HomeMy WebLinkAboutBuilding Permit #078-15 - 700 CHICKERING ROAD 7/23/2014 "� NoRty
BUILDING PERMIT
TOWN OF NORTH ANDOVER ° T.
APPLICATION FOR PLAN EXAMINATION "
Permit NO: Date Received " 0 —s.,.,.— •r +"
Date Issued: it
c►+us
IMPORTANT:Applicant must complete all items on this page
LOCATION :700 0_In i r k2jp c't ,nct oa& , L)ID& MR
PROPERTY OWNER S'X NnA k AyJQ�R�Pc- LLL A/roIa_ k��tr+yl�iv^v��v �r� ttnuaV'P
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial �^
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District
Water/Sewer
X744-ou,
Identification Please Type or Print Clearly)
OWNER: Name: Rep: Phone: 878--683--t306
Address: 00 der i J• VMA-
CONTRACTOR
VI CONTRACTOR Name: /- Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER MA Ardtitects, LIQ Phone:_515-232-8447
Address: 1421 s. Ben Ave., suite 101, mes, iA 50010 Reg. No. 31445
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ a y� FEE: $ � 4 � � d
Check No.: ":z Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access o the guaranty fund
Signature of Agent/Owner - w Signature of contractor L�
r 7
T
NORTH w-
;RMIT O��q
TOWN OF NORTH ANDOVERo Z.
APPLICATION FOR PLAN EXAMINATION * ,�
Permit No#: Date Received 7 p0RA7ED Pp` cy
ACUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: _ Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: 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.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Location �G�J /C—/` n/ 1°C
No. e!2 7? Date Oz ?
• - TOWN OF NORTH ANDOVER
. TUnI
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check#
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 0
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 Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department 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 No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
61
Nked
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit 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
o Building.Permit Application
a Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
Li 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
o Building Permit Application
Li Certified Surveyed Plot Plan
o Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
L3 Copy Of Contract
o 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
Li Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
E3 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Li Copy of Contract
o Mass check Energy Compliance Report
a 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 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
of gORTh TOWN OF NORTH ANDOVER
3:,� , oo� OFFICE OF
p BUILDING DEPARTMENT
400 Osgood Street
.e%Too'�a�� North Andover,Massachusetts 01845
1SSACHUyEt
D.Robert Nicetta, Telephone(978)688-95454
Building Commissioner
Fax 978 688-9542
CONTROL CONSTRUCTION— SECTION 116.0 M.S.B.C.
CERTIFICATE OF ENGINEERING/ARCHITECTURE
BULDING INSPECTOR
TOWN OF NORTH ANDOVER
400 OSGOOD STREET
NORTH ANDOVER MA 01845
I, Michael T. Stott HEREBY CERTIFY THAT
THE BUILDING CONSTRUCTED AT 700 Chickering Road, North Andover, MA 01845
DOES CONFORM IN ALL RESPECTS TO THE MASSACHUSETTS STATE BUI
CODE AND APPLICABLE FEDERAL REGULATIONS FOR THE FOLLOW �w1H�rFo
n 140.31445
µEH, y
�i� IOWA Z,
AUTHORIZED SIGNATURE: P�
I�0
DATE: 09/27/2013
REGISTRATION: Massachusetts Reg. No. 31445
NOTE: ENGINEER"WET STAMP"MUST BE AFFIXED TO THIS FORM
Control Construction Form revised 11.15.2004
BOARD OF APPEALS 688-9541 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535
Enter construction cost for fee cal - North Andover Fee Calculation
Construction Cost
84,400.00 m
$ - $ 1,012.80
Plumbing Fee $ 126.60
Gas Fee 100 comm. $ 100.00
Electrical Fee $ 126.60
Total fees collected $ 1,366.00
700 Chickering Road
078-15 on 7/23/2014
Enclose Third Floor Porch
Location—W lr C iii '
No. a Date
E
• - 1 TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $T,,_
Other Permit Fee �gvxtr $—��
TOTAL $
Check#
� 3Jy f. /
s' ` . Building Inspector
� � NQRTIy
own of y. : :. ¢ ndover
u4j
No.
o h ver, Mass, 2 201 ,
COC�KICNl WICK
S U
BOARD OF HEALTH
Food/Kitchen
PERMI L D Septic System
THIS CERTIFIES THAT6 .,..... BUILDING INSPECTOR
.... .ft. ..has permission to erect ........ ................ building 300.... .... .... ....... �, �---
gh ���• ��
3 fir'.. ,Qw ... .Or, ... .15
to be occupied as ....... ............ .. ....... ......... ......... ... .�.................. Zhimney,
provided that the person accepting this permit shall in every respec conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES INfrWNV4 ELECTRICAL INSPECTOR
UNLESS CONSTRUC S _ ug 6,t-
Service
............. ................................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
' c10 R TIS
,..
