HomeMy WebLinkAboutBuilding Permit #276 - 27 ABBY LANE 10/16/2008 i
NORTH
1 BUILDING PERMIT
1 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION 70
Permit NO: Date Received
�SSACMUs�t
Date Issued: ?�
IMPORTANT:Applicant must complete all items on this page
i
LOCATION ,' 46R,�L K�LE
Print
PROPERTY OWNER -61g ,` S K r'/t g
•nt
MAP'NO: 66�'PARCEL:dng ZONING DISTRICT: Historic District yes
Machine Shop Village yes <12P 4
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential i
i
New Building ne fame
Addition Two or more family Industrial
teration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK T9 BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: gfzn, S «I 4�, Phone:!M-340 p,-77� -
Address: — Kl-
E
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home 'Improvement License: Exp. Date:
T
ARCHITECT/ENGINEER L d--e AA Phone:
Address: 571--9 A/hs C22 4 cZ Z ,�Lur Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ � FEE: $ �� ^
Check No.: ! l j Receipt No.: O
NOTE: Persons contractingwi unregister contractors do not have access to the guaranty fund
Signature of Agent/Owner Y - Signature a contractor i
Location
No. Date
MpRTh TOWN OF NORTH ANDOVER
O 0
' Certificate of Occupancy $ _
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2 6 u 1 � --
Building Inspector
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 DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS,
'
O S.
HEALTH , Reviewed on Signature
COMMENTS
Zoning• y B•ard of Appeals:Variance, Petition No: Zoning decision/receipt submitted yes
Planning.Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT Temp Dempster on site yes no
Located at 124 Main Street
Fire Department signatureldate
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— For department use
C
-LSS p yO
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
7;.
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
E3 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
I
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Com Affidavit
t
❑ 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)
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable) r
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products I
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
t
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
I
Revised 2.2008
Performance Data
Canadian tt
Tested to:CAN/CSAA440-M90 The mullion was tested and the deflection was within the maximum allowable of L/175 at positive and negative loads of 2600 Pa.
Wind Load Resistance Wind Load Resistancez
Units Air Water Resistance to forced Units Air Water Resistance to forced
Tested Tightness Tightness and blow-out entry Tested Tightness Tightness and blow-out entry
CX16 A-3 B-7 CA Pass FX-12050 Fixed B-7 C-5 Not Applicable
P6050 Fixed B-7 C-4 Not Applicable AF-608 Fixed B-7 C-5 Not Applicable
A41 A-3 B-3 C-5 Pass SP-802 Fixed B-7 C-5 Not Applicable
AXW51 A-2 B-2 C-2 Passt
FWH6080AP A-3 B-2 C-3 Pass
TW3862 A-3 B-2 C-2 Pass 9080SASR A-3 B-2 C-3 Pass
NL3862 A3 B-3 C-3 Pass FW06080AP A3 B-4 C-3 Not Applicable
DHP5662 Fixed B-3 C-3 Not Applicable 3180 A-3 B-4 C-3 Not Applicable
G65 A-3 B-2 C-3 Pass FWG8080 A-3 B-3 C-1 Pass
Cir Ovl 3048 Fixed B-7 C-5 Not Applicable 160611 A-3 B-2 C-1 Pass
El8 Fixed 3-7 C-5 NotApplicable M8080 A-3 B-2 C-1 Pass
Andersen NFRC CertifiedTotalt
Andersen'windows and patio doors meet or exceed the following standards:WDMA;I.S:2,W.D.M.A d.S:4(WDMA license No.129),Hallmark certified.Independent testing laboratories have performed all required tests on selected sizes.Compliance with these standards is
confirmed by ongoing testing in Andersen Laboratories.These products are covered by one or more of the following patents:4,999,950;5,595,409;5,775,749;6,055,786:5,544,450;5,566,507;5,582,445;5,097,629;5,740,632;5,199,234;D312,565;D397,604;and
D417,831.Other patents pending.
