Triple 1-314" x 14" VERSA -LAM® 2.0 3100 SP Floor BeamIH22 three ply BC CALL® 9.3 Design Report - US 1 span I No cantilevers 10/12 slope Wednesday, M '00 12:30 Build 057 Standard Load Unf. Area (psf) Left 00-00-00 14-00-00 File Name: BC.BCC 2.5 Job Name: Condurelli Residence Headers/ Beams at removed walls Description: H22 three ply Address: Lot 18, 170 Hickory Hill Road Specifier: Dan L. Gelinas, PE City, State, Zip: North Andover, MA Designer. Gelinas Structural Engineering LLC Customer: Lary Palmisano Contractor 508-509.7593 Company: 579A North End Blvd., Salisbury, MA 01952-1738 Code reports: ESR -1040 Misc: phone 978.465.6436 [Fax 51601 LL 3966 lbs LL 2219 lbs DL 3909 lbs OL 3188 lbs SL 4830 lbs SL 4830 lbs Total Horizontal Product Length a 14-00-00 LOW Tag Summary Description Load Type Ref. Start End Lire 100% Dead 9016 Snow 116% wind Roof Live 133% 126% Trib. 1 Standard Load Unf. Area (psf) Left 00-00-00 14-00-00 0 0 Total Load Defl. 16-00-00 2 Reaction from Designs\Head... Cone. Pt. (lbs) Left 04-00-00 04-00-00 3945 1627 2 Na 3 roof Unf. Area (psf) Left 00-00-00 14-00-00 Span / Depth 10 30 17-00-00 4 attic Unf. Area (psf) Left 00-00-00 14-00-00 20 10 Bearing Supports 08-00-00 5 wail Unf. Area (psf) Left 00-00-00 14-00-00 0 10 92.2% 06-00-00 6 to roof Unf. Area (psf) Left 00-00-00 14-00-00 10 30 06-00.00 Controls Summary Value % Allowable Duration Load Case Span Location Pos. Moment 39915 ft -lbs 79.7% 115% 2 1- Internal End Shear 10898 lbs 67.8% 115% 2 1 - Left Total Load Defl. U297 (0.547") 80.8% 2 1 Live Load Defl. 0430 (0.378") 83.8% 2 1 Max Defl. 0.547" 54.7% 2 1 Span / Depth 11.6 n/a 1 % Allow % Allow Bearing Supports Dim. (L x w) Value Sum Member Material BO Post 3-1/2" x 5-1/4" 12705 lbs Na 92.2% Unspecified B1 Post 3-1/2" x 5-1/4" 10236 lbs n/a 74.3% Unspecified Column at Bearing BO analyzed for bearing only, column analysis has not been performed. Column at Bearing B1 analyzed for bearing only, column analysis has not been performed. Notes Design meets Code minimum (0240) Total load deflection criteria. Design meets Code minimum (0360) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Page 1 of 2 Disclosure Completeness and accuracy of input must be verified by anyone who would rely on output as evidence of suitability for particular application. Output here based on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide or ask questions, please call (800)232-0788 before installation. BC CALLS, BC FRAMERS, AJSTM, ALUOISTS, BC RIM BOARDTM, BC19, BOISE GLULAM-, SIMPLE FRAMING SYSTEMS, VERSA -LAMS, VERSA -RIM PLUSS , VERSA -RIMS, VERSA -STRANDS, VERSA -STUDS are trademarks of Boise Wood Products, L.L.C. 0`7 0 (c. 0) • BOISE" Double 1-3/4" x 16" VERSA -LAMS 2.0 3100 SP Floor Beam\1i22 two ply BC CALCS 9.3 Design Report - US 1 span I No cantilevers 0/12 slope Wednesd 16, 200712:29 Build 057 File Name: BC.BCC ?� Job Name: Condurelli Residence Headers/ Beams at removed walls Description: H22 two ply Address: Lot 18, 170 Hickory Hill Road Specifier: Dan L. Gelinas, PE City, State, Zip: North Andover, MA Designer: Gelinas Structural Engineering LLC Customer. Larry Palmisano Contractor 508-509.7593 Company: 679A North End Blvd., Salisbury, MA 01952-1738 Code reports: ESR -1040 Misc: phone 978.465.6436 (Fax 5160) LL 3966 lbs LL 2219 lbs DL 3874 lbs DL 3153 lbs SL 4830 lbs SL 4830 lbs Total Horizontal Product Length =14-00-00 Load Summary Live Dead snow Wind Roof Live 1 Standard Load Unf. Area (psf Left 00-00-00 14-00-00 0 0 2 Reaction from DesignslHead... Cone. Pt. (lbs) Left 04-00-00 04-00-00 3945 1627 3 roof Unf. Area (psf) Left 00-00-00 14-00-00 10 4 attic Unf. Area (psf) Left 00-00-00 14-00-00 20 10 5 wall Unf. Area (psf) Left 00-00-00 14-00-00 0 10 6 to roof Unf. Area (psf) Left 00-00-00 14-00-00 10 Controls Summary value % Allowable Duration Load Case Span Location Pos. Moment 39806 ft -lbs 92.6% 115% 2 1 - Internal End Shear 10663 lbs 87.1% 115% 2 1 - Left Total Load Defl. L/296 (0.548') 80.9% 2 1 Live Load Defl. 1-/427 (0.38") 84.2% 2 1 Max Deft. 0.548" 54.8% 2 1 Span / Depth 10.2 Ma 1 % Allow % Allow _Bearing Supports Dim. (L x! Value Support Member Material BO Post 3-112" x 3-112" 12671 lbs nla 137.9% Unspecified 81 Past 3-112" x 3-1/2" 10202 The n/a 111.0% Unspecified Column at Bearing BO analyzed for bearing only, column Column at Bearing B1 analyzed for bearing only, column has not been performed. has not been performed, Design meets Code minimum (1-1240) Total load deflection criteria. Design meets Code minimum (0360) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria, User Notes loads conservative. bearing below ok for two ply Page 1 of 2 71P 30 17-00-00 08-00-00 06-00-00 30 06-00-00 Disclosure Completeness and accuracy of input must be verified by anyone who would rely on output as evidence of suitability for particular application. Output here based on building codeaceepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes, To obtain Installation Guide or ask questions, please call (800)232-0788 before installation. BC CALLS, BC FRAMERS. AJS-, ALUOISTS , BC RIM BOARD-, BCIS , BOISE GLULAM-, SIMPLE FRAMING SYSTEMS, VERSA -LAMS, VERSA -RIM PLUSS , VERSA -RIMS, VERSASTRANDO, VERSA -STUDS are trademarks of Bo" Wood Products, L.L.C. w 1 1 - Internal Completeness and accuracy of input must End Shear 4593 lbs 48.5% 100% Triple 1-3/4" x 9-1/2" VERSA-LAMV 2.0 3100 SP Floor BeamlHeader H21 3 ply BC CALL® 9.3 Design Report - US 1 span I No cantilevers 0/12 slope Wednes a 16, 200712:24 Build 057 Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load File Name: BC.BCC 00-00-00 Job Name: Condurelli Residence Headers/ Beams at removed walls Description: Header H21 3 ply 16-00-00 Address: Lot 18, 170 Hickory Hill Road Specifier: Dan L. Gelinas, PE 12-03-15 City, State, Zip: North Andover, MA Designer. Gelinas Structural Engin LC Customer. Lary Palmisano Contractor 508-509.7593 Company: 579A North End Blvd., Salisbury, MA 01952-1738 Code reports: ESR -1040 Misc: phone 978.465.6436 (Fax 51601 LL 3945 lbs LL 3945 lbs DL 16271bs DL 1627 lbs Total Horizontal Product Length = 12-03-15 Load Summary 1 1 - Internal Completeness and accuracy of input must End Shear 4593 lbs 48.5% 100% Live Dead Snow Wind Roof Live Tao Deserlptlon Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf. Area (pen Left 00-00-00 12-03-15 0 0 16-00-00 2 2nd fir Unf. Area (psf Left 00-00-00 12-03-15 40 10 13-00.00 3 wall Unf. Area (psf) Left 00-00-00 12-03-15 0 10 06-00-00 4 attic Unf. Area (psf Left 00-00-00 12-03-15 20 10 06-00-00 Controls Summary value %Allowable Duration Load Case Span Location Disclosure Pos. Moment 15921 ft -lbs 76.0% 100% 1 1 - Internal Completeness and accuracy of input must End Shear 4593 lbs 48.5% 100% 1 1 - Left be verified by anyone who would rely on Total Load Defl. L/265 (0.538") 90.7% 1 1 output as evidence of suitability for Live Load Doff. 0374 (0.381") 96.3% 1 1 particular application. Output here based Max Defl. 0.538" 53.8% 1 1 on building code -accepted design Span / Depth 15.0 n/a 1 properties and Installation tion o BOISEengineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim. (L x W) Value Support Member Material building codes. To obtain Installation Guide BO Post 3-1/2" x 5-1/4" 5572 lbs n/a 40.4% Unspecified or ask questions, please call (800)232-0788 before installation. B1 Post 3-1/2" x 5-1/4" 5572 lbs n/a 40.4% Unspecified BC CALCO, BC FRAMER®, AJSTM, Cautions ALUOISTS , BC RIM BOARD-, BCI®, Column at Bearing BO analyzed for bearing only, column analysis has not been performed. SYSTEMS, VEBOISE S , VE TM, SIMPLE FRAMING RSA -LAMS, VERSA -RIM Column at Bearing Bi analyzed for bearing only, column analysis has not been performed. PLUS®, VERSA -RIMS, VERSA -STRANDS, VERSA -STUDS are Notes trademarks of Boise Wood Products, Design meets Code minimum (L/240) Total load deflection criteria. L.L.C. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (10) Maximum load deflection criteria. a minimum = 2" c = 5-1/2" b minimum = 2-1/2"d = 6" Member has no side loads. Connectors are: 112 In. Staggered Through Bolt Page 1 of 1 B GSMble 1-3/4" x 11-114" VERSA -LAM® 2.0 3100 SP Floor Beaml...Header H21 two ply BC CALC®' 9.3 Design Report - US 1 span I No cantilevers 10/12 slope Wednesday, , 200712:22 Build 057 File Name: BC.BCC ,�i Job Name: Condurelli Residence Headers/ Beams at removed walls Description: Header H21 two ply Address: Lot 18, 170 Hickory Hili Road Specifier. Dan L. Gelinas, PE City, State, Zip: North Andover, MA Designer: Gelinas Structural Engineering LLC Customer. Larry Palmisano Contractor 508-509.7593 Company: 579A North End Blvd., Salisbury, MA 01952-1738 Code reports: ESR -1040 Misc: phone 978.465.6436 (Fax 51601 LL 4000 lbs LL 4000 lbs DL 1632 lbs DL 1632 lbs Total Horizontal Product Length =12-06-00 Load Summary Tag Description Load Type Ref. Start End Live 100% Dead 90% Snow Wind Roof Live 115% 133% 125% Trib 1 Standard Load Unf. Area (psf) Left 00-00-00 12-06-00 0 0 16-00-00 2 2nd fir Unf. Area (psf) Left 00-00-00 12-06-00 40 10 13-00-00 3 wall Unf. Area (psf) Left 00-00-00 12-06-00 0 10 06.00-00 4 attic Unf. Area (psf) Left 00-00-00 12.06-00 20 10 06-00-00 Controls Summary vatue %Allowable Duration Load Case Span Location Pos. Moment 16332 ft -lbs 85.0% 100% 1 1 - internal End Shear 4524 lbs 60.5% 100% 1 1 -Left Total Load Defl. L/282 (0.51311) 85.2% 1 1 Live Load Defl. 11396 (0.365") 90.8% 1 1 Max Defl. 0.513" 51.3% 1 1 Span 1 Depth 12.8 n/a 1 %Allow %Allow Bearing Supports Dim. (L x W) Value Support Member Material BO Post 3-1/2" x 3-1/2" 5632 lbs n/a 61.3% Unspecified B1 Post 3-1/2" x 3-1/2" 5632 lbs n/a 61.3% Unspecified Cautions Column at Bearing BO analyzed for bearing only, column analysis has not been performed. Column at Bearing B1 analyzed for bearing only, column analysis has not been performed. Design meets Code minimum (L/240) Total load deflection criteria Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Connection Diagram a minimum = 2" c = 7-1/4- b minimum = 2-1/2"d = 6" Holts are assumed to be Grade A307 or Grade 2 or higher. Member has no side loads. Connectors are: 112 in. Staggered Through Bolt Page 1 of 1 Disclosure Completeness and accurecy of input must be verified by anyone who would rely on output as evidence of suitability for particular application. Output here based on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood products must be In accordance with current installation Guide and applicable building codes. To obtain Installation Guide or ask questions, please call (800)232-0788 before installation. BC CALC®, BC FRAMERS, AJ$Tm, ALUOIST®, BC RIM BOARDTM, BCI®, BOISE GLULAMTM, SIMPLE FRAMING SYSTEM®, VERSAAAMO, VERSA -RIM PLUS®, VERSA -RIMS, VERSA -STRAND®, VERSA -MOO are trademarks of Boise Wood Products, L.L.C. el,, S * �, I X . ♦- ­.. I V wd�JL4,c ., wr I GEUKAA fgw;4 - — wf"jmumm4=4mFm= 04-10-2007 11:50AM FROM-FERDINANDO INS ASSO INC 603 645 4331 T-423 P.001/001 F-739 MVVI�I.i— \i `1\ 1 11 IV/—\ 1 1. VI LIl1VIL1 1 1 11,111 \l1Vh.. JPBUI_1 1 04/10/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Fordinando Insurance Assoc Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 637 Chestnut Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR Manchester NH 03104 Phone: 603-669-3218 FdX:603-645-4331 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Acadia Insurance Company INSURER B: AIG Ins. Cos. J.R. Builders, Ync. Laurance R. Pkmlsano INSURERC ^ INSURER D: 599 Canal street Lawrence MA 01840 INSURER E: r`nVr. R A!