Town of _ Andover
0 to
No. DI _ 115 * _
Il I h
oh ver, Mass,
COc NIC Ml W'C�[ 1•
5°RA rE o #"per��(5
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT ... .....�. �d ,,, /t( c���" BUILDING INSPECTOR
. .... ........... .........
has permission to erect buildings on ..7LQQ..0,� �-T!,C��-%�, Foundation
.......... J, ...,��.��.................
� Rough
to be occupied as ................ ..� /,� f "'�G�....... f<^ g
....�....�.1.:C.•
• ��....... ,�................ Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
• UNLESS CONSTRUCT N STARTS Rough
Service
............. .�?.�r. rC.[.t .^rti..,..................................
BUILDING INSPECTOR Final
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Fina'
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
l`
J
A a i
December 17, 2014
Michael T. Stott, AIA
Stott Barrientos &Associates Architects, LLC
1421 South Bell Avenue
Ames, IA 50010
RE: Ashland Farms—Third Floor Addition-Existing Door Opening Enlargement
700 Chickering Rd—North Andover, MA
(DEI Project No.D2878.1)
Dear Michael:
We have reviewed the proposed enlargement of the existing door opening (to the south and into
the abandoned fireplace opening) between the dining room and the new sunroom addition. Based
on our site observations on 12/16/14 it appears structurally feasible to increase the door opening
to roughly 5 feet wide provided a new triple 1.75" x 11.25" header is installed to support the ends
of the typical roof trusses which bear onto this section of the wall. Limiting the opening to this
size will avoid the need to re-support the double-ply roof girder truss (which bears on this wall at
approximately the center of the former fireplace opening) on the new LVL header. The new triple-
ply LVL header will need to bear onto double 2x6 jack studs with single 2x6 king studs at each
end. An additional king stud and double 2x6 stud posts will need to be installed to allow for trim-
ming back the mid-height wall header which currently supports the roof girder truss over the
abandoned fireplace opening. These framing adjustments were discussed with Mark Seo while on
site who agreed that would be a reasonable approach and understood the requirements.
We trust this report will address your needs at this time. Feel free to call if there are any questions
or if you need additional assistance.
Very truly,
DAIGLE ENGINEERS INC.
JONATHAN y�
V LONGCHAMP
STRUCTURAL y
No.35867
Jonathan M. Longchamp, PE, SECB (ext. 117) 90���/STE�� 4"�
Principal/President ssl NAL tiev`
flongchamp@daigleengineers.com
x/c: Mark Seo
JML/dei
Daigle Engineers,Inc.
1 East River Place
Methuen,MA 01844-3818
978 682 1748
978 682 6421 fax Over 35 Years in Business-Est. 1979
www.daigleengineers.com DEI♦12/17/14♦D2878.IR121714.does♦Page 1 of I
Final Construction Control Document
„!4�I (This Document is for Structural Design and Construction Review.)
ill i+ Illli° Submitted by a Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Ashland Farms-Third Floor Sunroom Addition Date: December 16,2014
Project Address: 700 Chickering Rd-North Andover,MA DEI Proj.No.: D2878
Project: Check(x)one or both as applicable: ®New Construction ®Existing Construction
Project Description: Overbuild existing Third Floor Roof deck per DEI Drawings S100&S101 dated 9/17/13
I, Jonathan M.Lon cg hamp,P.E., of Daigle Engineers, Inc. MA Registration Number: 35867 Expiration Date: June 30,
2016, am a registered design professional, and I have prepared or directly supervised the preparation of the structural de-
sign plans,computations and specifications concerning:
❑ Architectural ® Structural ❑ Mechanical
❑ Fire Protection ❑ Electrical ❑ Other:
for the above named project. I,or my designee,have performed the necessary professional services and was present at the
construction site on a regular and periodic basis. To the best of my knowledge, information,and belief the work proceed-
ed in accordance with the requirements of 780 CMR and the design documents that I or my designee:
I. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals
by the contractor in accordance with the requirements of the construction documents.
