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HomeMy WebLinkAboutBuilding Permit #751-13 - 22 DAVIS STREET 5/13/2013Permit NO: 1— /3 Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this page L.00ATI [x061= -`� Print 100 Year Old Structure yes no MAP NO: hG7� PARCEL ZONING DISTRICT: Historic District yes no 7 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition 0 Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition VOther ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Arlrlracc- CONTRACTOR Name: Address: Phone: 6C-? e�'09 LGA% Supervisor's Construction License: 4rSt /00 AP Exp. Date: ` 13 ` �y Home Improvement License: Date: / -// - --� 0 I3 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: $ FEE: $ 71,00 Check No.: Receipt No.: ,;26 3 NOTE: Persons contracting with unregistered contractors do not have access to th ..guarantyfund ti Signature of Agent/Owner Signature of contractor. Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ tamped Plans 101 I a Location 02 / J Cj 61 No. Date s 2 Check # l/ C 26378 TOWN OF NORTH ANDOVER '- Certificate of Occupancy $ Building/Frame Permit Fee $L Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ,7 BGilding Inspector F., M 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 DATE REJECTED PLANNING & DEVELOPMENT ❑ DATE APPROVED COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature A COMMENTS j Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Y ti Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow; Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet Fire Departinert signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes filo MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NOTES and DATA — (For department use ® Notified for pickup - Date E I ! t Doe.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ 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) a 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 o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the app; al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2012 J W x LL O cc a0 mE L au_+ 0 LL aw N U .Q In O d Z Z Q m �p "O :3E LL t cr N C U C LL O C z Z m J d L p cc C CL O N Z J u c J W t 0 d' U N LL cc cc U a N Z Q 7 O _ LL z CW c cc Q a p W LL C 3 m Z aL+ N N ai E N y �I 0 E v c V > :w O cn E cc z i mQ :O 0 Z O {.+ O ai En Z CLL N m 1�NN O Y/ CD t Cl) M d Of • 0 O Cl) cn O •— �~ o = 1=—• Q U) Z '� O O �• O� ; mm Q � Cfl O O a i R L A♦ a Z_U cam. m = cn _ oas > ° m .— o� > v D O Z Q CL LU �= o 2 U N Q �•c W O > 3 c W J _o~ aZ CLOS • ��r m 0O �• v .r c C Q v • C � . V AM ij O O _ Q L L R •a .O N y v m N A O O Ii •� N R w c O Q •� z t/1 � W v .a c V O L � as •- U0 -0 (D CL v� N M "o 4- = c •� cLov O > uj O U) uj U) W W 19 LLIW U) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/05/02/22013013DDNY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services Central, Inc. Southfield MI office CONTACT , NAME: (AICNNo.Ezt): (866) 283-7122 AIC.No.; 800-363-0105 3000 Town Center suite 3000 E-MAIL ADDRESS: Southfield MI 48075 USA MWZY SIR applies per policy terns INSURER(S) AFFORDING COVERAGE NAIC ii INSURED Builder Services Group, Inc. d/b/a Quality Insulation A Masco Corporation Company INSURER A: Old Republic Ins Co 24147 INSURER B: ACE American Insurance Company 22667 INSURERC: Indemnity Insurance Co of North America 43575 110 Perimeter Road INSURER D: Nashua NH 03 063-13 01 USA INSURER E: INSURER F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE DoPOLICY INSR WVD I POLICY NUMBER MM/DD/YYYY) EXP IMMIDD/YYYYI LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR MWZY SIR applies per policy terns & conditions EACH OCCURRENCE $2,000,065 $2,000,000 PREMISES Ea