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Home My WebLink AboutBuilding Permit #862 - 74 INNIS STREET 6/5/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: U �� Date Issued: `Z' 4�1 PORTANT: Applicant must ' 'L®Ci4TION. .7-r PROPERTY�.OWNERt., z4. tom— MAFONO .P_ARGELZONINGD Date Received all items on this pa; LRIQT: Historic pistnct Machine ShopVllao TYPE OF IMPROVEMENT PROPOSED USE yw 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 . Wetland`s.; Watershed ®istrict. Y ... Watee/Sewe_r_ t DESCRIPTION OF WORK TO BE PREFORMED: T'e- 4W'W'-t�' " Identification Please Type or Print Clearly) OWNER: Name: fe:rR4/ Phone: AririrPcc• 7 7 IVI) t-�'/� v � Rhone:_ Go � .fig 1 (;641 'Q ONTRACTOR: Name:: �Y�r.�-1-�/ .� l� �i"� _ _ _ .. ... . � _ . I Address: 1/-0�.n�-rte Supervisorfs:Coristeuction}License:, Home, lmprovement License .. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULD/NG PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �'3 1�?. �7 FEE: $ �% O0 Check No.: Receipt No.: o`�S-� $9 0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 9__ 9. Si' nature of A ent/Owner Si nature of contracto v>� 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 COMMENTS CONSERVATION COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea 3ts4 usgooa Street 'C/p :FIREtDEPARTMENT ;TemADumpster d 5 'L'ocatWd?at-,124 Mam.Street, Fire Departinentsi`gn'ature/dated 'COMMENTS _Al 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 MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 No 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o 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) ❑ 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 7 Location 7 �' -/- ,�F6 "? - / z Check it. 25360 6 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL /Building Inspector Y. CIA d a Lu Y. W 01 rA W I' 00Oman a W o w G v u \ 71 co v H w z A w s b � G Uw c o w rn ,� a �_ mcli w w. u w c��' u cn w x O a; iw z a A x �' G m z cn Q v cn 0 F. z 0 W W I O ' L O o � Z CD CL I C cm C CO2 p 'O yc o ECD m m CL F— Z., CDL Cc a �a H CcC C3CO) �v C Z CD 0 CL C, ND � C C _c CL CO2 E LLI 0 uj W W 19 W = o CO = o C h O =O vCc V CL C ev ea :m= oCc hE cc i _ J C : • m i:+ L s on \ \ /• ~'' N �: om \: \' H R O m yCC.*3 v C� m W N V N O v � Z m O. D o aw W CD . C °C Go �E = CO -o v " o o®=c cW.3 y a m 'e O •O = �_sm�m A .D � y 0 F. z 0 W W I O ' L O o � Z CD CL I C cm C CO2 p 'O yc o ECD m m CL F— Z., CDL Cc a �a H CcC C3CO) �v C Z CD 0 CL C, ND � C C _c CL CO2 E LLI 0 uj W W 19 W 9�W4nmow ajea� W Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cointractor Registration Registration: 164005 Type: Private Corporation Expiration: 8/11/2013 Tr# 215145 MASCO HOME SERVICES, INC, LUCAS BENSON 2339 BEVILLE RD DAYTONA BEACH, FL 32119 SCA 1 0 WM-W%1 Office of Consumer Affairs dr Business Reeutatiou ME IMPROVEMENT CONTRACTOR Istratlon: .164005 Type: !ration: , 8!11/2013 Private Corporation MASCO HOME SERVICES.. NC.'' WELLHOME LUCAS BENSON 2339 SEVILLE RD DAYTONA BEACH, FL 32119 v Undersecretary Address and return card. Mark reason for change. Iress (J Renewal Cl Employment (] Lost Card License or registration valid for individul use only before the expiration date., If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza -Suite S170 Boston, MA 62116 Not valid without signature Ell A DATE(MM/DONYYY) ,Logo CERTIFICATE OF LIABILITY INSURANCE I 07AIM12 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:f the certificate holder Is an ADDITIONAL INSURED, the poi cy(les) must be endorsed. If SUBROOATION 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(*). PRODUCER CONTACT Aon Risk Services Central, Inc.