2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the pro-
gress and quality of the work and to formulate our professional opinion if the work was performed in a manner
consistent with the intent of the construction documents,industry standards,and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
Enter in the space to the right a"wet”or5,��-tH OF
electronic signature and seal: z JONATHANM.
�
a
w
oLONGCHAMP
v STRUCTURAL Sc
No.35867
Sof kht fd
Phone Number: 1-978-682-1.748 ext. 117 Email: jlongchamp@daigleengineers.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Surface Logic PURCHASE
ORDER
10640 Iron Bridge Rd.,Ste 2B Purchase Order 017543
an J Jessup,MD 20794
LOGIC` Revision 0
+w V Iv PhoFax: (240)581-989900 Date 3/21/2014
Order Type Regular Order
Vendor ID MARS-0000
Project No CEBALHCRASH02014
Phase/Room CECO2000000001
RWO
TO: TO:
MARK SEO CONSTRUCTION See Line Items Below for Shippii
10 BURGESS ST
NASHUA,NH 03064
•• TO:
Ashland Farms at N Andover 2014 CapEx Surface Logic
700 Chickering Road Accounts Payable
North Andover,MA 01845 10640 Iron Bridge Rd.,Ste 2B
Jessup,MD 20794
Confirm to:
F.O.B.POINT
ORDER DATE TERMS
3/21/2014 Benchmark Contract
LINE PART NUMBER QUANTITY UNITS DATE REQUIRED PRICE EXT.PRICE
1 SUBCON-TR-ACTLABOR 1.00 EA 3/21/2014 84,400.000 84,400.00
Porch construction per scope attached
This Purchase Order is further governed by the Master Agreement between Benchmark Senior Living , LLC
Surface Logic, LLC, andt he Contraf or . In the event of any conflict between the terms of this Purchase
Order and the Master Agreement, the terms of the Master Agreement shall control.
Surface Logic, LLC by issuing this Purchase Order becomes a party thereto of this Purchase
Order. This paragraph represents Surface Logic, LLC signature and agreement.
Contractor please print the Purchase Order, sign and date, and submit to:
Benchmark Senior Living by email: kvogis@benchmarkquality.com or fax: (781)489-7205
and Surface Lo?#by email: darrellwillson@surfacelogic.com or fax: (410)379-0400
AXX,�� ii 5' ai iy
Contractor at Benchmark Senior Living Date '
• 84,400.00
Job Tn,aa T-Type c17 pv Ashland Fames-Addrdon
151205886 VO4 Valley 1 1 0005
Unhetsel FOtsel Products JoD Refnanoe(
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REACTIONS AO berinae 14dto.
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FORCES(b)-Ma.CwVAA r.Ten.-Al fmn 250(b)or lea except when sham,
WEBS 3-7-857/10,2410.1 R43,46-64=43
NOTES
1)~.ASCE 745:10M";TCOL-5.DW,,aCDL•5.0pq;h-248:CeL ll;Exp C;endosed:MWFRS om dla)and CC Exterior(?)mne;C.0 for metro"and forma MVM far reactions LL: s,M:Luriber DOL-1.00 plate pip DOL-1.W3)Unbehinced arm W&have bow conddomd 2)TCASCE 7-05:Pf-50.0 pat(Sat roof anon);Cate"ll;Exp C:Pat*Exp:Ct•t.i
q Aon thk deYpn.
Gable regthrm 0orrOnuoue botlom dad
5)TNs bus has been designed for a 10.0 pt bottom chord Iva load rgrwnctineM wOh any ctjw Iva beds.
6)Prodda meeha kW c"'emotim MY 00m)of MW to beaft plate capable of***K dna 100 b 4A 61)*4)1 except 01-b)8-132.6-132.
7)This bus is t1ted m accordance rd h the 20M ImrmaBorW BWft Cada stxsirn 2308.1 and refrat W stardrd ANSON 1.
8)'SrK1I111111 01chb vols bndtrdnp heeb'Mentor end EtOy model was used in Ona ans"is and des4n of finis bus.
