2 PIERCE AVE - BUILDING INSPECTION -7-��ni � �9
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Ulf Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Off ' I Use Only
Building Permit Number: D e Applied:
Building Official(Print Name) SignatureJ 3 Date /
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
P�eRCe 4Ve Salem fqa• 0
1970
l.la is this an accepted street?yes ,yfS no Map Number Parcel Number
1.3 Zoninglnformatio 1.4 Property Dimensions:
B a 1 0.055 ACIVS
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L e.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public�l Private❑ Zone: 1I Q Outside Flood Zone?
Check if yes[] Municipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP' -
2.1 Owner of Record:
T'&rta BvRb',ne Salcmr ma. ol9'10
Name(Print) City,State,ZIP
Na PieRG2 ave Sam le ma 019gQ 9gg51�7/9� none
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building�J Owner-Occupied ❑ Repairs(s) Alterations) ❑ Addition ❑
Demolition Accessory Bldg.❑ Number of Units y Other ❑ Specify:
Brief Description of Proposed Work': li�'iCr� 6 i/n`Ot� 1✓4� (�� r G
1 lt�la` m• �-sax, q � q-� o •fat, c
N'cW wltcQo.�S�F ` ' 1tC Ga CI t + P/vYy d d
i S, .o ,. eya�.vtnd- . �u_ � A Si • o ,$�' e�
C '�'��'" "" °" g t SECTION 4i ESTIMATED CONSTRUCTION COSTS Prt•� a 4l„
Item- - Estimated Costs: -
Official Use Only
Labor and Materials
1.Building $ //01 L700 1. Building Permit Fee: $ - Indicate how fee is determined:
2.Electrical ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ a7 CV-0 2. Other Fees: $ �x
4.Mechanical (HVAC) $ List:: LJ
5.Mechanical (Fire "
Suppression) $ 3, aa_G Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 154J OL 13 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
�+ P%A CS- 06.041
l�'eg W o• GASA�e o All Q +i p el�nel License Number Expiration Date
Name of CSL Holder ✓ V
t � List CSL Type(see below)
3 SoQhre
No.and Street Type - Description
rnQ• o id/'/i U Unrestricted Buildings u to 35,000 cu.ft.
Kvv�i Z to C/ R Restricted 1&2 Family Dwelling
City/fo�wn_,—S1tate,ZIP M Masonry
PC4FICX�� Mq• RC Roofing Covering
I WS Window and Siding
/� (.'f SF Solid Fuel Burning Appliances
-8i5-6357 G�< u• A tkiv I�QA;76YI I Insulation
Telephone Email address • D Demolition
5.2 Registered Home'
IBmpprovement Contractor(HIC) /a 1f o //—S`'/S—
CTw0 WCrfA Le A)1 G•')'�Q4 tl•Mf� CO HIC Registration Number Expiration Date
HI Company Fame or C Registrant Name
Soph•e otN- CAAI< &'Ve4;Yon. ri
No.and Rnee{{
Peabaik /I Ma, pT`J'(96 !? 5-3S63 Email address 1
Ci /Town,State,ZIP Tele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........X No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN T
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
//�v o^ /� __ //.,l�� v.s.A.1 r7
1,as Owner of the subject property,hereby authorize Ge—lut 10L W• C1gSi9/C/[6 13
to act on my behalf,in all matters relative to work authorized by this building permit application.
(� �Y•ny, R�1cb�nt
Printwner's Name(EINAKnic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contain m this appplicatio4n i true and accurate to the best of my knowledge and understanding.
CeK•t�9 W G,tfAle p /s 0/
X 1 .►. 4v. a `f
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dys
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
SCOTT GOLDEN
ARCHITECTURAL SERVICES
RESIDENTIAL AND COMMERCIAL y _
9 Chestnut Street - =_---
Danvers,MA 01923
978-578-1568
TO: MARCH 24, 2014
Gerald Casaletto
All-City Remodeling Co.
3 Sophie Road
Peabody, MA 01960
RE: Code compliance issues for (Burbine) 2 Pierce Avenue, Salem, MA 01970
In accordance with IRC 2009 — (one and two family dwellings), the following areas need to be brought up
to current code compliance:
R302 FIRE-RESISTANT CONTRUCTION
R302.3 Two-family Dwellings. Dwelling units in two-family dwellings shall be separated from each other by
wall and/or floor assemblies having not less than one-hour fire-resistance rating when tested in accordance with
ASTM E 119. Fire-resistance-rated floor-ceiling and wall assemblies shall extend to and be tight against the
exterior wall, and wall assemblies shall extend to the underside of the roof sheathing.
