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Building Permit #504-14 - 181 FARNUM STREET 12/16/2013
TOWN OF NORTH ANDOVER 4 APPLICATION FOR PLAN EXAMINATION �A Permit NO: Date Received Date Issued: 0-1101M ANT: Applicant must complete all items on this page (, LOCATION:, r PROPERTY OWNER alx ,*,t1f% - -,�.%� Ud/!.: ___ -, - -- ) Print 100 Year Old Structure yes no MAP NOL _PARCEZONING DISTRICT: Historic District yes no Machine Shop Village yes ,no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 2,6ne family ❑ Addition ❑ Two or more family ❑ Industrial [iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: 2- emolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain, 0 Wetlands 0 Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Arlrlrcee• % CONTRACTOR Name:l)Ji>RA1 s aeTu 2.wi/,oxA?Phone:0?/ Address: / etf&.jd�S rJ, 0a, F Supervisor's Construction License: c` -S-5, AL lloa 3 Exp. 'Date: Home Improvement License: Exp. Date: v? ` ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED O,N $$,1215.00 PER S.F. Total Project Cost: $'� �i�4��; 6 FEE: $ 's'"�o'ZY7) _ t No.: b� Receipt Check No.: p NOTE: Persons contracting with unregistered contractors do not have access to tl �guZanund gnature of Agent/Owner Sig7atureof contracto._i y Plans Submitted E Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑ r r Location ' �� t��v✓1 c-� No. DateYe0 eh, e 1 p�b Check J U k 271 U0 TOWN OF NORTH ANDOVER, Certificate of Occupancy $ Building/Frame Permit Fee $2A` --M Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped -Plans ❑ TYPE --OF ;SEWERAGEDiSPOSAL- 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 DATE REJECTED DATE.APPROVED PLANNING & DEVELOPMENT' ❑ ❑ COMMENTS -CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comme Conservation Decision: Comments Water & Sewer ConrlectioniSignature & Date Driveway Permit DPW Towo Engineer: Signature: Loc ted 384 O: FIRE DEPARTM;ENT -Temp Dumpster on site yes no Located -at 124 Mair Street: -Fire . epartmer&$igriature/date' 4 COMMENTS ood Street �AW_Afflw_� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: ELECTRICAL: Movement of fleeter 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 deoartrnent use) L. CL k- vw� s� CA t,&, wL L, V L ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department . e - ; The fol,'swing is -a ii'st of the required forms to be filled out for the appropriate. permit to be obtained. Roofipg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the aprr,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 .. J -O Y_ / V Id - /3 x,.17 Q�u7 The Commonwealth of Massachusetts -•- Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Uf www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Orgmizationftdividual): PYl y 1 C , City/State/Zip: I,�,c3 ®� ,/ Phone #: Are you an employer? Check the appropriate box: 'Type of project (required): 1. Imo! 'Iam a employer with J_ 4. ❑ 1 am a general contractor and I 6.. ❑ New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner - have Hired the sub -contractors listed on the attached sheet. �• [J Remodeling ship and'have no employees working for mein any capacity. These sub -contractors have workers' comp. insurance. S. E] Demolition g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions required.] 3. ❑ 1 am a homeowner doing all work officers have exercised their right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roofrepairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also fillout the section below showing their workers' compensation policy information. i 'Homeowners who submit this affidavit indicating they 2ie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. f I _ e---- , i ..l is 1 Insurance Company Name:. IYA= teI I IAJ VC7/n Policy # or Self -ins. Lic. #: % Expiration Date: Job Site Address: /��,¢/9/P/J?I%N / City/State/Zip: X)h Act( M -A A Attach a copy of the workers' compensatioupol'ICY declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of 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. 