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Job
131206868 V01 lValley 1rflm 1 Ashland Fames-Addition 0002
Job Reference
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BCLL 0.0 Rap Strafe 9m VES WB 0.47 HN#Ty 0.01 7 Wo Na
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hj appled S.M oe
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FORCES (b)-Max.CotepA4=.Tan.-N faces 250(b)a lea except when shown.
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2)TCLL:ASCE 7-05;P*W.0 Paf(fW r0elemw);CatVM il:Exp C:Parody Exp.;6.1.1
3)UnbaWKW snow loads have bean wrteldend far dtisdeebrt.
4)N pbtn are 1.54 MT20 Wee otnwWgq idmW.
5)C>ahla taWM euntanntam bosom dxxd b-ft.
6)TNs Was ha been tldgned for a 10.0 pet bottom dmd Iva load noncawvnma wb any tsarer Fa beds.
7)Provide medrdcd 00m dw(by Oftm)oftruss to barhp plate capable dwMistooding 100 b tyil 50ot94)1 exa0 QM)11.125,12.159,9.125,8.159.
8)The true B deai)pted N axmbrtee WIM Os 2W91n1enslpW Bufdng Cob sedbn 2306.1 and rabrerteW stardard ANSIRPI I.
9)-Sftfnl4 W Plaurab inrdu ft hoofs"Mwrbw ane taffy model wm used In be an*=and dealon of this bnm.
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mfumxrionY h may rdde lot specific building.Catifmtim is"WOWY Mtn 1FP cuss is falric"by-tcmWy.Bracing db ufaIslas&suppmdo-uas members Soy enddots wt smu-cy dthe deli
permanent boring.Refs m Building C.V-Safay Inf--(HOBOtea
lewd guidnm mgading swage,duvay,aacrroa rad hsiog-vsWWe Som SBCA and Tress Mm lnsurow. aenim and
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TCOL 10.0 Luvberhxrme 1.15 SC 0.30 Wrt(TL) rye Na 999
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OTHERS 2x4 SPF Not or 2x4 SPF Stud BOT CHORD Rad oe6rp Areca,appred a 10-U oc bradng.
REACnM (6141ie) i-50711x7-0(min.0,2.11).5.503%a7a(nin.oQ-11),s-3/6/1x76(min.0.2-11)
Mex HHor=1--72(LC 6)
Max L"M-4 1(LC a),5-48(LC 9).a-1(LC 7)
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FORM(6)-Mos.CaMAUx.Ten.-Ar fomes 250(b)or lass exoW when atrowm
TOP CHORD 1-1-494/210.2-7.661/127,3-7-WIrM,U-Mira7,4-0-.561!!17,4•fi-69K210
BOT CHORD 16--1061561,54--105561
WEBS 34-3WM
NOTES
1)Mrlak ASCE 765;t00mph:TCDL-SBpd;BCDL-S.Opst h-24t CsL 11:EXP C:a 400d:WWM 6t.dee)end CC 6Rnbr12)mne;C-C 6r nw nbers and forae 8 MWFRS fm mwborra a1w m tinter OOH.-180 piwb pip DOL-1.00
2)TCLL:ASCE 7-06;Pf-50.0 pd(Rd roof-ov4;Cotepay u:Exp C;Paley Exp;Ct-1.1,Upso"
3)Utsia nced snow bade have been oorwidwed for itis deegn.
4)Provide sde*mft drdnepe b prevent Was pomp.
5)cab*Mquhn raGlxwus bottom dmrd berhp.
6)We buss hss been designed bf a 10.0 pd bosom dwrd Iva bad rw c npmmi with any odwr Na bads.
7)Provide mwdwdut aplrraclm Ny dhns)o(Mm to bawhp pkto sspade ofwtwWndinp 100 6 uplR d)okrt(s)1,5.6.
8)The Inox Y designed b acoadwm with the 2009IniN w5onal Bddrp Code swMM 2308.1 ad raYnnad(6)1 5 ANSVIPI 1.
h9W MIN nbu and�GT10 ml nprassr6ft doss not depd s�or the odGPtdwr of do M0601 VON,used in the p lydo�deeipnof wbottm.
purirr abrp the top ardlor bcltam dwra.
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SOT CHDRD21(4SPF No2 TOP CHORD StuOhnlvrood011110rgdirCWmpfedrS.0 pd..
