HomeMy WebLinkAboutBuilding Permit #760-11 - 34 SECOND STREET 5/10/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: -76 o d Date Received
Date
ANT: Applicant must complete all items on this
Print
PROPERTY OWNER
Print 100
MAP NO: 3 d PARCEL: ZONING DISTRICT: Historic Districtes no ��
Machine Shop Village yes no 0
TYPE OF IMPROVEMENT
PROPOSED USE
��9
Residential
Non- Residential
❑ New Building
0 One family
❑ Addition
0 Two or more family
0 Industrial
❑ Alteration
No. of units: 2.❑
Commercial
❑ Repair, replacement
0 Assessory Bldg
0 Others:
❑ Demolition
❑ Other
D�Sept�c OkWell, }-
`��Floodplari - `��Wetlands3 ''
'❑}° � � '�
Watershed i ict
a
-
n-F,,y,CRTPTI
N OF WORKeTO BE PERFORMED •
Address
,OW4
CONTRACTOR Name: zn/v
L Phone: 9 71,
Address: // 7 A ��1 F�I� � A/`S(Zl�—J�_- yba
Supervisor's Construction License:J4 S_Exp. Date:
- /' / // q / // Y_ -
Home Improvement License: ���! �, Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. N
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925,00 PER S.F.
Total Project Cost: $ �%1 %. 6FEE: $_—`
Check No.: 6 7 y Z Receipt No.: �2 y/ Cid
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Sw"mg 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
PLANNING & DEVELOPMENT
COMMEN
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
DATE APPROVED
Reviewed on Signature
Reviewed on Siqnature
G
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
]DPW Town Engineer: Signature:
Located 4 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
CONEVMNTS
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.$10041000 fine
Doc:.Building Permit Revised 2008
Building Department
The following is a fist 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
❑ 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
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Ph oto Copy of H. I. C. And C. S. L. Licenses
❑ Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Muss 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)
o 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)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording .
lust be submitted with the building application
Doc: Doc.Building permit Revised 2008mi
Location
No. % G- Date 3-110-///
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
'�s''^•''<�
Building/Frame /Frame Permit Fee $ Z3Z "�-
s�cMusE 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # b / 7 2—
2 4 5
Building Inspector
HISTORIC
Town of Nora
APPLICATION FOR CERTIFICATE OF APPROPRIATENESS
aukotx DEPT
Application is hereby made for the issuance of a CERTIFICATE OF APPROPRIATENESS under
Chapter 40C for proposed work as described below and on plans, drawings, or photographs
accompanying this application.
CHECK CATEGORIES THAT APPLY:
1. Exterior building construction:
Type of Building
2. Demolition or Removal of:
3. Signs or Billboards
4. Structure:
TYPE OR PRINT LEGIBLY
;) New Building
;) Addition
Alteration
Home
;) Garage
;) Commercial
;) Other
() New Signs
() Existing Sign
() Other
O Fence
() Wall
() Other
Address of Proposed Work: Date:
Owner:
Home Address (if different from above):
Agent or Contractor:
Address:
Assessors Map
Telephone #,
Telephone #
Assessors Lot #:
Detailed Description of Proposed Work: Give all particulars of work to be done (see #8 below), including materials to
be used, if specifications do not accompany plans. In case of signs, give locations of existing signs and proposed
locations of new signs. (Attached additional sheet if necessary.)
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Office of Consumer Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
t' Registration: 141124
Expiration: 1/12/2012
Type: Supplement Card
A+M GENERAL CONTRACTING INC.
MICHAEL FITZGERALD
5 SOUTH RIDGE CIRCLE a—
LYNN, MA 01904 Undersecretary
. NIa..actill wtI Department „t Public �afct�
►.3oard ut Builtlin_ Re„ulati„n% and Ntantl11-6
Construction Supd3 visor Specialty License
License: CS SL 99933
Restricted to: RF,WS,DM,IC
R
MICHAEL FITZGERALD
9 WINCHEST COURT
GLOUCESTER, MA 01930
Expiration: 6/19/2012
t mu„i i .ui•r Tr= 99933
From:Susan Petro FaxID: Page 2 of 2 Date3/242011 09:36 AM Page:2 of 2
OP ID: SM
A ORLa" CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DDNYYY)
03!24111
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 781-224-5700
Mazonson LLC www.mazonson.com 781-224-5777
701 Edgewater Drive
Suite 230
Wakefield, MA 01880-6236
TACT
cNAME:
PHOS FAX.