11 X do hereby certr u depalns dpenaldes ofperjury that the information provided above is true and correct. moi/, d,/�✓ ,,afA• /M /Sl / Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit cense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - - Contact Person: Phone #• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, • express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a- deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -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 au LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain aworkers' 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 willl 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 be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. 'Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your.cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The GA mon-weajtla,ofMossachv,�et, Department ofladustrial Accidents Office of Investigations 600 Washbigton. Street Boston} MA 02111 Tel, # 617„7.27-4900 ext 406 or 1-877-MASS.AFF Revised 5-26-05 Fax # 617-727-7749 vaww.�ass,g¢vfda, DATE ID)A-CORD CERTIFICATE OF LIABILITY INSURANCE 01/13/2014 PRODUCER 781.729.8770 FAX 781.729.0053 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION John A. Pierce Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 934 Main St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Winchester, MA 01890-1994 INSURERS AFFORDING COVERAGE NAIC # INSURED Robert Swymer INSURER A: The Travelers Indemnity Co 25658 20 Cranston Circle INSURER B: Woburn, MA 01801 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE F—] OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY $ HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ - (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION TBI 01/11/2014 01/11/2015 WC STATU- T- X I TORY LIMITS ER AND EMPLOYERS' LIABILITY Y� E.L. EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Aerations usual to residential carpentry. Robert Swymer has not elected workers compensation coverage. C`FRTIFIrATF HAI nFR CANCELLATION ACORD 25 (2009/01) FAX: 978.688.9542 © 1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL North Andover, Town of 1600 Osgood St IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UP T RER, ITS AGENTS OR „ ,.. REPRESENTATIVES. ^g Y 0 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE' yi" [Kevin Pierce ACORD 25 (2009/01) FAX: 978.688.9542 © 1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 45,035.00 m $ - $ 540.42 Plumbing Fee $ 67.55 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 67.55 Total fees collected $ 775.53 181 Farnum Street 504-14 on 12/16/13 Den Renovation r 0 O _ M O • _ � o •Q• L � Q O, U) V G Q • � . L to r O = • O G1 4 �L N1co � L m � > _ � L of d O = d C U) a' _ t s E "' O d z CL U-) O A �. . IM > O = o Q Q d �. 0 0 e c = rn 0 = r- 2! L L ca (D = d F=- O CL .r (D m N s w - W C O O. •N to _ W .E C) N O cA n (D>W N1 O O t 4. 0.00 cn 2 Z m CC Z W x LLII-- LU W G.. z N __ O = z u u W ui W O W d . (A Vf u x z z a = LL z Ou, Z Q z W O z V 0 0 m c N Q W O m W LL E cu p) m J d J W a� O N +v_+ ? 