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WEBS 4.10-UI)D.3-11-143255,2-12-13!217,50-4 43M.S-0N3S217
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arGC{r rtmbars ose 8 MVYFRS tai rsec6rs aho�m:l.unbr DOL.1.60 pale 9rfp OOL-1.50
2)TOLL:ASCE 7415;Pf-50.0 psf(fm roof anow�CabBory ll;Exp C;PaftW Exp.;CWT
3)UneMnnd um beds home been doraMarad for thisdesipn.
4)N plain aro 1.5x3 M720 taeaa d haWsa it dilated.
S)Gabb mQWaa conlnmw b0m,dad beating.
a)This has has been d=Wod br a 10.0 pal bd0an dad Na load con-munwd 1111 any 0tla Na keds.
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9)Sanirt8id Wilt"al a—Aft lr W Member and h1Y modai wq used b tM anayaia arW daipn o1Sta ttwa.
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OOTSPF Not 2x4 SPF Not
OTHERS RS TOPTOP CHDRO 66uaurd wood sh9a9i di
2x4 a 2x 1 SCM OOT CHORD Rigid 09*V dhec8y applied�0-00-0 ac b dog.
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reacu"250 b orless Mjdrd(s)esoept 1.307(LC t),5.307(LC 1),7.352(LC 1),&875(LC 2),b8351LC 3)
TOP CHOFro)-Max.C-PA2M45dwr,ran.-Ar farces 250(b)«lest except when shown.
WEBS 3.7•.1002,2.8-710r1OS ,48•-7109305
NOTES
1)TCL ASCE 7-05:t00mph pd p Y N
TOLL: MdWo* CCM.o:Exp C:endowW;MWFRS pwy.deo)end C-C Fklerp M_:CC to menbem and faces 6 WM�RS Ta
2) ASCE 7-05;PI SO.o
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a)Grealloa shown:Lamhx OO1t180 phis gdp OOL•7.80
able mq� u daly MM bo8om dasd bea ft. .
S)This sues hell been designed kw a 10.0 pM bdtom diad rve lad nw=nmmwt WM srry other Me bade.
8)Provide (by o0we)of sues b
7)� PBdl designeda aooadrma whh Oro 2009&W Surdi Coded 2308.1 WMatanding 0 �Mput(�)1.5 except(pb)8.171,8.171.
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GUAR®�
,•-� Workers Com ensation and Employer's Liability Polic
NorGUARD Insurance Company - A Stock Company
��t INSURANCE
IV
Policy Number MAWC463053
it GROUP Renewal of MAWC352323
NCCI No.[25844]
a Berkshire Hathaway company
Policy Information Page
I
(1] Named Insured and Mailing Address Agency — t
Mark Seo Construction LLC PAYCHEX INSURANCE AGENCY
10 Burgess Street 1S0 Sawgrass Drive
Nashua, NH 03064
Rochester, NY 14620 j
3
Agency Code: NYPAYC10
Federal Employer's ID 20-8200621
Insured is Limited Liability Co. (LLC)
i
iE
1
[2] Policy Period
From August 28, 2013 to August 28, 2014, 12:01 AM, standard time at the insured's mailing address.
---- -- i
[3] Coverage
A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation
Law of the following states: Massachusetts, New Hampshire
B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed f
in item [3]A. The limits of our liability under Part Two are:
Bodily Injury by Accident - each accident $500,000
Bodily Injury by Disease - each employee $500,000
Bodily Injury by Disease - policy limit $500000 i
' i
i C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in I
item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. '
D. This policy includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
[4 Premium
The Premium Basis and, therefore, the premium will be determined by our Manual of Rules,
Classifications, Rates, and Rating Plans. All required information is subject to verification and change by
�----`._audit. -(Continued on another page)^---.�—___.__—_..�._.M.�___._._._.__y—___..�.___._—.T__^,�,—�____
Total Estimated Policy Premium - $ 3,761 � � I
Total Surcharges/Assessments $ 113
Total Estimated Cost $ 3,874
INTERNAL USE XX
MGA :MAWC463053 Page- 1 - Information Page
Date :07/29/2013
WC OOOOOlA
MANOTE
16 South River Street•P.O. Box A-H• Wilkes-Barre, PA 18703-0020•www.guard.com
4�14
REScheck Software Version 4.5.0
m liCertificate
Co
Compliance
Project Ashland Farms Porch Addition
Energy Code: 2012 IECC
Location: North Andover, Massachusetts
Construction Type: Multi-family
Project Type: Addition
Climate Zone: 5 (6322 HDD)
Permit Date:
Permit Number:
Construction Site: Designer/Contractor:Owner A ent:
/ 9
700 Chickering Road Katya A.Vogis Mike Stott/Mark Seo
North Andover, MA 01845 Benchmark Senior Living SB&A Architects/Seo Construction
40 William Street, Suite 350 10 Burgess Street
Wellesley, MA 02481 Nashua, NH 03064
(781)489-7105 603-888-0900
kvogis@benchmarkquality.com seoconstruction@comcast.net
Compliance: trade-off
Compliance: 7.8%Better Than Code Maximum UA: 141 Your UA: 130
The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home.