Without Grilles Without Grilles MeMIM
Andersen'400 Series HP HP Low-E4 HP HP Low•E4 Andersen'400 Series HP HP Low-E4 HP HP Low-E4
Product Type Low-E4' Sun Low•E4 Sun Product Type Low-E4 Sun Low•E4 Sun
Casement U-Factor' 0.30 0.31 0.31 0.32 Elliptical Window U-Factor' 0.30 0.30 0.31 0.32
24"x 48"size SHGC' 0.34 0.20 0.31 0.18 48"x 48"size SHGC' 0.36 0.21 D.32 0.19 j
VP 0.55 0.30 0.50 0.27 VP 0.60 0.33 0.53 0.29 /S
Awning U-Factor' 0.30 0.31 0.31 0.31 Circle Top" U-Factor' 0.29 0.29 0.31 0.31 1
48"x 24"size SHGC2 0.33 0.20 0.30 0.18 Casement SHGC' 0.36 0.21 0.33 0.19 11
VP 0.54 0.30 0.49 0.27 48"x 48"size VP 0.60 0.33 0.54 0.30
Casement/Awning U-Factor' 0.29 0.29 0.31 0.31 Circle/Oval U-Factor' 0.29 0.29 0.31 0.31
Picture Window SHGC2 0.36 0.21 0.33 0.19 48"x 48"size SHGC2 0.36 0.21 0.33 0.19
48"z 48"size
\i 0.60 0.33 0.54 0.30 VP 0.60 0.33 0.54 0.30
Woodwright'Full-Frame U-Factor' 0.31 0.32 0.33 0.34 Arch Window U-Factor' 0.30 0.30 D.31 0.32
Double-Hung SHGC2 0.32 0.19 0.29 0,17 48"x 48"size SHGC2 0.35 0.20 0.31 0.19
36"x 60"size
VP 0.53 0.29 0.47 0.26 VP 0.58 0.31 0.52 0.28 r
Woodwright'Full-Frame U-Factor' 0.30 0.30 0.31 0.32 Flexiiframe' U-Factor' 0.29 0.30 0.31 0.31 l
Picture Window SHGC' 0.34 0.20 0.30 0.18 48"x 48"size SHGC2 0.35 0.20 0.31 0.19
48"x 48"size
VP 0.56 0.31 0.50 0.27 VP 0.58 0.31 0.52 0.28
Woodwright'Full-Frame U-Factor' 0.30 0.30 0.30 0.30 Springline'Window U-Factor' 0.29 0.30 0.31 0.31 1
Transom SHGC2 0.35 0.20 0.31 C. 48"x 48"size SHGC' 0.35 0.20 0.31 0.19 }
48"x 48"size
VP 0.58 0.32 0.52 0.29 VP 0.58 0.31 D.52 0.28
Woodwright'Insert U-Factor' 0.33 0.33 0.34 0.34 Tempered
Double-Hung SHGC2 0.33 0.19 0.29 0.18 Skylight U-Factor' 0.56 0.56 0'55 0.56 '
36"x 60"size VP 0.54 0.30 0.48 0.26 48"x 48"size SHGC2 0.41 0.25 0.40 0.24
Woodwright'Insert U-Factor' 0.31 0.31 0.32 0.32 VP 0.68 0.38 0.66 0.37 j
Picture Window SHGC' 0.34 0.20 0.30 0.18 Venting U-Factor' 0.53 0.54 0.53 0.53 11
48"x 48"size VP 0.56 0.31 0.50 0.27 Roof Window SHGC2 0.38 0.23 0.37 0.22 t
Woodwright'Insert U-Factor 0.31 0.32 0.32 0.33 48"x 48"size VP 0.62 0.34 0.61 0.33
Transom SHGC2 0.34 0.20 0.31 0.18 Stationary U-Factor' 0.53 0.53 0.53 0.53
48"x 48"size Roof Window
VP 0.57 0.31 0.51 0.18 SHGC2 0.39 0.24 0.38 0.23
Tilt-Wash U Factor' 0.32 0.32 0.33 0.33
48"x 48"size VT3 0.64 0.35 0.62 0.34 t
Double-Hung
SHGC2 0.33 0.20 0.29 0.18 Please contact your Andersen supplierfor performance values on products that include patterned glass,tempered glass other
36"x 60"size VP 0.54 0.30 0.48 0.26 than skylights or roof windows and products ordered with capillary breather tubes.
Tilt-Wash U-Factor' 0.32 0.32 0.33 0.34 Skylight and roof window values are based upon NFRC 2001 procedures rated at a 20 degree angle.
Double-Hung Picture SHGC2 0.35 0.20 0.31 0.19 Grilles=Finelight or Full Divided light.