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SOU JHQ Ji -Q ¢¢_ �O w 10`n I -,Q wz =�U VSO zago ¢ �LL OZ W =-3 w W X500 0 .d > W WWWW 1 W > z o z 0 z� =oa ¢ ¢wz ~zw X �O~ wI--¢Lu_ mww Lu � uziww =a F -CLW JHQ Ji -Q ¢¢_ ¢=(L m � ► I O O Z Z w m w O Cl) wic i®Boise cascade Triple 1-3/4" x 11-7/8" VERSA -LAM@ 2.0 3100 SP Roof Beam1A Roof Ridge Dry 11 span I No cantilevers 10/12 slope Wednesday, December 11, 2013 BC CALCO Design Report - US Build 2565 File Name: BC 13169.bcc Job Name: Lavoie Description: Designs\A Roof Ridge Address: 181 Farnum St Specifier: Dan L Gelinas, PE City, State, Zip: North Andover, MA 01845 Designer: Gelinas Structural Engineering LLC, 579A North End BI, Customer: Bob Swyer Gen Contractor 781.929.5776 Company: Salisbury MA 01952 [phone 978.360.2562] Code reports: ESR -1040 Misc: danlgelinas@comcast.net Total Horizontal Product Length = 18-00-00 Reaction Summary (Down / Uplift) (Ibs ) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 927/0 3,825/0 B1, 3-1/2" 927/0 3,825/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 2 Unf. Area (tb/ft^2) L 00-00-00 18-00-00 10 50 08-06-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 20,311 ft -lbs 55.3% 115% 4 09-00-00 End Shear 4,076 lbs. 29.9% 115% 4 01-03-06 Total Load Defl. L/274 (0.768") 65.7% n/a 4 09-00-00 Live Load Defl. L/341 (0.618") 70.5% n/a 5 09-00-00 Max Defl. 0.768" 43.9% n/a 4 09-00-00 Span / Depth 17.7 n/a n/a 0 00-00-00 % Allow % Allow Bearing Supports Dim. (L x W) Value Support Member Material BO Post 3-1/2" x 5-1/4" 4,752 lbs n/a 34.5% Unspecified 61 Post 3-1/2" x 5-1/4" 4,752 lbs n/a 34.5% Unspecified Cautions For roof members with slope (1/4)/12 or less final design must ensure that ponding instability will not occur. For roof members with slope (1/2)/12 or less final design must account for Rain -on -Snow surcharge load. 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 CALCO, BC FRAMER@ , AJSTM ALLJOISTO , BC RIM BOARDTM, BCI@ , BOISE GLULAMTM, SIMPLE FRAMING SYSTEM@ , VERSA-LAMO, VERSA -RIM PLUS@) , VERSA -RIM@, VERSA -STRANDS, VERSA -STUD@ are trademarks of Boise Cascade Wood Products L.L.C. Notes Design meets Code minimum (L/180) Total load deflection criteria.✓ Design meets Code minimum (L/240) Live load deflection criteria. X -r Design meets arbitrary (1.75") Maximum total load deflection criteria. r- r ^ C L Calculations assume Member is Fully Braced. l Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the results. '- - Fastener Manufacturer: Simpson Strong -Tie, Inc.y,�t [,,r V V Y I../ I= 1 V Dec 12, 2013 Page 1 of 2 R ®Boise Cascade Triple 1-3/4" x 11-7/8" VERSA -LAM® 2.0 3100 SP Roof Beam1A Roof Ridge b minimum = 6" d = 24" e minimum = 1" Calculated Side Load = 255.0 Ib/ft Install Screws with screw heads in the loaded ply, d Connectors are: SDW22500 L i^ �v STRijCT jRAL O :- Job 13169 d Dec 12, 2013 Page 2 of 2 BC CALM BC FRAMER@ , AJS-, ALLJOIST@ , BC RIM BOARDTM,'BCI@ , BOISE GLULAMTM, SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND@, VERSA -STUD@ are trademarks of Boise Cascade Wood Products L.L.C. Dry 11 span 1 No cantilevers 10/12 slope Wednesday, December 11, 2013 BC CALCO Design Report - US Build 2565 File Name: BC 13169.bcc Job Name: Lavoie Description: Designs�A Roof Ridge Address: 181 Farnum St Specifier: Dan L Gelinas, PE City, State, Zip: North Andover, MA 01845 Designer: Gelinas Structural Engineering LLC, 579A North End BI1 Customer: Bob Swyer Gen Contractor 781.929.5776 Company: Salisbury MA 01952 [phone 978.360.2562] Code reports: ESR -1040 Misc: danlgelinas@comcast.net Connection Diagram Disclosure b d Completeness and accuracy of Input must be verified by anyone who would rely on a output as evidence of suitability for • particular application. Output here based on building code -accepted design i 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 a minimum = 1-1/2"c = 8-7/8" (800)232-0788 before installation. b minimum = 6" d = 24" e minimum = 1" Calculated Side Load = 255.0 Ib/ft Install Screws with screw heads in the loaded ply, d Connectors are: SDW22500 L i^ �v STRijCT jRAL O :- Job 13169 d Dec 12, 2013 Page 2 of 2 BC CALM BC FRAMER@ , AJS-, ALLJOIST@ , BC RIM BOARDTM,'BCI@ , BOISE GLULAMTM, SIMPLE FRAMING SYSTEM®, VERSA -LAM®, VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND@, VERSA -STUD@ are trademarks of Boise Cascade Wood Products L.L.C. Project: Beams Lavoie 181 Farnum St N Andover MA Location: Beam B Front Elevation Header Multi -Loaded Multi -Span Beam [2009 International Building Code(2005 NDS)] ( 3 ) 1.75 IN x 11.875 IN x 17.0 FT (2 + 13 + 2) Versa -Lam 3100 Fb - Boise Cascade Section Adequate By: 42.0% Controllinq Factor: Deflection page Dan L Gelinas P.E. t Gelinas Structural Engineering LLC 579A North End Blvd of Sallsbury MA 01952-1738 ;Ph 978,465.6436 StruCalc Version 8.0.113.0 12/11/2013 4:48:32 PM CAUTIONS Read Provided Section Modulus: * Laminations are to be fully connected to provide uniform transfer of loads to all members 123.39 in3 JOb 13169 Area (Shear): 15.46 int 62.34 in2 Dec 12, 2013 Moment of Inertia (deflection): DEFLECTIONS Lie Center Right LOADING DIAGRAM Moment: 17865 ft -Ib Live Load -0.02 IN 2U1926 0.05 IN U2890 -0.02 IN 2U1926 Shear: 2937 Ib 11845- Ib Dead Load -0.12 in 0.25 in -0.12 in Total Load -0.14 IN 2L/340 0.30 IN L/514 -0.14 IN 2L/340 Live Load Deflection Criteria: L/360 Total Load Deflection Criteria: U240 REACTIONS 8 8 Live Load 500 Ib 500 Ib Dead Load 2545 Ib 2545 Ib Total Load 3045 Ib 3045 Ib Bearing Length 0.77 in 0.77 in BEAM DATA Left Center Ripht Span Length 2 ft 13 ft 2 ft Unbraced Length -Top 2 ft 13 ft 2 ft i--2 ft 13 ft 2 ft—{ Unbraced Length -Bottom 2 ft 13 ft 2 ft Live Load Duration Factor 1.00 Notch Depth 0.00 UNIFORM LOADS Left Center E= MATERIAL PROPERTIES Uniform Live Load 0 plf 0 plf 0 pif Versa -Lam 3100 Fb - Boise Cascade Uniform Dead Load 0 plf 60 pif 0 plf Base Values Adjusted Beam Self Weight 18 plf 18 pif 18 plf Bending Stress: Fb = 3100 psi Fb' = 3035 psi Total Uniform Load 18 plf 78 plf 18 plf Cd=1.00 C/=0.98 CF= 1.00 POINT LOADS - CENTERSPAAM. tlA' 4, t , Shear Stress: Fv = 285 psi Fv' = 285 psi Cd=1.00 Modulus of Elasticity: E = 2000 ksi E'= 2000 ksi Load Number One Live Load 1000 Ib` r , Comp. -L to Grain: Fc -1= 750 psi Fc - -I-' = 750 psi Dead Load 4000 Ib _ Location 6.5ft L4''�7� Controlling Moment: 17865 ft -Ib 6.5 Ft from left support of span 2 (Center Span) J i �t 'L Created by combining all dead loads and live loads on span(s) 1, 2, 3 Controlling Shear: 2937 Ib At a distance d from left support of span 2 (Center Span)-rc Created by combining all dead loads and live loads on span(s) 1, 2, 3 � 5; ,�4 Comparisons with required sections: Read Provided Section Modulus: 70.64 1n3 123.39 in3 JOb 13169 Area (Shear): 15.46 int 62.34 in2 Dec 12, 2013 Moment of Inertia (deflection): 515.94 in4 732.62 in4 Moment: 17865 ft -Ib 31207 ft -lb Shear: 2937 Ib 11845- Ib NOTES Front Elevation header max. span 13 feet continuous LVL header wall to wall part of shear wall Beam B Front Elevation Header -s' ® Boise Cascade BC CALC@ Design Report - US A Double 1-3/4" x 9-1/2" VERSA -LAM® 2.0 3100 SP Floor BeamlHeader C Dry 11 span I No cantilevers 10/12 slope Wednesday, December 11, 2013 Build 2565 Value File Name: BC 13169.bcc Job Name: Lavoie Description: Designs\Header C Address: 19Y Famuin St Specifier: Dan L Gelinas, PE City, State, Zip: North Andover, MA 01845 Designer: Gelinas Structural Engineering LLC, 579A North End BI, Customer: Bob Swyer Gen Contractor 781.929.5776 Company: Salisbury MA 01952 [phone 978.360.2562] Code reports: ESR -1040 Misc: danlgelinas@comcast.net Total Horizontal Product Length = 10-00-00 Reaction Summary (Down / Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live B0, 3-1/2" 548/0 2,500/0 B1, 3-1/2" 548/0 2,500/0 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf. Area (Ib/ft^2) L 00-00-00 10-00-00 10 50 10-00-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 6,938 ft -lbs 43.2% 115% 1 05-00-00 End Shear 2,388 lbs 32.9% 115% 1 01-01-00 Total Load Defl. L/504 (0.227') 47.7% n/a 1 05-00-00 Live Load Defl. L/614 (0.186") 58.6% n/a 2 05-00-00 Max Defl. 0.227' 22.7% n/a 1 05-00-00 Span / Depth 12.1 n/a n/a 0 00-00-00 % Allow % Allow Bearing Supports Dim. (L x W) Value Support Member Material BO Post 3-1/2" x 3-1/2" 3,048 lbs n/a 33.2% Unspecified 61 Post 3-1/2" is 3-1/2" 3,048 lbs n/a 33.2% Unspecified Notes Design meets Code minimum (L/240) Total load deflection criteria. Design meets Code minimum (L/360) Live load deflection criteria. Design meets arbitrary (1 ") Maximum total load deflection criteria. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. Deflections less than 1/8" were ignored in the results. Fastener Manufacturer: Simpson Strong -Tie, Inc. v ✓" vvv it �v � v Dec 12, 2013 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 CALCO, BC FRAMER@ , AJSTM, ALLJOISTO , BC RIM BOARDTM, BCI@) , BOISE GLULAMTM' SIMPLE FRAMING SYSTEM@ , VERSA -LAM@, VERSA -RIM PLUS@ , VERSA -RIM@, VERSA -STRAND@, VERSA -STUD@ are trademarks of Boise Cascade Wood Products L.L.C. ® Boise Cascade BC CALCO Design Report - US Double 1-3/4" x 9-1/2" VERSA -LAM@ 2.0 3100 SP Floor BeamlHeader C Dry 11 span I No cantilevers 10/12 slope Wednesday, December 11, 2013 Build 2565 File Name: BC 13169.bcc Job Name: Lavoie Description: Designs\Header C Address: 181 Famum St Specifier: Dan L Gelinas, PE City, State, Zip: North Andover, MA 01845 Designer: Gelinas Structural Engineering LLC, 579A North End BI Customer: Bob Swyer Gen Contractor 781.929.5776 Company: Salisbury MA 01952 [phone 978.360.2562] Code reports: ESR -1040 Misc: danlgelinas@comcast.net Connection Diagram Disclosure y- b d Completeness and accuracy of input must L be verified by anyone who would rely on a output as evidence of suitability for • • • particular application. Output here based C 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 a minimum = 1-1/2"c = 6-1/2" or ask questions, please call (800)232-0788 before installation. b minimum = 6" d = 24" e minimum = 1" Install Screws with screw heads in the loaded ply. Member has no side loads. Connectors are: SDW22338 s Y -o Q` '.ug :f G. L" c10� 910 s3J94 s. AL Job 13169 d Dec 12, 2013 Page 2 of 2 BC CALCO, BC FRAMER@ , AJSTM, ALLJOISTO , BC RIM BOARD TM, BCI®, BOISE GLULAMTM, SIMPLE FRAMING SYSTEM@ , VERSA -LAM@, VERSA -RIM PLUS@ , VERSA -RIM@, VERSA -STRANDS, VERSA -STUD@ are trademarks of Boise Cascade Wood Products L.L.C, ®Boise Cascade Triple 1-3/4" x 9-1/2" VERSA -LAM® 2.0 3100 SP Floor BeamlBeam D Ceiling Dry 11 span I No cantilevers 10/12 slope Thursday, December 12, 2013 BC CALC® Design Report - US Build 2627 File Name: BC 13169.bcc Job Name: Lavoie Description: Designs\Beam D Ceiling Address: 181 Farnhum St Specifier: Dan L Gelinas, PE City, State, Zip: North Andover, MA 01845 Designer: Gelinas Structural Engineering LLC, 579A North End Bh Customer: Bob Swyer Gen Contractor 781.929.5776 Company: Salisbury MA 01952 [phone 978.360.2562] Code reports: ESR -1040 Misc: danlgelinas@comcast.net V 17-00-00 V BO B1 Total Horizontal Product Length = 17-00-00 Reaction Summary (Down / Uplift) (lbs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 1,020/0 633/0 B1, 3-1/2" 1,020/0 633/0 -A .. Job 13169 d Dec 12, 2013 Page 1 of 2 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 Standard Load Unf. Area (Ib/ft^2) L 00-00-00 17-00-00 20 10 06-00-00 Disclosure Controls Summary Value %Allowable Duration Case Location Completeness and accuracy of input must Pos. Moment 6,651 ft -lbs 31.8% 100% 1 08-06-00 be verified by anyone who would rely on End Shear 1,442 lbs 15.2% 100% 1 01-01-00 output as evidence of suitability for Total Load Defl. L/455 (0.437") 52.8% n/a 1 08-06-00 particular application. Output here based on building code -accepted design Live Load Defl. L/737 (0.269") 48.9% n/a 2 08-06-00 properties and analysis methods. Max Defl. 0.437" 43.7% n/a 1 08-06-00 Installation of BOISE engineered wood Span / Depth 20.9 n/a n/a 0 00-00-00 products must be in accordance with current Installation Guide and applicable %Allow %Allow building codes. To obtain Installation Guide Bearing Supports Dim. (L x W) Value Support Member Material (8 ask questions, please call (800)232-0788 before installation.