(866) 283-7122 fAX (847) 953-5390 Southfield MI office aGNo.Est): A�c'No" 3000 Town Center E4RAIL Suite 3000 ADDRESS: Southfield MI 4807S USA INSURER(SI AFFORDa)G COVERAGE NAIL* THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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. Limks shown are as requested INSR ILTR TYPE Of INSURANCEADD GUaF1 INSURED Builder services Group, Inc. d/b/a Quality Insulation A Masco Corporation Company 110 Perimeter Road Nashua NH 03063-1301 USA INSURERA. Old Republic Ins Co 24147 INSURER E: National Union Fire Ins co of Pittsburgh 19445 INSURER C: ACE American Insurance Company 22667 INSURER D: indemnity Insurance Co of North America 43575 INSURER E: DABAGETORENIkU $2, 000, 000 INSURER F: OC\rl Ql^lU Rol 11aDED• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED 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. Limks shown are as requested INSR ILTR TYPE Of INSURANCEADD GUaF1 POLICY NUMBER KXP LIMITS GENERALLIABILITYMWZ X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 12,000.000 DABAGETORENIkU $2, 000, 000 MED EXP Wry one person) $25,000 CLAIMS -MADE ❑X OCCUR PERSONAL 6 ADV INJURY $2,000,000 GENERAL AGGREGATE $5,000,000 PRODUCTS. COMP/OP AGG $1010001000 GEN'L AGGREGATE LIMIT APPLIES PER: X � POLICY PLOC _ A AUTOMOBILE LIABILITY NWrB - COMBINED 81NGLE LIMIT s5 , 000, 000 BODILY INJURY (Por person) X ANY AUTO ALL OWNEDHSCHEDULED BODILY INJURY (Per seddent) PROPERTY DAMAGE er ecddenl AUTOS AUTOS HIRED AUTOS NON•OWNEO .1 AUTOS B X UMBRELLA LAS EXCESS LAS X OCCUR CLAIMS -MADE 25030307 06/30/201106/30/2012 FACHOCCURRE14CE $2,000.000 AGGREGATE $2,000,00 0 OEO RETENTION D C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory In NN) WIf yyeess describe under NIA - WL RC4648 648 Deductible - AOS WLRC46480636 Deductible - Minnesota 06 30/201106 06/30/201106/30/2012 012 X TORY LIMITS OTH• ER - E.L. EACH ACCIDENT $1,000,000 E.L. DLSEAS&EA EMPLOYEE $1,000,000 E.L. DIBEASE-POLICY LIMIT $1,000,000 c DESCRIPTION OF OPERATIONS below Excess WC WCUC46480624 Self -Insured States 06 0 2011 06/30 2012 De uct a 2,000,000 Limit (1) included SIR applies per policy to s & condi ions ttBcRIPnON of OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, AddlBonal Remarks Schedule, Amon space Is required) RE: Project Name: All Projects. Conservation Services Group, Nstar and National Grid are included as Additional Insured with respect to the General Liability policy, as required by written contract. CERTIFICATE HOLDER CANCEL.L.AnvN SNOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE - POLICY PROVISIONS conservation services Group AUTHORIZED REPRESENTATIVE Attn: Insurance Admin SO Washington street rig �� Westborough MA 01581 USA c [yam/ ,goy S(ii�tlll6�t E0 SM -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Attachment to ACORD Certificate for Builder Services Group, Inc. The terms, conditions and provisions noted below are hereby attached to the captioned certificate as additional description of the coverage afforded by the insurer(s). This attachment does not contain