48"x 48"size "High-Performance Low-E4"(HP Low-E4)and"High-Performance Law-E4 Sun"(HP Low-E4 Sun)are Andersen
VP 0.58 0.32 0.51 0.28 trademarks for"Low-E"glass
.
Tilt-Wash U-F2ctor' 0.28 0.29 0.30 0.30 1 L.-Factor defines the amount of heat loss through the total unit in BTU/hr sq.n'.°F
Double-Hung Transom SHGC' 0.33 0.20 0.30 0.18 The lower the value,the less heat is lost through the entire product. r/^`j ,7
48"x 48"size 2 Solar Heat Gain Coefficient SHGC defines the fraction of solar radiation admitted through the glass both directly transmitted '�/ t
ura 0.56 0.31 0.49 0.27 ( )
r and absorbed and subsequently released inward.The lower the value,the less heat Is transmitted through the product. }
Gliding Window U-Factor 0.33 0.33 0.34 0.34
60"x 36"size z 3 Visible Transmittance(fl measures haw much light comes through a product(glass and frame).
SHGC 0.30 0.18 0.27 0.16 The higher the value,from 0 to 1,the more daylight the product lets in over the product's total unit area.
VP 0.50 0.28 0.44 0.24 Visible Transmittance is measured over the 380 to 760 nanometer portion of the solar spectrum.
This data is accurate as of October 17,2007.Due to ongoing product changes,updated test results, A
or new industry standards,this data may change over time.
254 e
Andersen®
Center of r Data
"High Performonce Low-E4'•(HP Low Ell)and
Dual-Pane Glass Visible Fading %RH "High Performance Low-E4 Sun"(HP Sun)are
(Air filled) Light' SC' SHGC' RHG° TUVs Tdws U-Factor' @centers IGSTB Andersen trademarks for"Low-E"glass.
1 Casement/Awning,Narroline'DH, Based on NFRC testing/simulation conditions using
Narroline Transom,200 Series Tilt-Wash Windows 5.2 and NFRC validated spectral data.
0°F outside temperature,70°F inside temperature
and Gliding Window 83% 0.92 0.79 191 62% 64% 0.50 41% 45oF and a 15 mph wind.
Casement/Awning Picture/Transom, 1 Visible Transmittance(VI)measures how much light
200 Series Fixed Units(Tempered) 82% 0.90 0.77 187 57% 60% 0.51 40% 44oF comes through the glass.The higher the value,from
0 to 1,the more daylight the glass lets in.Visible
Perms-Shield'Patio Door82% 0.87 0.75 181 54% 58% 0.49 42% 46°F Transmittance is measured over the 380 to 760
Narroline`Glidin Patio Door 82% 0.89 0.78 186 58% 61% 0.49 38% 43°F nanometer portion of the solar spectrum.
S 2 Shading Coefficient defines the amount of heat
gain through the glass compared to a single lite
of clear 1/8"(3 MM)glass.
3 Solar Heat Gain Coefficient(SHGC)defines the
fraction of solar radiation admitted through the
High-Performance Low-E4° glass both directly transmitted and absorbed and
and Low-E Glass Visible Fading %RH subsequently released inward.The lower the value,
(Dual-pane,Low-E4,argon blend filled glass) Light' SC' SHGC' RHG° To Tdws U-Factor @centers IGST' the less heat is transmitted through the glass.
4 Relative Heat Gain is the amount of heat gain
Casement/Awning,400 Series Tilt-Wash, through a glazing incorporating U-Factor and
Narroline DH,Narroline Transom, Solar Heat Gain Coefficient.
20OSenesTilt-Wash and Gliding Window 73% 0.50 0.43 104 17% 34% 0.28 60% 55°F 5 Transmission Ultra-Violet Energy(TUVyThe
Woodwright*Double-Hung Full-Frame, transmission of short wave energy in the
i 300-380 nanometer portion of the solar
Woodwright'Double-Hung insert 72% 0.50 0.43 104 16% 33% 0.28 60% 56°F spectrum.The energy can cause fabric fading.
Casement/Awning Picture/Transom, 6 Transmission Damage Function(TDW).The
Double-Hung Picture,Woodwright Full-Frame transmission of UV and visible light energy in the
tPicture/Transom,Woodwright Insert(Tempered) 73% 0.50 0.43 103 16% 33% 0.30 58% 55°F 300-600 nanometer portion of the solar spectrum.