No Ext): AlC, No
E-MAIL
RODUCE:R
CUSTOMERI,,.A&MGE-1
CBP8762001
John Scanlon
INSURER(S) AFFORDING COVERAGE NAIC
INSURED A&M General Contracting, Inc.
INSURER A: Peerless Insurance Co
Norman DubeINSURER
B :ACE - USA
INSURER C
i 119R Foster Street
Peabody, MA 01960
INSURER D
INSURER E:
GENERAL AGGREGATE
INSURER F
LAG GREGATE LIMIT APPLIES PER
h-,"POLICY
PRO-
JECT F-ILOC
rnvccAr-cc rcoyimrATI= All IMRFR• RFVISION NLIMRFR:
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. _
INSR
LTR
TYPE OF INSURANCEADDL
INSR
SUER
WVD
POLICY NUMBER
POLICY EFF
MMIDDNYYY
POLICY EXP
MM/DDNYYY
LIMITS
A
GENERAL LIABILITY1,000,000
X COMMERCIAL GENERAL LIABILITY
r
CLAIMS -MADE u OCCUR.
CBP8762001
03/20111
03/20112
EACH OCCURRENCE
$
PREMISES Ea occurtence
$ 100,000
MED EXP (Any one person)
$ 5.000
PERSONAL & ADV INJURY
$ 1.000.000
GENERAL AGGREGATE
$ 2.000.000
LAG GREGATE LIMIT APPLIES PER
h-,"POLICY
PRO-
JECT F-ILOC
PRODUCTS-COMP/OP AGG
$ 2.000.000
$
A
AUTOMOBILE LIABILITY
l I ANY AUTO
ALL OWNED AUTOS
X SCHEDULEDAUTOS
X HIRED AUTOS
X NON-OWNEDAUTOS
BA8762301
03/20111
03120112
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Perperson)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Peracadent)
$
_
$
' A
X
I-
UMBRELLA LIAB X
EXCESS LIAB
OCCUR
CLAIMS -MADE
CU8762501
03/20111
03120/12
EACH OCCURRENCE
$ 1.000.000
_
AGGREGATE
$ 1.000.000
DEDUCTIBLE
RETENTION $ 10,000
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOP,IPARTNEPIE.XECUTIVE Y�'I
OFFICERIMEMBER EXCLUDED" i_J
(Mandatory in NH)
If yes, describe under
. DESCRIPTION OF OPERATIONS belowE
I N / A
C46275251
03120111
03/20112
WC STATU- OTH-
TORY LIMITS ER
EL EACH ACCIDENT
$ 500.000
EL DISEASE-EAEMPLOYE-
$ 500.000
L DISEASE -POLICY OMIT
$ 500.000
DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space is required)
CERTIFICATE HOLDER
r- - - -- —
Town of North Andover
120 Main Street
North Andover, MA 01845
ACORD 25 (2009109)
TOWNAN1
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.
AUTHORIZREPRESENTATIVE
O 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
` Boston, MA 02111
www.mass.gov/dia
.Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
pplicant Information _ Please Print Legihl,
Name (Business/Organization/Individual):_IA/
Address:_&z�f rt/:
(M&
& 2�
City/State/Zip:
6 Phone #:
Are ou an employer? Check the appropriate
1. I am a employer with
box:
4. ❑ I am a general contractor and I
Type of project (required):
employees (full and/or part-time).
have hired the sub -contractors
6. ❑ New construction
2. ❑ I 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.
employees and have workers'
9. E] Building addition
[No workers' comp. insurance
comp. insurance.+
required.]
5. ❑ We are a corporation and its
10.❑ Electrical repairs or additions
3. ❑ I am a homeowner doing all work
officers have exercised their
11. ❑ Plumbing repairs or additions
myself. [No workers' comp.
right of exemption per MGL
12 ❑ oof repairs
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
13. V Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic.�j� �'�� Expiration Date:Zzo X/
Job Site Address: �o �`� l (� fiJf/City/State/Zi el?,ff—
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb�Yfyy0�the pains an enSof perjury that the information provided above is true avid correct
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 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 of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 4-24-07
www.mass.gov/dia
1.WEATHERSTRIPPING/CAULKING
Door IOts Q -Lon or Equiv.
Door Sweeps (Regular)
Door Sweeps (Automatic)
Reglaze Windows /In.inch
Wlndow.Weathstr Schlegal per side
Attic/Basement bypass sealing man/hr
Attic sealing with 2 -part foam man/hr
SUBTOTALS
2A.INFILTRATION I INSULATION
Domestic pipe Hot Water Tank 1st 5
Sill Insulation R-19 CF
Sill Two Part Foam w/ Fiberglass Batt
Drape Perimeter R5 Anch. Sq. ft.