all terms, conditions, coverages or exclusions contained in the policy. INSURED Builder Services Group, Inc. d/b/a Quality insulation A Masco Corporation Company 110 Perimeter Road Nashua NH 03063-1301 USA ADDITIONAL POLICIES If a policy below does not include limit information, rotor to the corresponaing poucy on me ric,tjmD certificate form for policy limits. INSR LrR TYPE OF INSURANCE ADDL INSR SUBR WYD POLICY NUMBER/ POLICY DESCRIPTION POLICY EFF (MM/DD/YYYY) POLICY EXP -(MM/DD/YYYY) LIMITS WORKERS COMPENSATION C N/A SCFC464806SA Retro - AZ,HI,MA.OR,WI 06/30/2011 06/30/2012 Certificate No: 570045210588 IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS OR ORGANIZATIONS (Masco Form RR) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM WHO IS AN INSURED (SECTION 11) is amended to include a person or organization as defined above. We shall indemnify the Additional Insured for all covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured. We shall further reimburse the Additional Insured for reasonable and necessary attomeys fees and litigation costs incurred in defending against covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured, except for those attorney's fees and litigation costs paid by another insurer. Our duty to indemnify and to reimburse attorneys' fees and litigation costs shall not exceed the product derived by multiplying the total dollar amount of liability for covered damages, or the total dollar amount of attomeys' fees and litigation cost, by that percentage of legal liability attributable to the Named Insured for covered damages as determined by a trier -of -fact in an arbitration or trial. GL 319 002 0609 Masco Corporation MWZY 55525-11 Effective 6-30-11 /12 SCHEDULE Name of Person or Organization: Any person or organization, not otherwise scheduled as an Additional Insured under this Policy, that the Named Insured agreed to name as an Additional Insured in .a written contract executed prior to the occurrence for which a claim is made under this Policy, WHO IS AN INSURED (SECTION 11) is amended to include a person or organization as defined above. We shall indemnify the Additional Insured for all covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured. We shall further reimburse the Additional Insured for reasonable and necessary attomeys fees and litigation costs incurred in defending against covered damages proximately caused by the negligently performed or negligently completed work of the Named Insured, except for those attorney's fees and litigation costs paid by another insurer. Our duty to indemnify and to reimburse attorneys' fees and litigation costs shall not exceed the product derived by multiplying the total dollar amount of liability for covered damages, or the total dollar amount of attomeys' fees and litigation cost, by that percentage of legal liability attributable to the Named Insured for covered damages as determined by a trier -of -fact in an arbitration or trial. GL 319 002 0609 Masco Corporation MWZY 55525-11 Effective 6-30-11 /12 2A.INFILTRATION I INSULATION Job Number .4281 DATE 22 -May -12 0. Client Sill lhSUlatIon.R-19CF PETER AZIZ 978-682-4260 0.00' sddr4ss.:. 0 ... 74.INNIS STREET Drape Perimeter R-5 Anch. Sq. ft: cit /down .. y NORTH:ANDQVER:MA 0 1$45 . Perimeter2" T-max or equlvalent foam board sq, ft.. contractor, 0.00 Vh G / 7 6 77O:t9 1.WEATHERSTRIPPING/CAULKING QUANTITY TOTAL 0. AUDITOR NOTES Duct Insulatlon &.Tape,sq. ft. R-5 Door Kits R l on or Equiv... 