\n\nBC BO Post 3-1/2" x 5-1/4" 1,653 lbs n/a 12% Unspecified CALC&, BC FRAMER@,AJSTM, B1 Post 3-1/2" x 5-1/4" 1,653 lbs n/a 12% Unspecified ALLJOIST&, BC RIM BOARDT/A BCI&, BOISE GLULAMTM' SIMPLE FRAMING Notes ls( + fg -d SYSTEM@ , VERSA-LAMO, VERSA -RIM Design meets Code minimum (U240) Total load deflection criteria. +�'-{ • 'sem 1 r PLUS(D, VERSA -RIM@, VERSA -STRAND@), VERSA -STUD@ are Design meets Code minimum (0360) Live load deflection criteria. Swya y trademarks of Boise Cascade Wood Design meets arbitrary (1") Maximum total load deflection criteria. ; ,��: c_ L .+, Products L.L.C. Calculations assume Member is Fully Braced. Design based on Dry Service Condition. 5TR �k v_'. Deflections less than 1/8" were ignored in the results. Fastener Manufacturer: Simpson Strong -Tie, Inc. Al M, , �A6 -A .. Job 13169 d Dec 12, 2013 Page 1 of 2 , . , ®Boise Cascade Triple 1-3/4" x 9-1/2" VERSA -LAM@ 2.0 3100 SP Floor BeamlBeam D Ceiling Dry 11 span 1 No cantilevers 10/12 slope Thursday, December 12, 2013 BC CALC@ Design Report - US Build 2627 File Name: BC 13169.bcc Job Name: Lavoie Description: Designs\Beam D Ceiling Address: 181 Farnhum St Specifier: Dan L Gelinas, PE City, State, Zip: North Andover, MA 01845 Designer: Gelinas Structural Engineering LLC, 579A North End Bh Customer: Bob Swyer Gen Contractor 781.929.5776 Company: Salisbury MA 01952 [phone 978.360.2562] Code reports: ESR -1040 Misc: danlgelinas@comcast.net Connection Diagram ft b I F.— d a minimum = 1-1/2"c = 6-1/2" b minimum = 6" d = 24" e minimum = 1" Install Screws with screw heads in the loaded ply. Member has no side loads. Connectors are: SDW22500 c DAL s� No J,3—J94 Job 13169 d Dec 12, 2013 Page 2 of 2 41 C rl 4- k .0 a u � a k > 4j c Un u r ai 0 n k LH 4J In Ln N . k w N ,0 +J 4J R U) N v a) U rI �] cd p+ k E ca b� U O 3� d W �f�� mon • - L� 41 C rl 4- k .0 a u � a k > 4j c Un u r ai 0 n k LH 4J In Ln N . k w N ,0 +J 4J R U) N v a) U rI �] cd p+ k E ca b� U O 3� d M:. v Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contrador Law (MGL chapter 142A), but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of "A Massachusetts Consumer Guide to Home Improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Toy r Company Name &Z 4 1/ v AJ Street Address (do not use a Post Offire Box address) Contractor/ Salesperson/ Owner Name S v vl ` sr 1 � W ,W ele State City/rownQfJAn Zip Code Business Address (must include a street dress) 4/i p ! L t Daytime Phone Evening Phone Cayfrown State Zip Code Mailing Address (It different from above) Business Phone Federal Employer ID or S.S. Number Lj Ira regmres ton mop home Homerageovanent Contmctnr Reg. N®ba Enpimnnn care a -fid eeht afim aumb Mee a eaaa regbtrariaa Bomber 2 ^� / 1 4/ Y - / � A The Contractor agrees to do the following work for the Homeowner. (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.) &Ze /YA&ka 61-1, rs Required Permits -The following building permits are required Proposed Start and Completion Schedule -The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be IV �10,,,O A% excluded from the Guaranty Fund provisions of P �l/t� /r/XDate when contractor will begin contracted work. MGL chapter 142A.) a/V Date when contracted work will be substantially completed. Contract Price and Payment Schedule The Contractor agrees to perform the work, famish the material and labor specified above for the total sum of. Yu _ UjU i ®Q (') Payments will be made according to the following schedule: $ upon signing contract (not to exceed 1/3 of the totalcontractprice or the cost of special order items, whicheverisgreater) $ by /_/_ or upon completion of � ew_ldAal;^f $ by I /_ or upon completion of a iyu x-/ $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES: (*) Including all finance charges (**) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Exnress Warranty - Is an exoress warranty beine orovided by the contractor? 