Envelope Assemblies
Gross Area Cavity Cont. Glazing
Assembly or R-Value R-Value or Door UA
Perimeter U-Factor
Ceiling 1: Flat Ceiling or Scissor Truss 512 38.0 0.0 0.030 15
Wall 1:Wood Frame, 16"o.c. 128 19.0 0.0 0.060 3
Window 1: Other 8 0.280 2
Window 2: Other 8 0.280 2
Window 3: Other 4 0.280 1
Window 4: Other 20 0.280 6
Window 5: Other 20 0.280 6
Window 6: Other 10 0.280 3
Wall 2:Wood Frame, 16"o.c. 424 19.0 0.0 0.060 14
Window 7: Other 8 0.280 2
Window 8: Other 8 0.280 2
Window 9: Other 8 0.280 2
Window 10: Other 8 0.280 2
Window 11: Other 8 0.280 2
Window 12: Other 28 0.280 8
Window 13: Other 32 0.280 9
Window 14: Other 38 0.280 11
Project Title: Ashland Farms Porch Addition Report date: 07/09/14
Data filename: \\SERVER\RedirectedFold ers\MStott\Desktop\Untitled.rck Pagel of 2
4r .
Gross Area Glazing
Assembly or Cavity Cont. or Door UA
Window 15: Other 32 0.280 9
Window 16: Other 28 0.280 8
Wall 3:Wood Frame, 16"o.c. 128 19.0 0.0 0.060 3
Window 17: Other 8 0.280 2
Window 18: Other 8 0.280 2
Window 19: Other 4 0.280 1
Window 20: Other 20 0.280 6
Window 21: Other 20 0.280 6
Window 22: Other 10 0.280 3
Compliance Statement: The proposed building design described here is consistent with the building plans, specifications,and other
calculations submitted with the permit application.The proposed building has been designed to meet the 2012 IECC requirements in
REScheck Version 4.5.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Michael T. Stott, Architect 7/9/14
Name-Title Signature Date
Project Title: Ashland Farms Porch Addition Report date: 07/09/14
Data filename: \\SERVER\RedirectedFolders\MStott\Desktop\Untitled.rck Page 2 of 2
2012 IECC Energy
Efficiency Certificate
Insulation Rating R-Value
Wall 19.00
Floor 0.00
Ceiling / Roof 38.00
Ductwork (unconditioned spaces): NA-
Glass&
Door Rating U-Factor SHGC
Window 0.28
Door
CoolingHeating&
Heating System: --NA
Cooling System: ___NA (Adding fan coil unit to exist. system)
Water Heater: NA
Name: Date: 7/9/14
Comments
. .. .:.. .. .
SB&
ARCHITECTS
1421 S Bell Ave., Ste.101
Ames,Iowa 50010
phone (515)232-8447
fax (515)232-9521
C
PROVIDE ROOF INSULATION THROUGH Q
&INCLUDING SOFFIT.R=38 �--r
MATCH EXIST.EAVE HEIGHT 70
Q
L
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LL
00
O
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N
I � U
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ICUCu
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L
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1 Eave Detail
chUz
op O
a ti Z
Project no.
13015
Date:07/09/2014
Contents:
REVISIONS
Sheet no.