R302.11 Fireblocking. Fireblocking shall be provided to cut off all concealed draft openings (both vertical and
horizontal) and to form an effective fire barrier between stories, and between a top story and the roof space.
Fireblocking shall be provided in wood-frame construction in the following locations.
1. In concealed spaces of stud walls and partitions, including furred spaces and parallel rows of studs or
staggered studs; as follows:
1.1. Vertically at the ceiling and floor levels.
1.2. Horizontally at intervals not exceeding ten feet (3048 mm).
2. At all interconnections between concealed vertical and horizontal spaces such as occur at soffits, drop
ceilings and cove ceilings.
3. In concealed spaces between stair stringers at the top and bottom of the run. Enclosed spaces under stairs
shall comply with 780 CMR 3511.2.2.
4. At openings around vents, pipes, and ducts at ceiling and floor level, with an approved material to resist the
free passage of flame and products of combustion.
5. For the fireblocking of chimneys and fireplaces, see R1003.19.
6. Fireblocking of cornices of a two-family dwelling is required.
J
R314 SMOKE ALARMS
R314.3.1 Alterations, repairs and additions. When alterations, repairs or additions requiring a permit
occur, the individual dwelling unit shall be equipped with smoke alarms located as required for new
dwellings.
R314.2 Smoke detection systems. Household fire alarm systems installed in accordance with NFPA 72 that
include smoke alarms, or a combination of smoke detector and audible notification device installed as required
by this section for smoke alarms, shall be permitted.
R314.4 Power Source. Smoke alarms shall receive their primary power from the building wiring when such
wiring is served from a commercial source, and when primary power is interrupted, shall receive power from a
battery. Wiring shall be permanent and without a disconnecting switch other than those required for overcurrent
protection. Smoke alarms shall be interconnected.
Stairs are also a safety issue and do not meet code:
R311.7 STAIRWAYS
R311.3 Floors and landings at exterior doors. There shall be a landing or floor on each side of each exterior
door. The width of each landing shall not be less than the door served. Every landing shall have a minimum
dimension of 36 inches measured in the direction of travel.
R311.7.1 Width. Stairways shall not be less than 36 inches in clear width.
R311.7.4 Riser height. The maximum riser height shall be 7 3/4 inches.
R311.7.4.2 Tread depth. The minimum tread depth shall be 10 inches.
R311.7.2 Headroom. The minimum headroom in all parts of the stairwell shall not be less than 6 foot 8 inches
measured vertically from the sloped line adjoining the tread nosing or from the floor surface of the landing or
platform on that portion of the stairway.
Section N1102 — Building Thermal Envelope (Climate Zone 5)
Based on Table N1102.1 the following insulation requirements by component:
• Roof-attic ceiling R-38
• Walls R-20
• Floors over basement R-30
GENERAL CIRCUIT REQUIREMENTS:
NEC 406.4(A) Receptacle outlets shall be of the grounding type, be grounded, and have proper polarity.
NEC 406.12 & 406.4(D)(5) All 125-volt, 15- and 20- amp receptacles installed or replaced in dwelling
units shall be listed tamper-resistant. This includes receptacles installed outdoors, in basements and in
garages.
NEC 406.9(B)(1) & 406.4(D)(6) New receptacles installed in wet locations and existing receptacles in wet
locations that are being replaced shall be listed as weather-resistant type & have an in-use weatherproof
(bubble) covers installed.
NEC 210.52(E)(1) & 406.9(A)&(B) At least one GFCI protected, weather resistant receptacle accessible at
grade level shall be installed at the front and back of a dwelling, and shall have a cover that is weatherproof
whether or not an attachment plug cap is inserted.
NEC 210.52(E)(3) Balconies, decks and porches, regardless of size, that are accessible from inside a
dwelling unit shall have at least one receptacle installed within the perimeter.