0' :... 0:00 0 0100: . . Door Sweeps (Regular) 0 . 0.00 0 0.00: SteaMpipe Ins. tol.25" Iron.pipe R-5 Door Sweeps (Automatic) 1 .: 23.00 0 GARAGE TO IN Steampipe.Ins'. 3" iron.pipe R=5 Reglaze Windows An.inch .. 0 :.. 0.00:. . AIr.Conditioner Cover .. Wlndow.Weathstr Schlegal per side 0 0,00 0 0.00 Tenmat Recessed.Can Cover 0 0.00 Attic/Basement bypass sealing man/hr 1,5 90.00 Attie. sealing with 2 -part foam_ maNhr . _ 1.5 ...: 112.50..: SUBTOTALS 225.50 2A.INFILTRATION I INSULATION Domestic pipe Hot Water Tank 1st 6' 0. 0.00 Sill lhSUlatIon.R-19CF 0 0.00' Sill Two,, Part. Foam* Fiberglass Batt 0 ... 0.00: Drape Perimeter R-5 Anch. Sq. ft: 0 .. 0.00. . Perimeter2" T-max or equlvalent foam board sq, ft.. 0 0.00 Drape DOOR R-5 or T-max.or equivalenton door. 0 0.00 Tape Joints.(Aluma Grip only) per hr:. 0. 0:00 Duct Insulatlon &.Tape,sq. ft. R-5 0 0:00: Rigid Foam Board Anch.; 1"per board ; 0 0100: . Hydronic pipe insulation to V R-5. 0 .0.00. . Hydronic pipe Ins. 1.25"-1:5" R-5 0 0.00: SteaMpipe Ins. tol.25" Iron.pipe R-5 0 w0:00 0:00 Sleampipa Ins. 1.5"- 2" Iron pipe R-5 0 0.00 Steampipe.Ins'. 3" iron.pipe R=5 0 .... 0:00:.. . Air Conditioner Meeting Rail: AIr.Conditioner Cover .. 0 .. 0.00. Air Conditioner Cover Special Order 0 0.00 SUBTOTALS, 0.00: 2B.INSU4ATION . Open Unrestricted'R 49. 0.. 0:00. Open Unrestricted.R 38W.6 0:00 Open Unrestricted R 30 0' 0.00 Open Unrestricted R 2O.. 1507 1944.03. Open UnrestrictedR 10. 0 . 0.00. Restrict FC/Sloped R 30 . 0 0.00: Restricted FL/Sloped R 20 . 0 :.. 0.00:. . Restrict FL/Sloped R 10 546 709.80 R-19 FGB open rafters/walls/kneewalls 0 0.00 R-11,FG.B open rafters/walls/kneewalls 0 0,00 Attic Stairs(stairwell & common wall) 0. 0.00 Cover Pull Down Stairs. Thermadome : Q. 0:00 Site built pull down stairs.2"foam box ; 1 .180.00 Attic/ Kneewal Floor Transition. Dense pack cellulose 0 0.00: W:S. Hatch Q -Lon or equal : 0 0.00 W.S. & bat Hatch R-30 /Q -Lon or = 0 0:00: Kneewall R=12 cell behind 06r.Memb 0 0.00' Open Rafter R-20 Cell. M poly 0 .. .. 0.00 Open Rafter R730 Cell. 1w poly 0 0:00: Basement Overhead 'R-19 fiberglass 0 0.00 Basement. Overhead R-30 fiberglass 0 0.00 Crawlpace Overhead r 4'.hlgh. R19 0' : 0:00:.. . CravApaceOverhead<4'.high R30. .. 0 0,00. Garage Ceiling cavity filled w/cellulose . 0 0.00. Wood,Shake;Clapboard,Shingles Vinyl :.. .1056:.. 1.890.24.-. Asbestos (single nail) ( Asphalt 0 0:00 Asbestos (doUb. Nall)] Aluminum 0 0.00: Brick/Stucco 0 :. 0,00 .:.Vinyl over Asbestos 0 Multi -layered 3. or more layers 0 0,00. Drill, rough. plaster.or finish wood plug 0 0.00. Drill finish plaster 136 258:40 Test Drill Walls (all 4) 2 :, .. 120.00. 8b. REPAIR MATERIALILABOR . SUBTOTALS . .. Basement outside door only 0 ..'0.00 Basement outside door w/jambs 6 0.00 Door RepCpre hung 32 3$".$feel" w /Lite . 0 0:00.. . Door Repl interior solid core.28-32" 0 . 0.00. . Door Repl; pre hung 32-38" wood." w / Lite 0 .. 0.00 Window Replacement.w[SIR less.than l .. 0 :.. 0.00:. . Basement Window Repl: Awning/ Hopper 0. 0.00 Basement Window Repl.:With a frame 0 0.00 Lockset (door) Schlage or equal :. 0 :01.00 Repair /.Reff:Door. 0. 0:00... Replace. Side Stop 0.. 0100. Replace Casing :.. 0 '0,00. Glass Replacement to 64 0. 