occurrence MED EXP (Any one person) $25,000 PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER* PRODUCTS-COMP/OPAGG $10,000,000 X POLICY JECT L1 PRO- LOC A AUTOMOBILE LIABILITY MWTB 18398-12 06/30/2012 06/30/2013 COMBINED SINGLE LIMIT $5,000,000 Ea accident BODILY INJURY ( Per person) AUTO ALL OWNED SCHEDULED IxANY AUTOS AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) NON -OWNED HIRED AUTOS X AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION C B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR I PARTNER I EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A WLRC46786385 Deductible - AOS WLRC46786300 06 30/2012 06/30/2012 06 30 2013 06/30/2013 WC STATU- OTH- X TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 (Mandatory In NH) tf yes, describe under DESCRIPTION OF OPERATIONS below Ded - CA, MA E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 B Excess WC WC5C46786269 Self -Insured States 06/30/2012 06/30/2013 Deductible $2,000,000 Limit (1) Included SIR applies per policy terns &condi ions DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) [Prof: RE: Project Name: HWAP-WAP Program] [AI: Greater Lawrence Community Action Council, Inc. and HWAP-WAP Program] are included as Additional Insured with respect to the General Liability policy, as required by written contract. ,.cm IIrit mIt MULUtK CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Greater Lawrence Community Action AUTHORIZED REPRESENTATIVE Council, Inc. 305 Essex St. Lawrence MA 01840 USA JI7S n vlltv ? ., L ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ' AGENCY CUSTOMER ID: 570000027887 LOC #: ADDITIONAL REMARKS SCHEDULE Paae _ of AGENCY Aon Risk services Central, Inc. NAMED INSURED Builder services Group, Inc. POLICY NUMBER see Certificate Number: 570049808303 CARRIER 7=1 see Certificate Number: 570049808303 INSURER EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER TYPE OF INSURANCE INSURER SUBR WVD INSURER POLICY EFFECTIVE DATE MIDD/YYYY INSURER LIMITS ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL ]NSR SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE MIDD/YYYY POLICY EXPIRATION DATE MMIDD/YYYY LIMITS WORKERS COMPENSATION B N/A SCFC46786348 WI Only 06/30/2012 06/30/2013 C N/A WLRC46786427 TX Only 06/30/2012 06/30/2013 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS OR ORGANIZATIONS (MASCO FORM RR) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Greater Lawrence Community Action Council, Inc. and HWAP-WAP Program WHO IS AN INSURED (SECTION II) is amended to include a person or organization as defined above. We shall indemnify the Additional Insured for all covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured. We shall further reimburse the Additional Insured for reasonable and necessary attorney's fees and litigation costs incurred in defending against covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured, except for those attorney's fees and litigation costs paid by another insurer. Our duty to indemnify and to reimburse attorneys' fees and litigation costs shall not exceed the product derived by multiplying the total dollar amount of liability for covered damages, or the total dollar amount of attorneys' fees and litigation cost, by that percentage of legal liability attributable to the Named Insured for covered damages as determined by a trier -of -fact in an arbitration or trial. GL 319 002 0609 Masco Corporation MWZY 55525-12 Policy Period: 06-30-12 to 06-30-13 The Commonwealth of Massachusetts Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 www.massgov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiordlndividual): Address: City/State/Zip:�'�%�iL�„c,cJ Phone #6'0 & J fi." C/ Are you an employer? Check the appropriate box: Type of project (required): 1.H-1-9m—_aemployer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub -contractors 2. El am a sole proprietor or partner- listed on the attached sheet. �• ❑Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10. ❑Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. ❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 7 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. e V I ., Insurance Company Name: Policy # or Self -ins. Lic. #: d V 1 143 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 requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA. for insurance coverage verification. I do hereby certify under lie pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Jr— l3 ,' v/9 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: Information andInstruction-S 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-contractor(s) 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 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 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 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 Commonwealth oi,Massachusefts Department o#'industrial .Accidents Office ofIimstigatiolls 600 Washington Street Boston, MA02111 T01, # 617-7274900 ext 406 or 1-877:MASSAFF, Revised 5-26-05 Fax # 617-727;7749 __WWVV.Mass,goV1dia r 1.WEATHERSTRIPPING/CAULKING Door Kits Q -1 -on or Equiv, Door Sweeps (Regular) Door Sweeps (Automatic) Reglaze Windows /In.inch Window.Weathstr Schlegal per side Tenmat Recessed Can Cover Attic air sealing per man/hr basement and living space air sealing SUBTOTALS Job Number 4582 D IiTE 7 -May -13 Client -OUISE CARLSON 978-686-3188 address 22 DAVIS STREET city / town NORTH ANDOVER MA contractor QUILITY 460.76 2A.INFILTRATION I INSULATION QUANTITY TO "AL 3 fur 16.50 1 15.75 2 46.00 0 0.00 0 0,00 0 0.00 2 150.00 1.5 112.50 460.76 2A.INFILTRATION I INSULATION AUDITOR NOTES Domestic pipe Hot Water Tank 1 st 6' 1 15.78 Sill Insulation R-19 CF 0 0.00 Sill Two Part Foam w/ Fiberglass Batt 99 217.80 Drape Perimeter R-5 Anch. Sq. ft. 0 0.00 Perimeter 2" T-max or equivalent foam board sq. fl. 0 0.00 Drape DOOR R-5 or T-max or equivalent on door. 0 0.00 Tape Joints (Aluma Grip only) per hr. 0 0.00 Duct Insulation & Tape sq. ft. R-5 0 0.00 Rigid Foam Board Anch. 1" per board 1 62.74 FOAM BOARD FIREPLACE DAMPERS WITH STi Hydronic pipe insulation to 1" R-5 25 85.25 Hydronic pipe ins.1.25"-1.5" R-5 52 191.36 Steampipe Ins. tol.25" iron pipe R-5 0 0.00 Steampipe ins. 1.5"- 2" Iron pipe R-5 0 0.00 Steampipe Ins. 3" iron pipe R-5 0 0.00 Air Conditioner Meeting Rail 0 0.00 Air Conditioner Cover 0 0.00 Air Conditioner Cover Special Order 0 0.00 SUBTOTALS 572.93 28. INSULATION AUDITOR NOTES Open Unrestricted R 49 0 0.00 Open Unrestricted R 38 0 0.00 Open Unrestricted R 30 1287 1763.19 Open Unrestricted R 20 0 0.00 Open Unrestricted R 10 0 0.00 Restrict FUSloped R 30 0 0.00 Restricted FUSloped R 20 0 0.00 Restrict FL/Sloped R 10 0 0.00 R-19 FGB open rafterslwalls/kneewalls 0 0.00 R-11 FGB open rafters/wallslkneewalls 0 0.00 Attic Stairs(stairwall & common wall) 0 0.00 Cover Pull Down Stairs Thermadome 0 0.00 Site built pull down stairs 2" foam box 0 0.00 Is Attic f Kneewal Floor Transition. Dense pack cellulose W.S. Hatch Q -Lon or equal W.S. & bat Hatch R-30 /0 -Lon or Kneewall R-12 cell behind Per.Memb Open Rafter R-20 Cell. tw poly Open Rafter R-30 Cell. /w poly Basement Overhead R-19 fiberglass Basement Overhead R-30 fiberglass Crawlpace Overhead <4' high R19 Crawipace Overhead < 4' high R30 Garage Ceiling cavity filled w! cellulose Wood,Shake,Clapboard.Shingles Vinyl Asbestos (single nail) / Asphalt Asbestos (doub. Nail) / Aluminum Brick/Stucco Vinyl over Asbestos Multi -layered 3 or more layers Drill rough plaster or finish wood plug Dhil finish piaster Test Drill Walls (all 4 ) SUBTOTALS 2. INSULATION TOTAL 2A.