Drape DOOR R-5 Anch.
Tape Joints (Aluma Grip only) per hr.
Duct Insulation & Tape In. ft.
Rigid Foam Board Anch_ 1"
Hydronic pipe insulation to 1" R5
Hydronic pipe ins. 1.27-1.5" R-5
Steampipe Ins. to1.25" iron pipe R-5
Steampipe Ins. 1.5"-2" iron pipe R5
Steampipe Ins. 3" iron pipe R-5
Air Conditioner Meeting Rall
Air Conditioner Cover
Air Conditioner Cover Special Order
SUBTOTALS
28. INSULATION
Open Unrestricted R 49
Open Unrestricted R 38
Open Unrestricted R 30
Open Unrestricted R 20
Open Unrestricted R 10
Restrict FL/Sloped R 30
Restrict FL/Sloped R 20
Restrict FUSloped R 10
R-19 FGB open raftersAvalls/kneewalls
R-11 FGB open rafters/walls/kneewalis
Attic Stairs(stairwell & common wall)
Cover Pull Down Stairs Thennadome
Site built pull down stairs 2" foam box
Job Number 3856
Client
address
city I town
contractor
QUANTITY
4
3
1
0
0
3.5
2.5
1
0
87
0
1
0
0
0
0
0
121
14
0
0
0
0
0
312
0
0
0
872
0
0
0
0
0
0
0
DATE 9 -May -11
DEANA DEMARCO 978-794-3120
34 SECOND STREET LEFT
NOTH ANDOVERMA 01845
ABM
TOTAL
172.00
45.00
22.00
0.00
0.00
210.00
187.50
636.50
15.00
0.00
174.00
0.00
44.00
0.00
0.00
0.00
0.00
0.00
635.25
84.70
0.00
0.00
0.00
0.00
952.95
0.00
436.80
0.00
0.00
0.00
1229.52
0.00
0.00
0.00
0.00
0.00
0.00
0.00
AUDITOR NOTES
AUDITOR NOTES
tl0111F. 2153 F[f Sif
AUDITOR NOTES
1/2 OF THIRD FLOOR OPEN
IPLEASE SEE ME MANY NOTES I
Page 2
Attic / Kneewal Floor Transition. Dense pack cellulose
W.S. & bat Hatch R-19 /( -Lon or =
W.S. & bat Hatch R-30 /Q -Lon or =
Kneewall R-12 cell behind Per.Memb
Open Rafter R-20 Cell. /w poly
Open Rafter R30 Cell. AY poly
Basement Overhead R-19 fiberglass
Basement Overhead R-30 fiberglass
Crawlpace Overhead < 4' high R19
Crawlpace Overhead < 4' high R30
Garage Ceiling cavity filled w/ cellulose
Wood,Shake,Clapboard,Shingles Vinyl
Asbestos (single nag) / Asphalt
Asbestos (doub. Nail) / Aluminum
Brick/Stucco
Vinyl over Asbestos
Multi -layered 3 or more layers
Drill rough plaster or finish wood plug
Drill finish plaster
Test Drill Walls (all 4 )
SUBTOTALS
2. INSULATION TOTAL 2A.+2B.
3. STORM WINDOWS / DEADUTES
Plexiglass up to 88 u.i.
Additional per UI over 88"
Other (Negotiated Price)
SUBTOTALS
5. 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 Round
Vent Soffit Rectangular
Turbine Vents All
Stack Vent
Propa Vent
Permable House Wrap
Vapor barrier
Energy Star R-4 Rigid Vinyl Repl to 73" U -1 -
Energy Star R-4 Rigid Vinyl Repl 74.84" U.I.
Energy Star R-4Rigid Vinyl Repi 84-93" U.I.
Energy Star R4 Rigid Vinyl Rep] 94-101 U.I.
