1 HARRISON AVE - BUILDING INSPECTION REScheck Software Version 4.1.1
Compliance Certificate
Project Title: Habitate for Humanity
Report Date:09/10/07
Data filename: E:\PROJ-M-1\HABITA-1\HARRIS-1\habitate.rck
Energy Code: Massachusetts Energy Code
Location: Salem, Massachusetts
Construction Type: 1 or 2 Family, Detached
Heating Type: Other(Non-Electric Resistance)
Glazing Area Percentage: 10%
Heating Degree Days: 6268
Construction Site: Owner/Agent: Designer/Contractor:
1 Harrison Ave Habitate For Humanity North Shore Beacon Architectural Associates
Salem,MA 01970 145 South Street
Salem,MA 02111
ii BID
�r Your UA:
w
Gross Cavity Cont. Glazing UA
Assembly Area or R-Value R-Value or Door
9
f
ii
Ceiling 1:Flat Ceiling or Scissor Truss 1500 30.0 23.0 29
Wall 1:Wood Frame,16"o.c. 3600 11.0 7.0 198
I Window 1:Vinyl Frame:Double Pane with Low-E 360 0.400 144
k Door 1:Solid 90 0.700 63
Basement Wall 1:Solid Concrete or Masonry 0 0.0 0.0 0
Wall height:7.0'
Depth below grade:6.0'
Insulation depth:7.0'
I4i
Furnace 1:Forced Hot Air78 AFUE
The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design
Conditions found in the Code.The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design
load as specified in Sections 780CMR 1310 and J4.4.
IIS i
Project Title: Habitate for Humanity Page 1-of 4
Data filename: E:\PROJ-M-1\HABITA-1\HARRIS-1\habitate.rck Report date:09/10/07
REScheck Software Version 4.1.1
Inspection Checklist
Date: 09/10/07
4 Ceilings:
f ❑ Ceiling 1: Flat Ceiling or Scissor Truss,R-30.0 cavity+R-23.0 continuous insulation
Comments:
Above-Grade Walls:
❑ Wall 1:Wood Frame, 16"o.c.,R-11.0 cavity+R-7.0 continuous insulation
Comments:
Basement Walls:
❑ Basement Wall 1:Solid Concrete or Masonry,7.0'ht/6.0'bg/7.0'insul,R-0(uninsulated)
Comments:
Windows:
Cl Window 1:Vinyl Frame:Double Pane with Low-E,U-factor:0.400
For windows without labeled U-factors,describe features: !
#Panes Frame Type Thermal Break? Yes No
Comments:
Doors:
❑ Door 1:Solid,U-tactor:0.700
Comments:
Heating and Cooling Equipment:
❑ Furnace 1: Forced Hot Air:78 AFUE or higher
Make and Model Number:
.Air Leakage:
❑ Joints,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed.
❑ When installed in the building envelope,recessed lighting fixtures#meet one of the following requirements:
1 Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or
gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfm(0.944 Us)air movement from the the !�
conditioned space to the ceiling cavity.The lighting fixture has been tested at 75 PA or 1.57 lbs/ft2 pressure difference and
shall be labeled.
Vapor Retarder:
❑ Installed on the warm-in-winter side of all non-vented framed ceilings,walls,and Floors.
Materials Identification:
❑ Materials and equipment are identified so that compliance can be determined.
❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided.
❑ Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications.
❑ Insulation is installed according to manufacturers instructions,in substantial contact with the surface being insulated,and in a
manner that achieves the rated R-value without compressing the insulation.
Duct Insulation: SII
F Ducts are insulated per Table J4.4.7.1.
Project Title: Habitate for Humanity Page 2 of 4
Data filename: E:\PROJ-M-1\HABITA-1\HARRIS-1\habitate.rck Report date: 09/10/07
Duct Construction:
All accessible joints,seams,and connections of supply and return ductwork located outside conditioned space,including stud
bays or joist cavities/spaces used to transport air,are sealed using mastic and fibrous backing tape installed according to the
manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch.Duct tape is not permitted.
❑ The HVAC system provides a means for balancing air and water systems.
Temperature Controls:
Thermostats exist for each separate HVAC system.A manual or automatic means to partially restrict or shut off the heating and/or
cooling input to each zone or floor is provided.
Heating and Cooling Equipment Sizin :
Lj Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR
1310 and J4.4.
Circulating Hot Water Systems:
Circulating hot water pipes are insulated to the levels in Table 1.
Swimming Pools:
All heated swimming pools have an on/off heater switch and a cover unless over 20%of the heating energy is from non-depletable
f sources. Pool pumps have a time clock.