NEC 210.12(A) All branch circuits supplying 125-volt, 15 and 20 ampere outlets in dwelling unit family
rooms, dining rooms, living rooms, parlors, libraries, dens, bedrooms, sunrooms, recreation rooms, closets,
hallways, or similar areas shall be protected by a listed arc-fault circuit interrupter, (AFCI) combination
type, installed to provide protection of the branch circuit.
NEC 210.12(B) In any of the areas specified above where branch circuit wiring is modified, replaced, or
extended, the branch circuit shall be protected by a listed arc-fault circuit interrupter, (AFCI) combination
type protective device.
NEC 210.11(C)(1)(2)&(3) and 422.12 In addition to the branch circuits installed to supply general
illumination and receptacle outlets in dwelling units, the following minimum requirements apply:
NEC 210.11(C)(1) Receptacles installed in the kitchen to serve countertop surfaces shall be supplied by not
less than two separate small appliance branch circuits.
NEC 210.52(C) kitchen countertops, receptacle outlets shall be installed so that no point along the wall line
is more than 24 inch measured horizontally from a receptacle outlet in that space. Countertop spaces
separated by range tops, sinks or refrigerators are separate spaces.
NEC 210.52(C)1-5 A receptacle outlet shall be installed at each counter space 12-inches or wider and at
each island counter or peninsular space greater than 24-inches by 12-inches. Receptacles shall be located
not more than 20-inches above the countertop, or not more than 12-inches below the countertop and must
not be located below a countertop overhang greater than 6 inches.
NEC 210.52(D) At least one receptacle outlet shall be installed in bathrooms within in 3-feet of the outside
edge of each basin and must be located adjacent to the basin, if receptacle is located on wall or cabinet it
cannot be located more than 12- inches below counter or pedestal top.
NEC 210.52(A)1-4 Receptacle outlets in habitable rooms shall be installed so that no point measured
horizontally along the floor line in any wall space is more than 6-feet from a receptacle outlet. A receptacle
shall be installed in each wall space 2-feet or more in width.
NEC 210.52(H) A hallway of 10-feet or more in length shall have at least one receptacle outlet.
Sincerely, BRED AR
Cyr
o-4r o�j °pro 11�"s
� yG F2 1
No.2072
RS C I�
�p MASS.
G�
9�N OF MPSgP
CREScheck Software Version 4.5.0
�(J Compliance Certificate
Project Parseghian Residence
Energy Code: 2009 IECC
Location: Winchester, Massachusetts
Construction Type: Single-family
Project Type: Addition
Climate Zone: S
Permit Date:
Permit Number:
Construction Site: Owner/Agent: Designer/Contractor:
2 Thornberry Road Shant and Reem Parseghian Scott Golden
Winchester, MA 01890 2 Thornberry Road Golden Designs
Winchester, MA 01890 9 Chestnut Street
Danvers, MA 01923
978-578-1568
sgoldenarchitect@yahoo.com
;Compliance: Passes using UA trade-off
Compliance: 2.7%Better Than Code Maximum UA: 186 Your UA: 181
The o Better or Worse Than Code Index reflects how close to compliance the house is based on code tradeoff 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 or Door UA
Ceiling 1: Cathedral Ceiling 416 30.0 0.0 0.034 14
Ceiling 2: Flat Ceiling or Scissor Truss 936 38.0 0.0 0.030 28
Wall 1: Wood Frame, 16" D.E. 396 22.5 0.0 0.055 19
Window 1: Vinyl Frame:Double Pane with Low-E 54 0.320 17
Wall 2: Wood Frame, 16"D.E. 992 22.5 0.0 0.055 48
Window 2: Vinyl Frame:Double Pane with Low-E 128 0.320 41
Floor 1: All-Wood J oistfrruss:Over Unconditioned Space 416 30.0 0.0 0.033 14
Compliance Statement: The proposed building design described here is EDnsis with the building plans,specifications, and other
calculations submitted with the permit application.The proposed building hi en designed met the 2009 IECC requirements in
REScheck Version 4.5.0 and to comply with the mandatory requirements lis in the Sc ck spection Checklist.
Name-Title Signatulie 4F, QST.
f! hV
2
Nio.20726
` DANVERS
io bEASS. Jy"
q�"'i OF JAPSSPG�
Project Title: Parseghian Residence Report date: 03/21/1
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CREScheck Software Version 4.5.0
�(J Inspection Checklist
Energy Code: 2009 IECC
Requirements: 0.0% were addressed directly in the REScheck software
Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each
requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception
is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided.