+28, 3, STORM WINDOWS / DEADLITES Plexiglass up to 88 u.i. Additional per UI over 88" Other (Negotiated Price) SUBTOTALS 6. OTHER MATERIAL Ridge vent In ft. Vents Gable rectangular Varipitch Vent Vent Roof 135 (1 sq ft NFV) Large Vent Roof 865 (A sq ft NFV) Small Vent Soffit Rectangular Turbine Vents All Stack Vent Propa Vent Permable House Wrap Vapor barrier Energy Star R-4 Rigid Vinyl Repl 94-101 U.I, SUBTOTALS 6.17. E.C. MATERIAL/LABOR 8a. HEALTH 8 SAFETY 0 0 1 0 0 0 0 0 0 0 0 1240 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 5 0 0 10 0 0 0 AUDITOR NOTES 0.00 0.00 33.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2219.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4016.29 4589.22 AUDITOR NOTES 0.00 0.00 0.00 0.00 0.00 0.00 0.00 285.00 0.00 135.00 0.00 0.00 40.00 0.00 0.00 0.00 460.00 5509.97 X16 AUDITOR NOTES Page 3 AUDITOR NOTES I Vent Bays ; Kitchen Fan Dryer vent w/ exhaust duct Heartland Dryer Transition Duct only Blower Door Test Pre Post SUBTOTALS 8b. REPAIR MATERIAL/LABOR Basement outside door only Basement outside door w/ jambs Door Repl pre hung 32.36" Steel- w / Lite Door Repl interior solid core 28-32" Door Repl pre hung 32-36" wood- w / Lite Window Replacement w/ SIR less than 1 Basement Window Repl. Awning/ Hopper Basement Window Rept. With a frame Lockset ( door) Schlage or equal Repair / Refit Door Replace Side Stop Replace Casing Glass Replacement to 64 u.i. Glass Replacement per u.i. over 64 Sash Sidelock [Top Replacement Threshold (Wood) Threshold (Aluminum) Slide Bolts Plug Plate Cover Cut / finish attic-kneewall access Cut / close attic-kneewall access Labor Rale Hours Labor Rate Hours Labor Rate Hours Labor Rate Hours Labor Rate Hours Permits 1 Fees (Wap only) SUBTOTALS TOTAL REPAIR+ HEALTH & SAFETY 2 178.00 _ 1 89.00 1 40.00 1 45.00 IALWAYS INCLUDE PRE AND POST 352-00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 coo 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0 0.00 0.00 362.00 GRAND TOTAL WORK ORDER * (A) 4582 5861.97 LOUISE CARLSON 978-688.3188 22 DAVIS STREET NORTH ANDOVER MA Any alterations or deviations from the above specifications involving extra costs must be cleared in writing before installation. The Work Order must be complete within 15 working days from acceptance date below: CONTRACTOR/COMPANY: ACCEPTANCE:Company/Contractor AUTHORIZED SIGNATURE: AGENCY APPROVALS: CTI Authorized Signature: GLCAC Authorized Signature: AUDITOR NOTES QUALITY Date Date Date Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Coi aractor Registration MASCO HOME SERVICES, INC. LUCAS BENSON 2339 BEVILLE RD DAYTONA BEACH, FL 32119 SCA1 0 20"rdlr (;Ke W onwoNnxvr/// �� �. fryu�rev6a�a1/r Office of Consumer ARairs & Busham Regulaties ME IMPROVEMENT CONTRACTOR glstMftn: .164005 Type: piration: B/11I2013 Private Corporation MASCO HOME SERVICES, INC. VVELLHOME LUCAS BENSON 2339 BEVILLE RD -� DAYTONA BEACH, FL 32119' Undersecretary Registration: 164005 Tvpe: Private Corporation Uplratlon: 8/1112013 TO 215145 Address and return card. Mark reason for change. u --- rens MRenewal MEmployment MLost Card License or registration valid for individul use only before the expiration date, if found return to: OfAtt of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 62116 u Not valid without signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supcnisor SpccialtN License: CSSL-100189 !t _i., THEODOREJPLONA 18 THAYER AV>~ AUBURN MA 01501 Expiration 09/13/2014 commissioner