9NO ❑ Yes (all terms of the warranty must be attached to the contract). Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance- Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Imoroyement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE AREArtY BL) wo identical ow of the contract i nst be canpleted and signed One copy should go to the hao�amec o ome er's Signature toy's Signatdfie t i N a 9y i.3 �� �1w Date Date the contractor. W4 Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulatio d the: cons er shall be required to sub ' o such itration as provided In Massachusetts General Laws, ch r 2 Iffodeo-wner's Sighature ntractor's Sign NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law (MGL chapter 142A) and other consumer protection laws (i.e. MGL chapter 93A) may not be waived in any way, even by agreement. However, homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline (listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract, and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at hnp://www.mass.gov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at ham://www.mass.eov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: hqp://db.state.ma.us/homeimi)rovement/ficenseelist.ast) For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-6524800, 508-755-2548 or 413-734-3114 Version 2.1 - 11/22/2010 The Commonwealth ofMassachusetts Department of InrlustYiccl Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors)Electricians/Plumbers Address/o �} City/State/Zip: I,r�dl�r AAJ t ,144 e-31e6l Phone #: Are you an employer? Check the appropriate lox: - Type of project (required): 1.9Tam a employer with 4. ❑ I am a general contractor and 1 6. ❑ New construction employees (full and/or pari -time).' have hired the sub -contractors �• remodeling 2. El am a sole proprietor orpartner- listed on the attached sheet. � These sub -contractors have 8. RUemolition ship and'have no employees working for me in any capacity. workers' comp. insurance. 9. [l Building addition [No workers' comp. insurance 5. El We are a corporation and its 10.[] Electrical repairs or additions required.] 3. El am a homeowner, .doing all work officers have exercised their right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c.152, §1(4), and wehave no 12.QRoofrepairs insurance required.] q ] � employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#f must also fill outthe section below showingtheir workers' compensation policy information. i Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis 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. l n ---- ,�- Insurance Company N Policy # or Self -ins. Lic. #: !f t S !?,%6 Expiration Date: Vi edzV is %' City/State/Zip-11JA Job Site Address: ., g , Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of 'Investigations of the DTA for insurance coverage verification. Ido hereby provided above is true and correct. //,/a g Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Ph nti s. rl#- Information and Instructio- A ns 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 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 ofits political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to. the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be, advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 