Section Plans Verified Field Verified
# Pre-Inspection/Plan Review Value Value - Complies? Comments/Assumptions
& Req.ID
103.2 ;Construction drawings and as F M1 q'#❑Complies
[PR :documentation demonstrate ' r ' rys. i 4 • xal�'a ❑Does Not
energy code compliance for the3T ' r f, gfa. + + ,a " "i'r "I'
S .0 �x ; "",'`, []Not Observable
building envelope. ,
� :;' �I❑Not Applicable
103.2, {Construction drawings and ;e ❑Complies
403.7 !documentation demonstrate ❑Does Not
[PRV ;energy code compliance for
00 ,lighting and mechanical systems. , c ❑Not Observable
!Systems serving multiple a^ ;q f '��_❑Not Applicable j
;dwelling units must demonstrate }1
compliance with the commercial fit?+$`
:code. .9 -
403.6 Heating and cooling equipment is l Heating: Heating I❑Complies
[PR212 sized per ACCA Manual S based Btu/hr Btu/hr_ ❑Does Not
on loads per ACCA Manual J or Cooling: Cooling:
other approved methods. Btu/hr Btu/hr ❑Not Observable
;❑Not Applicable
Additional Comments/Assumptions:
11 High Impact (Tier 1) 1-2 JMediurn Impact(Tier 2) 'i 3 Low Impact(Tier 3)
Project Title: Parseghian Residence Report date: 03/21/1
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2009 IECC Foundation Inspection Complies? Comments/Assumptions
303.2.1 A protective covering is installed to I❑Complies
[F011]2 protect exposed exterior insulation ❑Does Not
Eand extends a minimum of 6 in. below
¢grade. ❑Not Observable;
S j❑Not Applicable j
403.8 Snow-and ice-melting system controls;❑Complies
[F012]2 installed. ;❑Does Not
V ;❑Not Observable
❑Not Applicable
Additional Comments/Assumptions:
111 High Impact (Tier 1) 2 1 Medium Impact(Tier 2) (3 11Low Impact(Tier 3)
Project Title: Parseghian Residence Report date: 03/21/1
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Section Plans Verified Field Verified
# Framing Rough-in Inspection Value Value Complies? Comments/Assumptions
& Req.ID
402.1.1, ;Glazing U-factor(area-weighted ; U-_ U- ❑Complies See the Envelope Assemblies
402.3.1, average). ❑Does Not table for values,
402.3.3,
402.5 I❑Not Observable
[FR211 ❑Not Applicable
303.1.3 ;U-factors of fenestration products uts x. �, fyM Msfl74"r�' ❑Complies
[FR4]1 ;are determined in accordance a ".,, �.., .f' "', ❑Does Not
;with the NFRC test procedure or a '«; �� '"]rU -' "^ ,( 1 �� '
;taken from the default table. 'r2 " ❑Not Observable
e,". i • ❑Not Applicable
N.' P
402.3.5 ;Sunrooms enclosing conditioned 1 U-_ U- I❑Complies
[FR8]1 :space have a maximum ❑Does Not
;fenestration U-factor of 0.50 in ❑Not Observable
Climate Zones 4-8. New glazing
:separating the sunroom from j❑Not Applicable
:conditioned space must meet
!code requirements.