The value includesboth the UV and visible light
Picture/Transom,CircleTop,Oval,Circle, energy that can cause fabric fading.This rating has
00 Series Fixed Units,Elliptical 73% 0.50 0.43 104 17% 34% 0.28 60% 56`F also been referred to as the Krochmann Damage
1 Function.This rating better predicts fading potential
Roof Windows and Skylights 73% 0.49 0.43 102 16% 33% 0.28 60% 56°F than UV transmission alone.The lower the Damage
00 Series Gliding Windows 73% 0.50 0.43 104 17% 34% 0.28 60% 56°F Function rating,the less transmission of short
Frenchwood'Hinged,Outswin and wave energy through the glass that can potentially
g g cause fabric fading,Fabric type is also a key
Gliding Doors,Frenchwood Sidelights/ component of fading potential.
Transoms,Narroline Gliding Door 72% 0.49 0.42 101 15% 32% 0.28 60% 56oF 7 U-Factor in this table is a measure of the
FleAframe,Arch,Springline,Full-Chord, heat loss through the center of glass in
Gothic,Elliptical,Octagon,Full Round, BTU/hr deg.F sit.ff.This U-Factor should not
be confused with U-Factor as measured by the
Quarter Round 71% 0.47 0.41 98 14% 31% 0.27 61% 56'F National Fenestration Rating Council(NFRC)which
represents heat loss through the total unit.Only
NFRC total unit U-Factor's should be used when
demonstrating building or energy code compliance.
i 8 Percent relative humidity before condensation
occurs at the center of glass,taken using center
High-Performance Low-E4'Sun of glass temperature.
and Low-E Sun Glass Visible Fading %RH 9 Inside glass surface temperatures are taken at
(Dual-pane,tinted Low-E4,argon blend filled glass) Light' SC' SHGC' RHG @c
Tuvs Tdw° U-Factor' enters IGST9 he center of glass,
Casement/Awning,400 Series Tilt-Wash,
Narroline'DH,Narroline Transom, Contact your Andersen supplier for center of glass
f 200 Series Tilt-Wash and Gliding Window 40% 0.30 0.26 64 17% 25% 0.28 57% 54°F performance data on windows with laminated glass.
oodwrighr Double-Hung Full-Frame
oodwrighr Double-Hung Insert 40% 0.29 0.25 62 16% 24% 0.29 57% 54oF
Casement/Awning Picture/Transom,
Double-Hung Picture,Woodwright Full-Frame
Picture/Transom,Woodwright Insert(Tempered) 40% 0.30 0.26 64 16% 24% 0.30 55% 53°F
Picture/Transom,Circle Top,Oval,Circle, o
200 Series Fixed Units 40% 0.30 0.26 63 17% 25% 0.29 57% 54°F
Roof Windows and Skylights 40% 0.29 0.25 62 16% 24% 0.29 57% 54*F
400 Series Gliding Windows 40% 0.30 0.26 63 17% 25% 0.29 57% 54°F
Frenchwood'Hinged,Outswing and
l Gliding Doors,Frenchwood Sidelights/
ransoms,Narroline Gliding Door 40% 0.29 0.25 62 16% 24% 0.28 57% 54°F
Flexiframe'Amh,Springlil Full-Chord,
/C Gothic,Elliptical,Octagon,Full-Round,
Quarter Round 37% 0.28 0.24 60 13% 22% 0.28 57% 54°F
3 This data is accurate as of October 17,2007.Due to ongoing product changes.updated test results,or new industry standards,this data may change overtime.