ASI-1
y 1'he Commonwealth of Massachusetts -
�lepaYtmentoflnc��cs€�rnlAccic�eniF�
Offlee
600 Washington Street
.Boston,.MA 02111
vmmass gov/rita
Workers Compensation bsurance Affidavit:Buifders/Cony°actors/Electriciam/Pliiinberp
.Applicant Information. Please Prim Ledbk
'Name(Busimsdorgani'zation/individual):
v
Address: /b
City'/State/Zip: Phone 1h �o -,f"�1 —J'D a
Are you an employer?Check the appropriate box: Type of project(required):
1.[ I am a employer with 4• ❑ I am a general contractor and I 6• New construction
employees(full and/or part time).* have lifted the sub-contractors
2-01 am a sole proprietor or partner listed on the attached sheet. 7• ❑Remodeling
ship and`have no.employeesThese sub-contractors have 8. E]Demolition
working forme in any capacity. workers'comp.insurance, g, 0 Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions
required.] officers have exerelsed.their
3.[J I am a homeowner doing all work right of exemption per MGL 11.0 Plumbingxepairs or additions
myself.[No workers'comp. c.152,§1(4),and we have no 12.[J Roofrepairs
insuraucerequired.]i employees..[No workers' 1311 Other
comp.insurance required.]
4Any applicautthat checks box#I mustalso M dutthe section below showingtheir workers'compensationpolicy information.
-Homeowners who submitihis affidavit indlcatingthey 2're doing allworlc and then Kira outside contractors must submit a new affidavit indicating such.
tContractors that checkthis box must attached an additional sheet showkEthe name ofthe sub-contractors andtheir workers'comp.policy information.
Yam an employer that isp�oviding workers'compensation insurance formy employees Below is I*epoZicy ancij0 site
information.
Insurance Company Name%
Policy#ox Set£ins.Lic.#: W C y� OS Expiration Date:
1 4Y
� �,�,� �c� Ci /State/Z ;
lob Site Address: 7 �--J , t3i' p .
Attach a copy of tete workers'co-mpenaatlon-pollcy declaration page(showing the policy number and expiration date).
Failure to secure coverage as regniredunder Section 25A,ofMGL o.152 can lead to the imposition of criminal penalties of a
flue up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ORDER and a tine
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
£Investigations of the DIA.for insurance coverage verification.
l do lieveby certfy under the pains and penalties o•fperpry that the information provided alcove is true and correct. -
Sipnature• Date: 640-4&IF V
Phone#• �O� �� --�/'D Z�
Oficial use oply. Do not write in iltis area,to be completed by city or tort 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.
Parsuapt to this statute,an employee is defined as"...every person in the service of another under any contract ofhire,-
express orimplied,oral orwritten."
An employer is defined as"an individual,partnership,association,corporation or other legal,entity,or any two or more
of the f6r6jokujen gaged in aJont,enterprise,and including the legal representatives ofa:deceased employeor the
receiver ox trusteefan individualpartnership,asociation or other legal entity,employing employees. Howeverth
e
owner of a dwelling house having not more than three apartments and who xesides therein,or the occupant ofthe
dwelling house of another who employs persons to do maintenance,construction orrepair 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 fox 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)andphononumber(s)alongwiththeir certificate(s)of
insurance. Limited Liability Compamies(LLC)or Limited Liability Partnerships(LLP)with no employees other than,the
members orpartuers,arenotrequiredto canyworkers'compensation insurance. If au LLC orLLP doeshave
employees,apolicyis required. De advised thatthis affidavit maybe submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. ilao affidavit should
be retumed 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 xequired to obtain.a workers'
compensationpolloy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance.license number on the appropriate he.
City or Town Officials
Please be sure that the affidavit is complete audpxintedlegibly. 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 jM in the permit/Rcense number whichwill be used as a reference number. 7n addition,an applicant
that must submitmultiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"7ob Site Address"the applicant should write"all locations in (city or
town)."AA:copy o£the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as pro ofthat a valid affidavit.is on file for future p ennits or licenses, .A,new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license o4ormit not related to any business or commercial venture
O.e.a dog license orpermit to burn leaves eta.)said person is NOT required to complete this affidavit.
The Office of investigations would like to thank you in advance for your cooperation and shquld you have any ciuestions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
Tho CQ QRWQalt� ofMlusaelh' ctts
DopaxtMent offududdal Accident
Office offya estfgavoon
6,Q0 Washiu Qn Sizeat
TOL 0&M-2Z,4900 at 406 ox 1-877.1V�A
Revised 5-26-05 `ay, 617-727-7749 749