402.3.5 ',Sunrooms enclosing conditioned U- U- ;❑Complies
[FR911 :space have a maximum skylight ❑Does Not
j U-factor of 0.75 in Climate Zones
;4-8 ❑Not Observable
❑Not Applicable
402.4.4 ;Fenestration that is not site built ❑Complies
[FR2011 ;is listed and labeled as meeting ❑Does Not
�;AAMA/WDMA/CSA 101/1.5.2/A440
for has infiltration rates per NFRC ❑Not Observable
.400 that do not exceed code % {, �r , "�,. ❑Not Applicable
;limits. '
402.4.5 IC-rated recessed lighting fixtures - _ € � " �.R❑Complies
[FR16]' sealed at housing/interior finish %, haw q ❑Does Not
and labeled to indicate s2.0 cfm tx ❑No[Observable
leakage at 75 Pa , a "�
.�int�'�x„ it ❑NOC Applicable
403.2.1 ;Supply ducts in attics are R- R- ❑Complies
[FR12]1 ;insulated to >_R-8.All other ducts R_ I R_ ❑Does Not
in unconditioned spaces or
;outside the building envelope are ;❑Not Observable
insulated to >_R-6. ;❑Not Applicable
403.2.2 All joints and seams of air ducts, � ' ;y1,.�y K ❑Complies
[FR13]1 :air handlers,filter boxes, and 'sr.. ' ' °k4: s e
',1I 1F �F , M 4 t 4' ❑Does Not
;building cavities used as return 'r�'w. i;,1a �, � s1 •
;ducts are sealed. �;tp�: � 1Q � i 'y y i1 ❑Not Observable
4 ^;,Al kk�sa an ra4a ❑Not Applicable
403.2.3 -IBuildingcavities are not used for ! �+ * '§ [. �o �011 s� ^m"❑Com lies
[FR15]' supply ducts. '"'�„lit ] fi i1 ❑Does pNot
) 1]
9 '1 `� ❑Not Observable
Ff
3i � `� * ,._ � :. ❑Not Applicable
403.3 HVAC piping conveying fluids R- ; R-_ ;❑Complies
[FR17]2 above 105 QF or chilled fluids ❑Does Not
,J below 55 4F are insulated to >_R-
3 I❑Not Observable
❑Not Applicable
403.4 CCirculating service hot water R-- I R-_ ❑Complies
[FR18]2 pipes are insulated to R-2. ❑Does Not
❑Not Observable
..-..._ ........_.
❑Not Applicable
403.5 Automatic or gravity dampers are ' __- ❑Complies
[FR19]2 installed on all outdoor air i ❑Does Not
intakes and exhausts. ❑Not Observable =,
.�.•. =4e3 '' i ° 1. ❑Not Applicable
Additional Comments/Assumptions:
1 1 High Impact(Tier 1) 2 'i Medium Impact(Tier 2) 13 1 Low Impact(Tier 3)
Project Title: Parseghian Residence Report date: 03/21/1
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1 JHigh Impact(Tier 1) (2 1 Medium Impact (Tier 2) 13`:1 Low Impact(Tier 3)
Project Title: Parseghian Residence Report date: 03/21/1
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Section Plans Verified Field Verified -
# Insulation Inspection& Req.ID Value Value Complies? Comments/Assumptions
303.1 All installed insulation is labeled 0 ❑Complies
[IN13]2 or the installed R-values n= _'' ❑Does Not I
provided.
„f ❑Not Observable
❑Not Applicable
402.1.1, Floor insulation R-value. R- I R ;❑Complies Seethe Envelope Assemblies
402.2.5, ❑ Wood ❑ Wood :❑Does Not ;table for values.
402.2.E[INl]' ❑ Steel ❑ Steel ❑Not Observable
❑Not Applicable
303.2, ;Floor insulation installed per .. a ❑Complies
402.2.6 ;manufacturer's instructions, and ❑Does Not
[IN2]1 :in substantial contact with the s, ❑Not Observable
❑Not Observable
,underside of the subfloor. j
402.1.1, (Wall insulation R-value. If this is a: R-_ R- I❑Complies ;See the Envelope Assemblies
402.2.4, (mass wall with at least YA of the ❑ Wood j❑ Wood :❑Does Not ;table for values.
402.2.5 ,wall insulation on the wall
[IN3]1 ;exterior,the exterior insulation El mass ❑ Mass ❑Not Observable
!requirement applies. ❑ Steel ❑ Steel :❑Not Applicable
303.2 :Wall insulation is installed per - - �.❑Complies
[IN4]1 ;manufacturer's instructions. ❑Does Not
C� ❑Not Observable
❑Not Applicable
402.2.11 jSunroonn wall insulation has a I R-_ R- !❑Complies
[IN8]1 ;minimum R-value of R-13. New ❑Does Not
;walls separating the sunroom !,❑Nat Observable
;from conditioned space must ';❑Not Applicable
Observable
;meet code requirements.
