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HomeMy WebLinkAboutBuilding Permit #517-2016 - 675 GREAT POND ROAD 10/26/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: I (�-'I Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page ,LOCATIONi _ ,.Print= ;P'RQPERTY QINNER 101- - '' Pnnt '�} 100 Year Stiucture MAP PARCEL: `t L , ZON,ING DISTRICT _ Historic District- _ Machine Shop Vill p' �•tf`ED1646NO\ +� - IL 1* m" � es no, yes: no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0( One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial K Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other O Septic 1.1N -11, �V ' 0 Floodplain Wetlands D 1Naters.hed Distrief EY 1Nate YSewer_ DESCRIPTION OF WORK TO BE PERFORMED: t� > s��� kA Identification - Please Type or Print Clearly OWNER: Name: Vi i.c Qyu—. Phone: RZ&—G_'I-00N AddrP.s: '.e ARCHITECT/ENGINEER Address: Phone 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: $ Sio,to FEE: Z Check No.: b o� Receipt No.: 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 ❑ 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 PLANNING & DEVELOPMENT Reviewed On COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Sianature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: LOcatea M4 , . AR�TMENT TempDurnpster��®rsiteyesno _ sgoo ree �r r Located at 124tMain�Street FrelDe�artment si nat=urMe/date._,_ _ - --- - f¢06%1\411nn`FNT. 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 Nu I t5 ana UA I A — (F -or department use ❑ Notified for pickup Call Email I Date Time Contact Name Doc.Building Pennit Revised 2014 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 ❑ 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 ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 ❑ 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Location e -0 —4-101K N66� Date TOWN OF NORTH ANDOVEO Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL 29.5.0 $ . 49z --,r Building Inspector sk _ Eq—* x Q x Ll O D Q O co U +_ O LL Eai N V) u O_ {n p F- W N Z z m C: O Y v 7 tLL s 7 T E U LL O H z Z C G J d s = — @ LL O LLI N Z u v J LY s = OC i N In — ro u. oC OV Ul cn Z Q (g s j O �' to U- Z LJ 1 F Q CL w W OC LL v L O m O Z N (% N Y N n V .u+ yf� •�CD L wJ � Q W 0 W 0 0 0 Z CL 0 tm o � '0 . w o 'a .E m m 0 �, d woo 0 � Q �C. 0 /CD W 0 V Vi ♦Y FRANCIS A. HEBB DESIGN/BUILD CONTRACTOR CONSTRUCTION MANAGEMENT AND CONSULTING Residential, Commercial Building & Renovations Construction Supervisory License #033217 Home Improvement License #107916 CONTRACT TO BUILD 70 Lake Shore Road, Boxford, MA 01921-1115 Shop (978) 352-6123 Fax (978) 352-5068 Cell (978) 423-6637 RESIDENTIAL CONTRACTING AGREEMENT Designated Registrant's Name: FRANCIS A. HEBB Registration Number: 107916 This agreement is made on _October 23, 2015` (date) between FRANCIS HEBB of 70 LAKE SHORE ROAD, BOXFORD, MA 01921 (978) 352-6123 hereinafter called "Contractor" and Paul Creamer (Owner) of 675 Great Pond Road, North Andover, MA 01845 hereinafter called "Owner". I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED Contractor agrees to perform in a good and workmanlike manner all work detailed below for the store and house roof projects. Such work consists of the following: Re -shingle entire roof, strip existing roof shingles, install new 30 -yr IKO architectural black shingles, ice and water barrier up 6' on edge of roof and valleys. Ice and water barrier over entire dormer roof. Metal ice belt on lower edge of dormer roof. Remove all rubbish and clean up. Redo step flashing on dormer cheeks. Install ridge vents. Additional work may be needed to replace any rotten wood once roof is stripped. II. PRICE Contractor agrees to do all work described in Section I for the total price $23,530.00. III. PAYMENT Payment will be made as follows: Payment due upon beginning of project $ 5,000.00 Payment due upon complete $15,000.00 and the remaining $3,530.00 upon completion verification of the work by Owner and Contractor as having been satisfactorily completed, which verification shall take place promptly after completion. Price does not include permits and labor to obtain permits. Cost of permits will be added to the next applicable payment after obtaining permits. Notice: No agreement for home improvement contracting work shall require a down payment (advance deposits) of more than one-third of the total contract price or the total amount of all deposit or payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount isegr, ater. IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified here in writing. Contractor will begin the work on October 27, 2015 and completion is scheduled for November 3, 2415. The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED The Contractor may not require payments to be made in advance of the times specified in Section III (Payment) above for the reason that he deems himself or the payments to be insecure. If, however, he deems himself to be insecure, he may require, as a prerequisite to continuing the work described herein, that the balance of the payments under this contract that are in the control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. VI. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself, his employees or his subcontracts in the performance of, or as a result of, the work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. VII. SUBCONTRACTING Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third parry, Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. VIII. CONSTRUCTION RELATED PERMITS The following construction related permits will be necessary in order to complete the scope of work included in this Agreement: Building and Demo (Price does not include permits and labor Lo obtain). The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction related permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies, authorities or individuals. Notice: If the homeowner obtains his own construction related permits for the work described under this agreement, the homeowner is hereby advised that in the event of a dispute, judgment and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A, M.G.L. a IX. MODIFICATION This Agreement, including the provisions related to price (Section II) and payment schedule (Section III) cannot be changed except by a written statement signed by both Contractor and Owner. X. CONSTRUCTION CHANGE ORDER Construction change orders will consist of any change to the original scope of work, such as hidden conditions and changes requested by Owner. These conditions may require adjustment in the overall price and time frame to complete the necessary work related to this Agreement. In such case the Contractor shall inform the Owner of such conditions forthwith and when necessary a written amendment to this Agreement will be negotiated and executed by the Contractor and Owner. XI. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of one year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired or replace such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed upon work. All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such equipment, which shall be and are hereby passed through directly to the Owner. Under such manufacturers' warranties, the Owner may be required to register or mail in a warranty card or other evidence of workmanship and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such equipment. This warranty gives the Owner specific legal rights, and Owner may also have other rights which vary from state to state. XII. COMPLETENESS OF AGREEMENT FOR EXECUTION The Owner is hereby advised that he should not sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. XIII. COPY OF AGREEMENT TO BE GIVEN TO OWNER It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time of execution. No work under this Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy thereof. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Date Signed (Contractor's Signature) Date Signed to t 2,31 o, The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information + = 9 11 Please Print Legibly Name (Business/Organization/Individual): �_KOIW_A& L id 621M T Address: `zc-"> "to— S1.,Q,1 City/State/Zip: 5oK&4 4yv, Phone #: riV? 2 I Are you an employer? Check the appropriate box: 1. [M I am a employer with 3.: employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.Q I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance. 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8. 0 Remodeling 9. ❑ Demolition 10 Building addition 11. F1 Electrical repairs or additions 12. FJ Plumbing repairs or additions 13.] Roof repairs 14.0 Other *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submif 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, aiey 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.�` V. Policy # or Self -ins. Lie. #: INWC', —Am— '7cy(o?44 ^ 2-o15)4 Expiration Date: `t (za C 4(0 Job Site Address: Lo 2 ear, P -A WcAnxl Ii City/State/Zip: j�\. ikkc , tr ii Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. 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 the pains and penalties of perjury that the information provided above is true and correct. Phone #: Q Z�3"(eCe 3'1 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # 2SP 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 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia 10/28/2015 10:14:19 AM 8740 10 02/02 A60cpR 47 CERTIFICATE OF LIABILITY INSURANCE DATEIMIMDOIYYYY) �.- 10120/21115 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 certiticate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditlons 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 04298 - 01 CC11ITACT BKM Inc dba Cross Insurance Peabody 139 Lynnfield Street Ste 210 Peabody, MA 01960 aAlttc1NEEry .Ext : (978) 532-5445 ale. No.: EMAIL ADDRESS: l GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY :LAII,IS-MADE OCCUF, INSURERISI AFFORDGCOVERAGE NA1C» INSURERA: A.I.M. Mutual Insurance Company 133758 (Francis i A Hebb Construction Inc INSURER C : INSURER hnEU E::P (A.np one per=, 1) —"-" INSURER D: 70 Lake Shore Rd Boxford, M 01921-1115 II45l1RER E INSURER F' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 R TYPE OF INSURA14CE gDDLISUBR INSR(4WD POLICY NUMBER POLICY EFF MIr11DD/Y YY POLICY EXP h1MIODlYYYY LIMITS l GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY :LAII,IS-MADE OCCUF, EACH n_CURRENCE e PDAEtr1HAIOEDGTErnec-1 j ,t ff hnEU E::P (A.np one per=, 1) —"-" PERSONAL •'. ADV I1-46UR`i.-- (pENEP.AL Ac.(-REG,ATE FEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMF40P Al -,G --- ---�`OUCY lRf T OC -•. AUTOMOBILE LIABILITY itd[:IIvtD 31Ni+LE 1-11,11` I -L------- ------ (Ea arrulrnl BODILY 11-4JURY (P r pereonl ANY AUTO ALL OVINED 'CHEDULED _ AUTO . AI,IT05 BODILY INJURY (f'er .,:nd&nt) `•D —"'--- HIRED AUTOS NON.CIPINEG — AI (TOS � PROF'ERT\' DAt,1gGE l ,r (Pec ab:iaentl i $ UMBRELLA LIAR OCCUR I I I EACH 1 EXCESS LIAB CLAIM: MADE " -- AGGREGATE I! DED RETENTION -- A WORKERS COMPENSATION ANO EMPLOYERS' LIABILITY1—_-- AN'i PPOPT-JETQP,'PART'llCC-F'lE':ECIJTIVE��YI�N 01=1= EMPLaEIr16EREABILIFIED'I N NIA AWC-400-7006999-2015A 1 7/28/2015 IBL 7/28/2016 l I X r j j��y'LI hIfT� -Ef f EACH A(-CIDEI,T i�— 100,000.00 E L DiSEAGE • EA EMPLOYEE 'i: 100,000.00 (Mandatory In NH) I I li vc5 1cGc; Lh?unrl.r DF.'5i PIPT'011 OF OPER::rIONIS tlr-lnw �—.•�.•. _ E.L. DISEASE- POLICY I.Rv11T F $00,000.00 ( � I k I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IF more space is required) v CERTIFICATE HOLDER Town of North Andover 1600 Osgood Street North Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ._ s reserved. ACORD 25 )2010/05) The ACORD name and logo are registered marks Of ACORD , 2069 Massachusetts. - Department of Pubis ' Safety- Board of Building Regulations and Standards Comtruction Supen isur License: CS -033217, ` ✓i FRANCIS A HEBB' # 70 Lake Shore Road i`= Boxford MA 01921 "d*a sti<j` expiration- Commissioner 03/26/2016 c�/fie tOamvmaf�zurea.�t� a���atacfucaella Office of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR teiegistration: 107916 Type- $. piration 8/10/2016 rp Private Cooration FRANCIS HEBB CON STRk1CTJON = M U- Francis Hebb ` 70 Lake Shore Rd Boxford, MA 01921 Undersecretary r