SUBTOTALS
6.17. E.C. MATERIALAABOR
46
0
0
0
0
0
0
0
0
0
0
1160
0
0
0
0
0
0
207
0
0
0
0
0
2
0
0
6
0
0
0
0
0
0
0
0
0
0
0
110.40
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1972.00
0.00
0.00
0.00
0.00
0.00
0.00
374.67
0.00
4123.39
5076.34
0.00
0.00
0.00
0.00
0.00
176.00
0.00
0.00
456.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
632.00
6344.84
L AUDITOR NOTES
FINISHED WALL THAT DIVIDES ATTIC
(FINISHED WALL IN ATIC I
AUDITOR NOTES
I AUDITOR NOTES
112 X 24 SEE ME ON PLACEMENT I
Page 3
8a. HEALTH & SAFETY
Vent Bath / Kitchen Fan 0 0.00
Dryer vent w/ exhaust duct Heartland 1 85.00
Dryer Transition Duct only 0 0.00
Blower Door Test Pre Post 0 0.00
SUBTOTALS
85.00
8b. REPAIR MATERIAi (LABOR
Basement outside door only
0
0.00
Basement outside door w/ jambs
0
0.00
Door Repl pre hung 32-6" Steel"
0
0.00
Door Repl Interior solid core 28.32"
0
0.00
Door Repi pre hung 323G' wood`*
0
0.00
Window Replacement w/ SIR less than 1
0
0.00
Basement Window Reps. Awning/ Hopper
0
0.00
Basement Window Repl. With a frame
0
0.00
Lockset ( door) Schlage or equal
0
0.00
Repair / Refit Door
1
50.00
Replace Side Stop
0
0.00
Replace Casing
0
0.00
Glass Replacement to 64 ul
0
0.00
Glass Replacement per u.i_ over 64
0
0.00
Sash Sidelock[Top Replacement
0
0.00
Threshold (Wood)
0
0.00
Threshold (Aluminum)
0
0.00
Slide Bolts
0
0.00
Plug Plate Cover
0
0.00
Out / finish attic-kneewall access
0
0.00
Cut / close attic-kneewail access
0
0.00
Labor Rate Hours
0
0.00
Permits / Fees (Wap only)
0
0.00
SUBTOTALS
50.00
TOTAL REPAIR + HEALTH & SAFETY
135.00
GRAND TOTAL WORK ORDER # (A) 3856 6479.84
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-
AUDITOR NOTES
AUDITOR NOTES I
I FRONT DOOR DRAGS I
CONTRACTOR/COMPANY: A & M
ACCEPTANCE:Company/Contractor
AUTHORIZED SIGNATURE:
AGENCY APPROVALS:
CTI Authorized Signature:
Date A�//
Date
GLCAC Authorized Signature: Date
1.WEATHERSTRIPPING/CAULIONG
Door Kits Q -Lon or Equiv.
Door Sweeps (Regular)
Door Sweeps (Automatic)
Reglaze Windows /ln.inch
Window.Weathstr Schlegel per side
AtticfBasement bypass sealing man/hr
Attic sealing with 2 -part foam man/hr
SUBTOTALS
2A.INFILTRATION I INSULATION
Domestic pipe Hot Water Tank 1st 6
Sill Insulation R-19 CF
Sill Two Part Foam w/ Fiberglass Batt
Drape Perimeter R-5 Anch. Sq. ft.
Drape DOOR R-5 Anch.
Tape Joints (Alums Grip only) per hr.
Duct Insulation & Tape In, ft.
Rigid Foam Board Anch. V
Hydronic pipe insulation to 1" R-5
Hydronic pipe ins.1.25"-1.5" R-5
Steampipe Ins. to125" iron pipe R-5
Steampipe Ins. 1.5"- 2" iron pipe R-5
Steampipe Ins. 3" iron pipe R-5
Air Conditioner Meeting Rail
Air Conditioner Cover
Air Conditioner Cover Special Order
SUBTOTALS
2B. INSULATION
Open Unrestricted R 49
Open Unrestricted R 38
Open Unrestricted R 30
Open Unrestricted R 20
Open Unrestricted R 10
Restrict FUSloped R 30
Restrict FUSloped R 20
Restrict FL/Sloped R 10
R-19 FGB open rafters/wals/kneewalls
R-11 FGB open rafters/walis/imeewalle
Attic Stairs(stairwell & common wall)
Cover Pull Down Stairs Thermadome
Site built pull down stairs 2" foam box
Job Number 3857
DATE
9 -May -11
Client
SUSAN BALSAMO 978-208-1025
address
0
36 SECOND ST RIGHT
cityltown
0.00
NO ANDOVER MA 01845
contractor
0
A & M
QUANTITY
TOTAL
AUDITOR NOTES_
3
129.00
0.00
1
15.00
43
1
22.00
TO BASEMENTSHAVE,CATCHES
0
0.00
0
0
0.00
0.00
2
120.00
TOP OF CEILING LARGE GAP AROIUND CHIC
1.5
112.50
398.50
1
15.00
0
0.00
68
136.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
0
0.00
67
351.75
43
260.15
0
0.00
0
0.00
0
0.00
0
0.00
762.90
0
0.00
0
0.00
0
0.00
630
774.90
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
I AUDITOR NOTES
AUDITOR NOTES I
Page 2
Attic / Kneewal Floor Transition. Dense pack cellulose
W.S_ & bat Hatch R -1910 -Lon or =
W.S. & bat Hatch R-30 /Q -Lon or =
Kneewall R-12 cell behind Per.Memb
Open Rafter R-20 Cell. AN poly
Open Rafter R-30 Cell. /w poly
Basement Overhead R-19 fiberglass
Basement Overhead R-30 fiberglass
Cmwlpace Overhead < 4' high R19
Crawlpace Overhead < 4' high R30
Garage Ceiling cavity filled w/ cellulose
Wood,Shake,Clapboard,Shingles Vinyl
Asbestos (single nail) / Asphalt
Asbestos (doub. Nail) /Aluminum
Briclr/Stucco
Vinyl over Asbestos
Multi -layered 3 or more layers
Drill rough plaster or finish wood plug
Drill finish plaster
Test Drill Walls (all 4 )