_ 0 C THC POLICIES OF INSURANCE L13TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY DE ISSUED OR MAY PERTAIN. THE INSURANCC 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, POLICY NUMBER DATE MMIDDlYU_L POLICY Y DATE MM �DMf N LIMITS LTR NSR TYPE OF INSURANCE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL David & Deborah Condurel l i GENERAL LIABILITY 170 Hickory Hill Lane IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR No- Andover MA EACH OCCURRENCE $ 1000000 PREMISES(Go oeeurence $250000 A X COMMERCIAL GENERAL LIABILITY CLA0210774 02/27/07 02/27/08 CLAIMS MADE E X I OCCUR MED EXP (Any one person) $ 500 0 PERSONAL BADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000• ^ GEMLAGGREGATE LIMIT APPLIES PER; PRODUCTS - COMPIOPAGG $ 2000000 POLICY PRO JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Eeaccaenl) $ BODILY INJURY (Per person) $ —. ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY _ HIREDAUTOS NON -OWNED AUTOS (Per seeidem) PROPERTY DAMAGE (Per occloonl) S GARAGE LIABILITY AUTO ONLY • EA ACCIDENT $ OTHER THAN EAACC $ ANY AUTO AUTO ONLY: ACG $ EXCES51UMBRELLALIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGCRECATE S S S DEDUCTIBLE S RETENTION S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOPJPARTNEPJExECUTIVE WC8943411 06/02/06 06/02/07 X TDRY LIMITS ERPI E.L. EACH ACCIDENT _ $500000 E.L. DISEASE - EAEMPLOYC• $500000 OFFICERIMEMBEREXCLUDED? 11yo doscribo under SPECIAL PROVISIONS below E.L,DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CONDD 01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SMALL David & Deborah Condurel l i 170 Hickory Hill Lane IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR No- Andover MA REPRESENTATIVES. AUT ILEO RESENTATIV —] AGORD 25 (2001/08) QQACORD CORPORATION 1989 9I 1 r - t. L�- C. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): vlLytrc f NC. Address: ;j 9 j!�,q &IM L S t7-- City/State/Zip: &9 ean, NcE InA n /Syc'Phone #: °/ 7J� Are you an employer? Check the appropriate box: 1. [ I am a employer with 1)— 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors t. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ 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.] [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other -r,ny appucam mat cnecKs oox IF t must also till 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: 404—b/4�C) R / < /W L)24,Ucf Ccs GC Z 7-710 7 Policy # or Self -ins. Lic. #: cA7/ - C"4.r96q / 77-' c- X9413 VII Expiration Date: L -IC 6/z/ p 7 Job Site Address: /70 /iG,rCo�y � � City/State/Zip: V0, R Al>OVgi^L_ 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern' ,,ceder the pa7'As yid enalties of rlury at the information provided above is true and correct. Date: 7 Phone #: v Official use only. 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ILfU U ILCLU) O T- a) CD N a ENERGY CONSERVATION APPLICATION FORM FOR LOW-RISE RESIDENTIAL NEW CONSTRUCTION and ADDITIONS 780 CMR Appendix J Applicant Name: u;ks /NC- Site Address: A __II__._, A i • �,,gw/Zfa10E; r»� O�tiiFe Applicant Phone: 97 $ - (OR 4 —PZ-) l Use Group: Date of Application: Applicant Signature: —,o -7 l Compliance Path (check one): ❑ Prescriptive Package (Limited to 1- or 2 -family wood frame buildings heated with fossil fuels only) Package (A through KK from Table J5.2.1 b): Heating Degree Days (HDD65) from Table J5.2.1. a: (For items d. through i., fill in all values that apply from Table J5.2.1 b:) a. Gross Wall Area sq.ft f. Wall R -value R- b. Glazing Areal sq.ft. g. Floor R -value R - c. Glazing % (100 x b - a) % h. Basement wall R- d. Glazing U -value U- i. Slab Perimeter R- e. Ceiling R -value R- j. Heating AFUE ❑ Component Performance: "Manual Trade -Off' (Limited to wood or metal framed buildings only) . Climate Zone (from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade -Off Worksheet from Appendix J, [and HVAC Trade -Off Worksheet, if applicable] ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate (HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY-'# a. Gross Wall + Ceiling Area 400 sq.ft. b. Glazing Areal '//. ?5_sq.ft. c. Glazing % (100 x b = a) /Q ❑"r.4DDITION with Glazing % (c.) up to 40% may use. 780 CMR Table J1.1.2.3.1 below: 1 2 3 Glazing Area may be either Rough Opening or Unit dimensions. Based on NIFRC Iisting. Applies either to every unit, or to area -weighted average of all units. R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full 11 -value over the entire ceiling area (i.