i
1
Page 2 of 7
Prime Double Hung NFRC Values - Standard Jambliner- Rectangular Only
Glass Type Gas Fill Dividers U-Value Solar Heat Visible Light R-Value
Gain Coefficient Transmittance
Clear I.G. Air N/A 0.48 0.56 0.59 2.08
Low-E2 Air* N/A 0.35 0.30 0.52 2.86
Low-E'-366 Air* N/A 0.35 0.20 0.47 2.86
Low-E2 Argon N/A 0.32 0.30 0.52 3.13
Low-E'-366 Argon N/A 0.32 0.20 0.47 3.13
Clear I.G. Air Internal Grid 0.48 0.50 0.53 2.08
Low-E2 Air* Internal Grid 0.35 0.27 0.46 2.86
Low-E'-366 Air* Internal Grid 0.35 0.18 0.42 2.86
Low-E2 Argon Internal Grid 0.32 0.27 0.46 3.13
Low-E'-366 Argon Internal Grid 2 0.18 0.41 3.13
Clear I.G. Air 7/8"SDL 0.48 0.50 0.53 2.08
Low-E2 Air* 7/8"SDL 0.35 0.27 0.46 2.86
Low-E'-366 Air* 7/8"SDL 0.35 0.18 0.42 2.86
Low-E2 Argon 7/8"SDL 0.32 0.27 0.46 3.13
Low-E'-366 Argon 7/8"SDL 0.32 0.18 0.41 3.13
Clear I.G. Air 1-1/8"SDL 0.48 0.45 0.46 2.08
Low-E2 Air* 1-1/8"SDL 0.35 0.24 0.41 2.86
Low-E'-366 Air* 1-1/8"SDL 0.35 0.17 0.37 2.86
Low-E2 Argon 1-1/8"SDL 0.32 0.24 0.41 3.13
Low-E'-366 Argon 1-1/8"SDL 0.32 0.16 0.36 3.13
Grey Air None 0.48 0.42 0.39 2.08
Grey/Low-E2 Air* None 0.35 0.27 0.35 2.86
Grey/Low-E2 Argon None 0.32 0.27 0.35 3.13
Grey Air 7/8"SDL 0.48 0.36 0.35 2.08
Grey/Low-E2 Air* 7/8"SDL 0.35 0.24 0.31 2.86
Grey/Low-E2 Argon 7/8"SDL 0.32 0.24 0.31 3.13
Grey Air 1-1/8"SDL 0.48 0.34 0.31 2.08
Grey/Low-E2 Air* 1-1/8"SDL 0.35 0.22 0.27 2.86
Grey/Low-E2 Argon 1-1/8"SDL 0.32 0.22 0.27 3.13
Bronze Air None 0.48 0.45 0.44 2.08
Bronze/Low-E2 Air* None 0.35 0.29 0.38 2.86
Bronze/Low-E2 Argon None 0.32 0.29 0.38 3.13
Bronze Air 7/8"SDL 0.48 0.41 0.39 2.08
Bronze/Low-E2 Air* 7/8"SDL 0.35 0.26 0.34 2.86
Bronze/Low-E2 Argon 7/8"SDL 0.32 0.26 0.34 3.13
Bronze Air 1-1/8"SDL 0.48 0.36 0.34 2.08
Bronze/Low-E2 Air* 1-1/8"SDL 0.35 0.23 0.30 2.86
Bronze/Low-E2 Argon 1-1/8"SDL 0.32 0.23 0.30 3.13
Clear I.G. Air TDL D.51 0.45 0.46 1.96
Low-E2 Air TDL 0.41 0.24 0.41 2.44
Low-E'-366 Air TDL 0.41 0.17 0.37 2.44
Grey Air TDL 0.51 0.34 0.31 1.96
Grey/Law-E2 Air TDL 0.41 022 0.27 2.44
Bronze Air TDL 0.51 0.36 0.34 1.96
Bronze/Low-E2 Air TDL 0.41 0.23 0.30 2.44
9/14/2007
For greater energy efficiency,argon is added to all Low-E glass units,at no cost to the customer,with the exception of those units
http://w-A,v.lincolnwindows.com/Lincoln%20NFRC%20Values_files/sheet005.htm 10/9/2008
ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR
ONE-AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00)
Applicant Name: C Site Address: --
print I �
Town:
Applicant Phone: �7 3�,�1 G
Applicant Signature: Date of Application:
NEW CONSTRUCTION-: (choose ONE of the followin -.two Options)
780 CMR TABLE 6107.1
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR
NEW ONE-AND TWO-FAMILY BUILDINGS
MAXIMUM MINIMUM
Ceiling or Slab
Option 1: Basement
�— Fenestration exposed Wall Floor Perimeter
U-factor floors R-Value R-Value Wall R-Value AFUE HSPF SEER
RVl
R-Value -Value and Depth
National Appliance Energy
R-10, Conservation Act(NAECA)of
.35 R-38 R-19 R-19 R-10 4 ft 1987 as amended,minimums or
greater as applicable
Note: This form is not required if you choose either of the two versions of REScheck as listed below.