303.2 ;Sunroom wall insulation installed 't. ❑Complies
, :
[IN9]' Iper manufacturer's Instructions. - . ❑Does Not
• ' ❑Not Observable
❑Not Applicable
402.2.11 ;Sunroom ceiling minimum R- R ❑Complies
[IN10]1 :insulation R-value of R-19 in ;❑Does Not
® !Climate Zones 1-4, and R-24 in
;Climate Zones 5-8. :❑Not Observable
❑Not Applicable
303.2 :Sunroom ceiling insulation is R's tb n��*� �`F , r_.„',. ; ; '„`❑Complies
[INll]' installed per manufacturer's , 6f�rt,� e ,; r01
§ a ❑Does Not
, al
instructions. �. x- ak rY.:, ° f fit ❑Not Observable
El
Not Applicable
Additional Comments/Assumptions:
1 JHigh Impact (Tier 1) 1 2`.Medium Impact(Tier 2) ? 3 1 Low Impact (Tier 3)
Project Title: Parseghian Residence Report date: 03/21/1
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Section Plans Verified Field Verified
# Final Inspection Provisions Value Value Complies? Comments/Assumptions
& Req.1D e
402.1.1, ;Ceiling insulation R-value.Where R- R-_ ❑Complies See the Envelope Assemblies
402.2.1, ;> R-30 is required, R-30 can be ❑ Wood j❑ Wood ❑Does Not ;table for values.
402.2.2 :used if insulation is not ❑ Steel ❑ Steel ;❑Not Observable
[Fll]1 ;compressed at eaves. R-30 may
:be used for 500 ft'or 20% ❑Not Applicable
j(whichever is less) where
{sufficient space is not available.
303.1.1.1, ;Ceiling insulation installed per ❑Complies I
303.2 ;manufacturer's instructions. ❑Does Not
[FI211 ;Blown insulation marked every
(gj 300 ft'. ! fr 1'" ❑Not Observable
❑Not A pplicable
402.2.3 ;Attic access hatch and door R-_ R- ❑Complies
[FI311 :insulation tR-value of the ❑Does Not
;adjacent assembly.
;❑Not Observable
❑Not Applicable
402.4.2, ;Building envelope tightness ACH 50 ACH 50 =_ ❑Complies
402.4.2.1 !verified by blower door test result ❑Does Not
[FI17]1 ;of<7 ACH at 50 Pa.This
;requirement may instead be met ;❑Not Observable
!via visual inspection, in which ❑Not Applicable j
';case verification may need to
;occur during Insulation
Inspection.
402.4.3 Wood-burning fireplaces have ,.Y4 ,� ❑Complies
[FIB 12gasketed doors and outdoor 4 Ya
combustion air. ^ r ¢ tf '# ,hodk ❑Does Not
❑Not Observable
` a ❑Not Applicable
403.2.2 ;Post construction duct tightness I _cfm cfm ❑Complies
[F1411 ;test result of<8 cfm to outdoors, I j❑Does Not
0 ;or 512 cfm across systems. Or, ❑Not Observable
<;rough-in test result of 6 cfm ❑Not Applicable
across systems or 54 cfm pP
;without air handler. Rough-in test;
;verification may need to occur
during Framing Inspection.
403.1.1 Programmable thermostats Y s ' f' t� ,"'1? , �- "T .!❑Complies
[FI9] installed on forced air furnaces. ;* r ? ❑Does Not
! [ ❑Not Observable
❑Not Applicable j
403.1.2 Heat pump thermostat installed px 1'e v [ i':` P UN t: x� " ❑Complies
[FI10]2 on heat pumps. °p ❑Does Not
❑Not Observable
❑Not Applicable
403.4 Circulating service hot water p „ xf"%"° y r° ; ' S ❑Complies
[Fill]2 systems have automatic or3r1' a Y; ` ' dal"2" �' t
„ fAx a'��i #« , ,�. ❑Does Not
V accessible manual controls. - f7:..� " a+sf
❑Not Observable
-;a �1' . .,, ❑Not Applicable
403.931 Readily accessible switch on w)i:J❑Complies
[FI12] heaters for swimming pools. 44 w"' : 11 p .� ,rna rs]' °+ ❑Does Not
e drrsNO
, g ` llay,°hr ,
'a ' " qlx #' ❑Not Observable
-" ,. ❑Not Applicable