=.- not compressed over e::terior walls, and including any access openings.) ❑ "SUNROOM" addition (greater than 40% glazinb-to-wall and ceiling grass area) Attach "Consumer Information Form" from 780 CMR Appcndix B. Gfficial's 114nme: Official's Signature: I r CONSTRUCTION CONTRACT Agreement made as of APRIL 1 , 2007 by and between: DAVID CONDURELLI and DEBORAH CONDURELLI, husband and wife hereinafter collectively referred to as owner, and JR Builders, Inc., a MA corporation hereinafter referred to as contractor. Owner and contractor, in consideration of the mutual covenants set forth in this agreement, agree as follows: SECTION ONE STRUCTURE AND SITE Contractor shall furnish all labor and materials necessary to alter a dwelling as more particularly described as set forth on the plans referenced hereinbelow upon the following described property, which owner warrants they own, free and clear of liens and encumbrances, except as may be elsewhere otherwise provided: Land at 17 Hickory Hill Road, North Andover, Ma, all as more particularly shown as Lot #16 on a plan of land by Merrimack Engineering Services dated September 1992. SECTION TWO PLANS Contractor shall alter the dwelling in conformance with the plans and specifications annexed hereto and made a part of this Contract, and will do so in a workmanlike manner (collectively hereinafter, the "plans"). Contractor is not responsible for furnishing any improvements other than the structures shown on the said plans (e.g., landscaping, grading, walkways, painting, sewer or water systems, steps, driveways, patios and aprons, etc.), unless such are specifically set forth on the plans and/or stated in the Scope of Work. 11 SECTION THREE PAYMENT AND DEPOSIT A. Owner shall pay contractor the sum of Eighty -Five Thousand and 00/100 ($85,000.00) Dollars, in installments as set forth in the payment schedule as described in the written proposal signed by the parties. By execution and delivery hereof, contractor acknowledges the receipt of the sum of Twenty Thousand and 00/100 ($20,000.00) paid by owner on account of this contract. B. In the event any installment is not paid when due as required under this agreement, contractor may stop work until payment is made. C. In the event any installment remains unpaid for thirty (30) days after it is due, contractor may take such action as may be necessary, including legal proceedings, to enforce its rights under this agreement. SECTION FOUR PERMITTING A. In the event that a building permit has not issued in or within twenty-one (21) days after application therefor, this contract shall be deemed void and of no further force or effect, and all funds then having been paid to contractor shall be returned to owner, subject to an equitable adjustment to contractor for all costs having been disbursed to date. 2 SECTION FIVE RESPONSIBILITY A. Contractor shall not be responsible for claims arising out of improper placement or positioning of boundary stakes or for damages to persons or property occasioned by owner or their agents, third parties, acts of God or other causes beyond contractor's control. B. Owner shall hold contractor completely harmless from, and shall indemnify contractor for, all costs, damages, losses, and expenses, including judgments and attorney's fees, resulting from claims arising from causes enumerated in this section. C. Contractor shall hold owner completely harmless from, and shall indemnify owner for, all costs, damages, losses, and expenses, including judgments and attorney's fees, resulting from claims asserted by any subcontractor retained by contractor and which is not a result of any negligence on the part of owner. D. At the commencement of this agreement, contractor shall provide owner with evidence of liability and workmen's compensation insurance in total coverage amount of not less than $1,000,000.00. 