SUBTOTALS
2. INSULATION TOTAL 2A.;28.
3. STORM WINDOWS J DEADLITES
PieAgiass up to 88 W.
Additional per UI over 88"
Other (Negotiated Price)
SUBTOTALS
5. 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 Round
Vent Soffit Rectangular
Turbine Vents All
Stack Vent
Props Vent
Permable House Wrap
Vapor barrier
Energy Star R-4 Rigid Vinyl Repl to 73" U_I_
Energy Star R-4 Rigid Vinyl Repl 74-84" U.I.
Energy Star R-4Rigid Vinyl Repl 84-93" U.I.
Energy Star R-4 Rigid Vinyl Repi 94-101 U.I.
SUBTOTALS
6.17. E.C. MATERIALIABOR
0
0
0
126
0
0
0
0
0
0
0
1150
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0.00
0.00
0.00
207.90
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1972.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2954.80
3717.70
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4116.20
I AUDITOR NOTES
ON LEFT SIDE AUDIT ACCESS ISSUE
(ACCESS HATCHES NEED TO BE CUT I
IREAD NOTES NOT DOING REAR SIDE APT
AUDITOR NOTES
I AUDITOR NOTES I
Page 3
Ba. HEALTH & SAFETY
85.00
Vent Bath / Kitchen Fan
0
0.00
Dryer vent w/ exhaust duct Heartland
1
85.00
Dryer Transition Duct only
0
0.00
Blower Door Test Pre Post
0
0.00
SUBTOTALS
85.00
8b. REPAIR MATERIALILABOR
Basement outside door only
0
0.00
Basement outside door w/ jambs
0
0.00
Door Repi pre hung 32-36" Steel"
0
0.00
Door Repl Interior solid core 28-32"
0
0.00
Door Repl pre hung 3235" wood-
0
0.00
Window Replacement w/ SIR less than 1
0
OAO
Basement Window Repl. Awning/ Hopper
0
0.00
Basement Window Repl. With a frame
0
0.00
Lockset ( door) Schlage or equal
0
0.00
Repair / Refit Door
0
0.00
Replace Side Stop
0
0.00
Replace Casing
0
0.00
Glass Replacement to 64 u.i.
0
0.00
Glass Replacement per u.i. over 64
0
0.00
Sash Sidelock /Top Replacement
0
0.00
Threshold (Wood)
0
0.00
Threshold (Aluminum)
0
0.00
Slide Bolts
0
0.00
Plug Plate Cover
0
0.00
Cut I finish attic-lmeewafl access
2
200.00
Cut / close attic-kneewail access
0
0.00
Labor Rate Hours
0
0.00
Permits / Fees (Wap only)
0
0.00
SUBTOTALS
200.00
TOTAL REPAIR + HEALTH & SAFETY
285.00
--------------
GRAND TOTAL WORK ORDER # (A) 3857 4401.20
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 worldng days from acceptance
date below:
CONTRACTORICOMPANY:
ACCEPTANCE:Company/Contractor
AUTHORIZED SIGNATURE:
AGENCY APPROVALS:
CTI Authorized Signature:
GLCAC Authorized Signature:
I- AUDITOR NOTES
MULTI
AUDITOR NOTES
IFINISHED ROOM HIDE PANELS I
A&M
Date Z% ///
Date
Date