❑ Option 2: v REScheck Version 4.1.2 or later variant software analysis must be completed
(780 CMR 6107.3.2)
v REScheck-Web which can be accessed at http://www.energycodes.gov/rescheck/
ADDITIONS OR ALTERATIONS TO EXISTING BUILDINGS OVER 5 YEARS OLD*
*Buildings under 5 years old must use option#1 or#2 in New Construction section above.
Complete the following formula to determine the% of glazing:
(a) Gross Wall &Ceiling Area equals Formula: (100 x b_a)
SF
100 x — _ % of glazing
(b) Glazing area equals SF b a
If glazing is=40% use the chart below. If glazing is>40% proceed to "SUNROOM" section
780 CMR TABLE 6101.3
PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING
LOW-RISE RESIDENTIAL BUILDINGS
MAXIMUM MINIMUM
Ceiling and Slab Perimeter
❑ Fenestration Wall Floor Basement Wall
Exposed floors R-Value
U-factor R-Value R-Value R-value R-Value and Depth
.39 R-37 a R-13 R-19 R-10 R-10,4 feet
a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling
area(i.e.not compressed over exterior walls,and including any access openings).
❑ SUNROOM—An addition or alteration to an existing building/dwelling unit where the total
glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the
addition.
Note: Owner to fill out Consumer Information Form (found in Appendix 120.P)
I f
NORTI# TOWN OF NORTH ANDOVER
�? '•°� OFFICE OF
BUILDING DEPARTMENT
49
1600 Osgood Street Building 20, Suite 2-36
North Andover Massachusetts 01845
�s t
SAtNUst
Gerald A.Brown Telephone(978)688-9545
Inspector of Buildings Fax (978)688-9542
HOMEOWNER LICENSE EXEMPTION
Please pfila
DATE: o v
JOB LOCATION: Z � L n , Qrl�nutr�l
Number Street Address MaplLot
HOMEOWNER S�
Name Home Phone Work Phone
PRESENT MAILING ADDRESS SAM G�
City Town State Zip Code
The current exemption for"homeowners"was extended to include owner-occupied dwellings to two units or less
and to allow such homeowners to engage an individual for hire who does not possess a license,provided that the
owner acts as supervisor). State Building (Code Section 108.3.5.1)
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which helshe resides or intends to reside,on which there is,or is intended
to be,a one or two family structures. A person who constructs more that one home in a two-year period shall not
be considered a homeowner.
The undersigned"homeowner"assumes responsibility for compliances with the State Building Code and other
Applicable codes,by-laws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of North Andover Building Department
minimum inspection procodures and that he/she will comply with said procedures and
requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING OFFICIAL
Re need 10.2005
Form Homeowners Exemption
' r
110AR.D OF \PPFAIS i.38-95d1 CONS E'RV.VHON 638-9510 HEALTH 58&9540 PL.LNINING 68.X--9535
i
r� \ The Commonwealth of Massachusetts
Department of Industrial Accidents
`1 x�_ ti Office of Investigations
Ih�._
600 Washington Street
Boston, MA 02111
t 3 www-mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibiv
Name (Business/Organization/Individual): 11.5
Address: e6 U!:4 L tJ
City/State/Zip: W, AUi?Wt-, Nl - Phone#: OD U- 3 r.O- O oZ-7
Are you an employer?Check the appropriate box:
Type of project(required):
1.❑ I an a employer with 4. F-1I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6' F-1 New construction
2.F-1I am a sole proprietor or partner- listed on the attached sheet. # 7• ❑ 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 10-0 Electrical repairs or additions
3.2fam a homeowner doing all work right of exemption per MGL 1.1-El 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 A fry L
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
. Homeowners Who submit this of ldavii indicating they are doing all work and then hire outside aontrac ors 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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the police and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify r t pains andpenqfties of perjury.that the information provided above is true and correct
Si�rtature: `
/ Date: U 0..06
Phone#: 29 - 3 b o ' O a 77
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 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-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 cant'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 permitllicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, -
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents.
Office of Investigatiions
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSA-FE
Revised 5-26-05 Fax#617-727-7749
www.mass.gov/dia
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