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: Ttireshold:(Aluminum). 0. :.. 0.00 slide Bolts.0 .. 0,00 Plug Plate Cover 0 0.00 Cut /.finish attic=kneewall access 0 0.00 Cut / close attic-kneewall access 0. 0:0.0 Labor Rate Hours 0 0:00: Permits l Eees (Wap only) . SUBTOTALS . .. .0.00. - . . TOTAL REPAIR + HEALTH & SAFETY 223.00 GRAND TOTAL WORK ORDER # (A) 4281 5556.97 ... PETER AZIZ 978.682=4260 74INNIS STREET. NORTH. ANDOVER MA 01845 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:.. CONTRACTORICOMPANY:. ACCEPTANCE:Company/Contractor AUTHORIZED SIGNATURE: Dat@ ..:. . AGENCY APPROVALS:: CTI Authorized Signature:.: bate GLCAC Authorized. Signature: Date U Greater Lawrence Community Action - Auditor- Renee Tofanelli _..... - Phone:978-857 7841 Job # Date: ,,4 ft 2/. Zoite Client First: f��/- _ Last : X21 Address: 741 11VA11S S1'- 1st fir CitV.' . 41a,&W Z"n Zip Code Phone 5?79s G 8Z •• �12 460 Phone 2 'House Type: Cape Split 1 fam fam 3 fam duplex 4 family Victorian Colonial Tenement Siding Type: �Wq:oDdVinyl Alumn Asb Single Asb Dble Condition �o Fair . Poor Vin 1 over Asb T111 Brick / Stucco Asphalt Comments: Roof Type. Roof Material Hip Flat G mbrel Asphalt late Rubber Tar & Gravel ondition Good Fair Poor Age o Ouse ,3 Heating System Prh Manufacturer: A1,00 I-444 Efficiency/ Excess Air q,3,� -------------testo 327-i ----- ------ CAZ Base Reading : Pre Post: Stack Temp 51p, - u1.17 ------------ CAZ Worst Reading :Pre Post: Primary Temp gs,l$,zoiz 10:4344 .Fuel Ox gen ------------------------ oil 2 FHW Steam FHA Space Heater CO 2 CO2 -max----- 15.7 7 Oil Gas Electric CO * ,Oow gas Woo Pellet Coal CO Air Free 569.1 OF T stack Flame Color .Flue i88060 EFF Treated Ducts : Yes No Age n�r �Pj 6 43.9 % Exy i r 6.7 Z Oxygen • "Pipes '" Yes <:jp' Ambient CO ffl 3 ppm CO 4 ppm co AirFree Domestic Hot Water Tank Smoke Reading -071582OFnHZAmbient temp Gas Oil Electric ankles Referred to HWAP 73.0 °F Instrum temp -_-_- °F Diff. temp. Gallons Temp Setting Date referred 0 ppm 20co Ambientmss Draft Spillage Yes / No Spillage ------- :Smoke Tests - - - Amb CO: Stack CO: Draft -49.e.,_q Avg. Smoke # - OilSpot -Y/N - Add 6 Feet ofpipe wrap / NO ---'-------------------- Number. of occupants _ 'C Number of smokers �(_ Number of pets Ambient CO Readings: Stove 4z4je- Oven a!O-- - Broilers' Dryer C Client 70",'W(110 Sr`` N•'�'!45;010— Doors Swapnc ��a�' 41 ■��4iJ:11L[� �' • Location Fire place uldpd .5M/46 Space Heaters Blower Door� Pre Post Knob and Tube Yes NO Locations Date inspector called 0 Condition QsZAWS Damper Yes/ No Reason not doing Blower Door Air Sealing Ai-�'�r/ '% uya� 51ti Client Aaavgrka Direction Windows - Comments ■■■■■■■■■■■■■■ MENNEN �MMMMI ■■■■■■■■■■■■ ° NOM■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■�■■■■■■■■■■■■ ■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ �NEON ■■■■■■■■-- Client 7_ ,s '0'- 'r/. Basement. ._., Conditioned ./ Uncondffloned . Crawl spaces Wirt floor Asbestos Yes No Location Basement Overhead Garage Overhead Sills Drape perimeter Crawl Space Done 1 inch 1114 Inch 1/1/2 Inch Steam Iron 2112 in Done Yes No Measunnents -/� 4664 Pipes Steam / Copper Ducts Basement Mastic seams nrs Square footage Basement Door Drape.. Repair Caulk Kit & Sweep Client 7 rr+/N�CS rs-r A/4 A,yDoW!E�g ` Walls Floor Plan I s p� ,S V Comments ist utile 2nd 3rd Sq Feet 1059 " Common