403.9.2 Timer switches on pool heaters :y . ❑Complies
[FI19]3 and pumps are present. -x ,[ «' & a , ❑Does Not
' M , ❑Not Observable
_, +r ❑Not Applicable j
1 High Impact (Tier 1) 112 ;1 Medium Impact (Tier 2) 3 ',1 Low Impact (Tier 3)
Project Title: Parseghian Residence Report date: 03121/1
Data filename: \\dellvault\EmpProfiles\Folders\sgolden\My Documents\REScheck\2 Thornberry- Page 7 of 8
Winchester.rck
#°n Plans Verified Field Verified
Final Inspection Provisions Value "" 'Value ,;.Complies?.., Comments/Assumptions
Sects
& Req.ID
403.9.3 feated swimming pools have a ❑Complies
[FI20I3over. Covers on pools heated ❑Does Not
ver 90 4F are insulated to R-12. 4A1* ,!A' ❑Not Observable
❑Not Applicable
404.1 150%of lamps in permanent ❑Complies
[FI6]1 fixtures are high efficacy lamps. ' ❑Does Not
7# srs;
❑Not Observable
❑Not Applicable
401.3 Compliance certificate posted. ,. omplies ;
[FI7]2 _ NotlRo,,
❑Not Observable
❑Not Applicable
303.3 iManufacturer manuals for ru CNot
Complies
[FI18]3 mechanical and water heating �, , � � Does Not
equipment have been provided. �a r�� �' .' Not Observable
r
" Applicable
Additional Comments/Assumptions:
1 1 High Impact(Tier 1) !.2 Medium Impact (Tier 2) 3 '.1 Low Impact (Tier 3)
Project Title: Parseghian Residence Report date: 03/21/1
Data filename: \\deI Iva ult\EmpProfiles\Folders\sgolden\My Documents\REScheck\2 Thornberry- Page 8 of 8
Winchester.rck
2009 IECC Energy
Efficiency Certificate
In! R-Value
Wall 22.50
Floor 30.00
Ceiling / Roof 38.00
Ductwork (unconditioned spaces):
Gla e.
Window 0.32
Door
Heating&Cooling Equipment Efficiency
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments
CnT OF SM.EN4MASSACHUSEM
Bt.'a=o DEP.�RIURff
120 WAStt¢vCr IN Si&M,r FLOOIL
TILL f;97g)745.9595
KIMERLEY DAISCOu FAX P8)74(I-M6
MAYOR TIMUNI STYMIn
DMWWR OF Ptiil X MOPUTY/BUMDING COMQBSWNER
Wtirkaii'Compensadon Insurance Atlidavit.BaUden/ContnetoryElectri�n�Plnn,)
vn
A
�latne(BmmesWrgkmmdarylodivimd): �� � Ci+ ylCtmodLe��hq CQ •f3A�P a(� u/ CAJ/lIG/[
Address 3 Sophle
City/Statomp:_ PeabcckV ma, oi4'6o pbm#: f7Y-,535-356.?
Are Imo an ampieyee?Chak the pox
1.0 1 am a employer with 4,1 am a®cam aalmemr
l end I Type of project(ragO�.
aapkryees(fill aodlor paea6me).• have liked the s b aosmtkcdam
2_❑ 1 am a Sole proprietor or pwmor. listed an die a#whed AmeL= 7. ❑Retnodelmg
ship and bwe on employees Theo¢ aka hm >R O Demolidon
woddr4 far me in say wry. wprt='Camp.hammooe.
[No wokkas'aomp,imaeaaa corporation S. �We am a rcorporationand its 9. 8urbdkR addkioa
required.) officers have exercised their 10.0 moc" al repein or adadmin
3.0 1 am a homeotrow doing all work right of atetmptima per MOL 1I1:1 Plumbing mpah or addttimu
myself(No workers'comp, C. IA$1(41 and we bave no 12.E Roof rcpW=
insurance required l f amPIDYM.[No wmkcw 13.Q Odor
comp.hwnu oe regkdmd.l -
firgI -vAoot teed*teaer mw dwituamvg uammommuAsv,m *Air.wtm.'000pa,dsaP H67mb mdm
Ilostaaaenaaoateabad tatbvit r.d3mdea�rf'a.de6pty waAk and am his eauidewnkapmr ama week Sam amine wdhmft &
=C•nuSats klr�Bi taS�e.a almoh.sa.adua.ka.�rmrey ae r�ee xl6.v+manea...a khdr setter'
�v��tartrawda..
law asaapasyerrberhp workers,
eaSepesaotlaabeweraoe
Jr q menbYers. Bt*w hr At pgcp amiAb alle
Insumoce company Name: ffSsex -:� hS'U12ah ce co.