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 "Many 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 fdlgd out each year. Where a home owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone anal fax number: Tho Comm.onwaltla o� �TassachusPtta Depaztmeut of Zndustxlal AA,ccidonts Office of111vostigatims 600 Washffigtoq Street Boston} MA 02111 Tel, # 617-727_4900 oxt 406 or 1-877-MASSAFF, Revised 5-26-05 Fax # 617-727-7749 - t Jnbox (4) - bswymer(q-),excite.com - Excite Mail Page 1 of 2 From: bswymer@excite.com Subject: home improvement Date: 11/12/2013 07:08 PM To: pslavoie@comcast.net OUTLINE AND DESCRIPTION OF WORK DEMOLITION: 1. ERECT WALLS IN HALLWAY AND KITCHEN TO PROTECT HOUSE FROM DUST AND OUTSIDE WEATHER 2. REMOVE HEAT IN AREA OF CONSTRUCTION 3. REMOVE A.C. DUCT WORK IN AREA OF CONSTRUCTION 4. REMOVE EXSISTING SHED AND MAIN ROOF OVER DEN FOR NEW ROOF 5. REMOVE EXSISTING CEILING IN DEN AS FAR BACK AS STAIRWELL. 6. REROUTE ANY ELECTRICAL IN CEILING 7. REMOVE WALL BETWEEN KITCHEN AND DEN 8. REMOVE WALL BETWEEN DEN AND HALL 9. REMOVE EXSISTING DOOR, CASEMENT WINDOW AND PICTURE WINDOW 10. STRIP EXTERIOR WALLS TO STUDS 11. REMOVE HARDWOOD FLOOR IN HALLWAY /a Dvmpe7r-011 NEW FRAMING: 1. REFRAME DEN FLOOR TO MATCH KITCHEN AND HALLWAY FLOORS 2. FRAME IN DEN DOORWAY AND CASEMENT WINDOWS 3. FRAME IN FRONT WALL FOR NEW 12' SLIDING DOOR 4. INSTALL L.V.L'S FOR ROOF AND CEILING SUPPORT 5. FRAME NEW ROOF WITH 2X1 O'S 16" ON CENTER HEIGHT TO MATCH EXSISTING 6. FRAME GABLE END FOR TWO WINDOW DESIGN T.B.D. 7. SHEATH EXTERIOR WALL WITH 1/2" CDX, ROOF WITH 5/8" CDX 8. ROOFING PART OF ROOF CONTRACT 9. STRAP CATHEDRAL CEILING FINISH 1. SET NEW 12' SLIDING DOOR 2. SET NEW GABLE WINDOWS 3. PROVIDE ROUGH WIRING FOR ELECTRICAL AND CABLE 4. INSULATE ROOF ,WALLS AND FLOOR WITH CLOSE CELL SPRAY ON INSULATION 5. COVER CATHEDRAL CEILING AND WALLS WITH 1/2" BLUEBOARD WITH SKIM COAT PLASTER 6. TRIM DOOR AND WINDOWS WITH 2 1/2" CASING TO MATCH EXSISTING HOUSE 7. INSTALL BASEBOARD FORCED HOT WATER HEAT http://webmail.excite.com/6058f750/gds/index_rich.php 11/19/2013 Inbox (4) - bswymer(a�excite.com - Excite Mail Page 2 of 2 8. INSTALL WOOD BASE ON BALANCE OF WALLS TO MATCH EXSISTING HOUSE 9. PAINT CEILING, WALLS AND TRIM 10. INSTALL PLUGS, SWITCHES, CABLE AND PLATES 11. FINISH FLOOR TO BE INSTALLED AS PART OF KITCHEN REMODEL 12. TRIM EXTERIOR OF DOOR AND WINDOWS WITH PINE TO MATCH EXSISITING HOUSE 13. INSTALL EXTERIOR SIDING TO MATCH EXSISTING 14. REROUTING AND RECONNECTING A.C. TO BE COORDINATED BY ROBERT SWYMER BUT PAID FOR BY OWNER 15. CLEAN AREA OF CONSTRUCTION AND REMOVE TEMPORARY WALLS i http://webmail.excite.com/6058f750/gds/index rich.php 11/19/2013 ROBERT SWYMER 20 CRANSTON CIRCLE WOBURN, MA 01801 TO: MR.&MRS. LAVOIE RE: LINE ITEM BUDGET FOR DEN RENOVATION DEMOLITION 1. TEMPORARY WALLS $ 500.00 2. REMOVE BASEBOARD HEAT $ 600.00 3. REMOVE A.C. $ 200.00 4. REMOVE ROOF $1,200.00 5. REMOVE CEILING $ 450.00 6. ELECTRIC DEMO $ 375.00 7. REMOVE WALLS $ 425.00 8. 9. REMOVE DOOR AND WINDOWS $ 300.00 10. STRIP WALL'S $ 425.00 11. REMOVE HARDWOOD $ 375.00 12. DUMPSTERS $1,200.00 FRAMING 1. REFRAME DEN FLOOR $ 900.00 2. FRAME IN DOOR AND WINDOW $ 375.00 3. FRAME NEW 12' DOOR $ 800.00 4. INSTALL ALL L.V.L'S $2,800.00 5. FRAME NEW ROOF $3,800.00 6. FRAME GABLE SHEATH WALL'S 7. ROOF AND STRAP CEILINGS $3,310.00 9. FINISH 1. SET NEW 12' DOOR $4,000.00 2. SET GABLE WINDOWS $3,600.00 3. WIRING $4,500.00 4. INSULATION $2,500.00 5. BLUE BOARD AND PLASTER $3,150.00 � t, 6. TRIM DOOR AND WINDOW'S 7. NEW BASEBOARD HEAT 8. WOOD BASEBOARD 9. PAINT WALL'S AND CEILING 10. PLUG'S,SWITCHES AND PLATES 12. EXTERIOR TRIM AND SIDING TOTAL JOB 324 SQ. FEET AVERAGE COST $139.00 $ 450.00 $ 1,000.00 $ 350.00 $1,800.00 $ 850.00 $4,800.00 $45,035.00 \ Al