3 SECTION SIX OWNER FINANCING A. Owner agrees to promptly complete the necessary requirements to obtain financing. B. In the event owner has not secured acceptable financing requirements by May 1, 2007, owner agrees that the contract price will be adjusted to the reflect current price list of all labor and materials in effect at the time the financing requirements are met. SECTION SEVEN GOVERNING LAW It is agreed that this agreement shall be governed by, construed, and enforced in accordance with the laws of the State of Massachusetts. SECTION EIGHT NO WAIVER The failure of either party to this agreement to insist upon the performance of any of the terms and conditions of this agreement, or the waiver of any breach of any of the terms and conditions of this agreement, shall not be construed as thereafter waiving any such terms and conditions, but these shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. SECTION NINE ATTORNEY'S FEES In the event that any action is filed in relation to this agreement, the unsuccessful party in the action shall pay to the successful party, in addition to all the sums that either party may be called on to pay, a reasonable sum for the successful party's attorney's fees. SECTION TEN ENTIRE AGREEMENT This agreement shall constitute the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this agreement shall not be binding upon either party except to the extent incorporated in this agreement. In the event that any provision of this contract shall be found to be unenforceable or illegal, only said section and not the entire contract shall be considered void, and the remainder of the contract shall continue in force and effect. 4 a SECTION ELEVEN MODIFICATION OF AGREEMENT Any modification of this agreement or additional obligation assumed by either party in connection with this agreement shall be binding only if evidenced in writing signed by each party or an authorized representative of each party. SECTION TWELVE ALTERATION TO PLANS AND SPECIFICATIONS Any alteration or change made to the plans for the structure or site and any resulting addition or reduction to the charge to be paid hereunder shall be approved in writing in advance by both parties. SECTION THIRTEEN ASSIGNMENT OF RIGHTS The rights of each party under this agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party. SECTION FOURTEEN TIME OF THE ESSENCE It is specifically declared and agreed that time is of the essence of this agreement. 67 SECTION FIFTEEN PARAGRAPH HEADINGS The titles to the paragraphs of this agreement are solely for the convenience of the parties and shall not be used to explain, modify, simplify, or aid in the interpretation of the provisions of this agreement. Executed as a sealed instrument the day and date first above written. C/ 0 71, P I Board of Building Regulations and Standards Construction Supervisor License License: CS 45137 Birthdate; 12/2611962 16 !2V,26/2008 12J26/200g Tr# 7580 Rs§trictlon 00 LAURENCE R PALNISANO. 599 CANAL ST LAWRENCE, MA 01840 Commissioner ✓he UO/!7I)2f)iZIUCCLLCI2 Q�i/((pQ jQ�fL�I6Pcfa \ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 106501 Expiration: 7/23/2008 Type: Private Corporation J.R. BUILDERS INC. Laurence Palmisano 599 Canal Street Lawrence, MA 01840 C:; d ^ Deputy Administrator