Palley k or Self-ins.Lis 1h 3 D E,;Io2 3 9 Eapkagoo Dem: d g-o Y4-ao/
1obSimAddrew a PhetiC *vie` Sn/fm MOM 01170 len, my, O/9r10
City/Smte/2ip`$v
Attach a espy of the wnrlien'aompl medim po ft dsdanden iM(shosrog tea pots .amber sad saplrottoo dace
Faikm a smm average asmquikW umler Sectim 25A ofMGL o. 152 can lead to dm i
fine UP m S I S00.00 ead/or rmpaition of ermktat penatlea of a
coe�ieevi b"Or advised
e wall as DPY Inlalges m the farm of a STOP WORK CIRDO ad a fine
In es i tious o a day against die enm c r. BeIle advised that a copy of his wm ement my
be forwarded m the Office of
Invwtigatioaa of the AU for insurance average vetifieation.
do J'eertl.6;aa/dn Me Paine and pesalltia of per/aTebw the W t PwPfiw abaw&aw and os+aea
Sigmamre:_X C^ad�E nor ,'A /,/ a0/�
ftonem
S 53S�S6
t?,�drkdamoa/SL Daamr�elndtlaarap,abeeoarphemdbyebyorreawaJ/&!aL
City or Town: PermWl k mte 0
lauiog Authority(aircb Omar
b.hoard or Ileatth 2.Ruildtag Department 3Olker .Cityfrown Clark 4 Ekctrleal IaSpeetor S PtnmbiaC Inpeow
Cooled Person: Phone pr
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 ofhire,
express or implied,oral or written."
An employer is defined as"an ladivkkW.partnership,association,aotpondon or other leo ondty,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a decented employer,or the
receiver or trustee of an individual,partnership,association or other legal amity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of de
dwelling house of another who outpioys persons to do mawta mce,construction or repair work on such dwelling house
Of on the grounds Or building appurtenant thereto shall not because of such employment be deemed to be an emp)oyv"
MOL chapter 152.125C(6)also states that"every state or local Beensisg agency shall withhold the Issuance or
renewal of a fiance or permit to operate a business or to contract buildings In the commseroca th for any
applicant who has not produced acceptable evidence of compliance with the iasur ice coverage required.
Additionally,MGL chapter 152.§2SQ 7)states"Neither the commonwealth nor any of its political a tlbdlViaiate.ball
enter into any contract for the puformance of public work until acceptable evidence of compliance with the inmates
requiretnents of this chapter have been presented to die contracting authority."
Applicants
Please tall out the workers'compensation affidavit completely,by chocking the boxes that apply to your situation and,if
Mammy,supply sub coutractor(e)mane(.).Wwrese(es)and phone numaber(s)along with their cerdficam(s)of
insmancs:. Limited Liability Companies(LLC)or Limier Liability Partnerships(LLP)with no employees other than the
members or parmem are not required to carry workers'compensation boastase. if an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be mbmhted to the Department of Dalustrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the a8ldavlt. 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 wotiteme,
c*MP=Udm Policy.Please ca11 the Department at the member listed below. Self-ima trod companies should enter their
self-insurance license number on de appropriate line.
City or Town Offidab
Please be gore that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of die affidavit for you to fill out in die event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the pemmittlicenae number which will be used as a reference number. In addition,an applrcmt
that must submit multPle Pcmdt/license applications do any given year,need only Submit one affidavit indicating catsmat
policy information(if necessary)and under"lob Site"Addroes"tie applicant should write"all locations in__(city or
town)."A copy of the affidavit that has been officially stamped or mocked by the city at town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or liccum A new affidavit must be filled out each
Year;wham a notate owner or citires is obtaining a license or permit not related to any business or commercial venture
(Le.a dog license or permit to bum leaves arc.)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 Commonweakh of Maw
DepBftmCDt of lndushial Aooidents
O®Qe of 111"Il tgattelas
600 Washington Sbvd
Boston,MA 02111
TeL#617-727-4900 eta 406 or 1477-MASSAFE
Revised 5-26-05 Fax#617-727-7749
www.mm.gov/dia