Ad" Total 1145.5 Exterior wall Ter .0 X /,YZ _ ze 5- Exter/or wall 2nd X, _ Please Indicate: Unheated /////// Interior wall X Z % O . Common '..... I Client S, Attic ILoose Wool or FIG 2:2 Cellulose 3.6 I FIG or Wool batts 3.2 Vermiculite 2.3 Storage to move Yes �v Recessed LightsQ /�T 4dw 1w i 12 x 12 1 0.38 1 16X 16 0.32 12x16 0.54 1 8x18 1 0.45 12x 18 0.62 Soffit dbl 5 In .43 per 10 ft 12 x 24 0.86 3 sect all open ..98 per 10 ft Turbine 3 ft. 3 sect center open .33 per 10 ft Roof 135 Lrg 1 ft Rldge Vent .98 per 10 ft 865 Sml 0.4 Triangle Gbl with 21 1/4 leas.4 to .8 Attic Air sealing Notes ®Bt g w C .N v � y Q �oo 1 �r C) 3 N. Q N ,C M E ro 0 = b S C Q •` O H V C 0 A N wQz w 0 C .N v � y Q 1 �r 3 N. W N ,C M ro 0 = a ° S C Q •` r. low) H V w 0 •(D d E N V N C A d V .N v � y Q 1 3 N. A d V v � y Q � c � V M ro = a ° � •` r. low) V w •(D E N G S. w V GLCAC INC. Inprogrees Q C Report Address: 71 11fZ11S s3' Date : Contractor : Inspector Attic Depth Level OK No Access OK No Hatches OK No Venting OK No Air sealing OK No Bath vent OK No Comments 2 Hole Dense Pack Plug & Patch Density Comments: OK NO OK NO OK NO OK NO Work Additional Measures Installed OK No Caulked in OK No Caulked out OK No Dead Lights OK No Basement General Heat Loss Air sealing Chimney Pipe Wrap Ducts Sills Dryer Vent Dryer Hose Comments OK NO OK NO OK NO OK NO OK NO OK NO OK NO Door Kits OK Sweeps OK Locks/Striker OK Caulking In OK Caulking out OK Glass OK Glazing OK NO NO NO NO NO NO NO Walls Windows 2 Hole Dense Pack Plug & Patch Density Comments: OK NO OK NO OK NO OK NO Work Additional Measures Installed OK No Caulked in OK No Caulked out OK No Dead Lights OK No Added by Inspector Missed by Auditor Work order to be changed Yes No Attic Inspection Form Mandatory for all Attic Insulation Jobs Client Name Job # —Date Section A: To be tilled out by WAP auditor during initial Interview with client . Are there any re ed tights in this* dweliing ? - . ES NO Don't Know Locations: Section B: I To be filled out by auditor 1 Recessed Ught/ng Fixtures Section C : Number of recessed lights Furnace flues Other heat Producers Total Guards needed i Inspection of the ceiling area beneath the attic Other potential Heat producers Gc�G �srrs To be completed by the insulation contractor at the time of installatiom Should agree with Section B. Section D: To be signed by insulation contractor after completion I have Installed guards Contractor Date: signed Section E I To be signed by the weadmizadon client I agree that the number of Insulation guards Indicated have been Installed as noted above. I have received the notice to the client that was attached below Signature: Date: IML --------------- - - - - -- ----.......,.--.--.-- ....._--- --------------------------------- Detach here and give to Client Notice to Weatheilzation clients; The purpose of the Insulation guards Is to ensure that your dwelling Is In compliance with the National Electric code .The Insulation used meets all Federal test speflcatlons. However since insulation retains heat, It Is essential that heat.producing sources be protected. For this reason it is important that -the insulation guards not be removed altered or covered. Be sure to use Insulation guards if you Install new recessed light fixtures or some similar fixture. Also be certain not to obstruct any attic ventilation devices.