Heating and Cooling Piping Insulation:
Cj HVAC piping conveying Fluids above 120 degrees F or chilled Fluids below 55 degrees F are insulated to the levels in Table 2.
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Project Title: Habitate for Humanity Page 3 of 4
Data filename: E:\PROJ-M-1\HABITA-1\HARRIS-1\habitate.rck Report date: 09/10/07
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Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes
Insulation Thickness in Inches by Pipe Sizes
Non-Circulating Runouts Circulating Mains and Runouts
Heated Water
Temperature(°F) Up to 1" Up to 1.25" 1.5"to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Table 2: Minimum Insulation Thickness for HVAC Pipes
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
!i Piping System Types Rangeff) 2"Runouts 1"and Less 1.25"to 2.0" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
!� Low Temperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0
Cooling Systems
Chilled Water, Refrigerant and 40-55 0.5 0.5 0.75 1.0
Brine Below 40 1.0 1.0 1.5 1.5
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g NOTES TO FIELD:(Building Department Use Only)
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Project Title: Habitats for Humanity Page 4 of 4
Data filename: E:\PROJ-M-1\HABITA-1\HARRIS-1\habitate.rck Report date: 09/10/07
IL
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
\L�u•M 12C9r.WUfa::JD 1EET MAVLU:ta *t1Y:19/'.
To.9M71i9S9! •F- 9MY404M
Construction Debris Disposaf Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 7S0 CNIR section i 11.5
Debris, and the provisions of MGL c 40.S 54;
Building Permit N _ _ is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by%IGL c
I 11. S 150A.
The debris will be transported by:
r
Ciivq S %S/'!I
orS�� Lf/! wG rte/ G'ttg
mama of hauler)
rhe debris will be disposed of in
t none�r ia,�ilry)-
..a4
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CITY OF SALEM
PUBLIC PROPRERTY
� .y DEPARTMENT
M.Mnr trEV URlit:l Al
MAYon IY'WAst .NGroxSTREET*SALEM.Mns4nctn.�r l ts01979
Thl_978-743.9595 a FAX:978.740.9846
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Anrillicant Information Please Print Leeibly
Name ltluaincsslOrganizatlotVlndiv,duap:
.address: ViV /ARK LS Ut Ie, /7d 019
CityiStare/Zip: 14244U/f N /3 kfJj t21�0I Phone #:_ 7V_ ?yV— 7 7f/q
Are you an employer? Check the appropriate box: Type of Project(required):
1.C3 i am a employer with 4. I am a general contractor d t 6 C3 New construction
employees(full and/or part-time).• have hired the sub-contractors
2. 1 am a soleP P rorietor or partner- listed on the attached sheet. : 7• Remodeling
ship and have no employeesThen e sub-contruton have
S. ❑ Demolition
workingfor me in an capacity. workers'comp. insurance.
Y9. E] Building addition
[Ko workers'comp. insurance S. ❑ We are a corporation and its !0.
required.) officers have exercised their Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MCL 11.❑ Plumbing repairs of additions
myself. (Ko workers'comp. c. 152,044),(4),and we have no 12.El Roof repairs
insurance required.] t employees. [ho workers' 13.E] Other
comp. insurance required.]
'Any upplium film checks boa nl must alto Fill out the section below ahowina their workeva'eompaneution policy inrurn tion
' Itomuowrwts who submit this ofltdavit indicating thry am doing all work and them him outside contmeton moat.uhrnl,anew anlda,it indicating etch.
C,mtrxvws that chock this bot must attached an additleatat sheet%lowing the name of the tubKontmetors and their workers'comp.policy information.
/am an oaP/ayer that/s providing workers'cooPensadon/nsararc
cjor ury,employees.
Below is the policy and Job site
information.
Insurance Company Name:
Policy N or Self-ins.Lia q; ._. .__ Expiration Date:
Job Sitc Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of.%,iGL c. 152 can lead to the imposition of criminal penaltiesofa
tine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a Jay against the violator. Ile advised that a copy of this slatcmunt may be forwarded to the UI)ice of
Invcatlgatiuns of the DIA for insurance covcrago verification.
/duh hereby certify r
r aan Ja.r thr/pains and penalties ujprrjury that the injuronation provided above is tree and correct
tiig:ruuret ��"/.�///t SllA.ui I).ttc• ////(�d 7�"
Official use Only. Do not write in thin area,to be ramp/eted by city orTown a iciaL
City or'rown: _- Permit/License N
Issuing Authority (circle one):
1. Board of ifeahb 2. Building I)epartment 3. City/fo%%n Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: — Phonc #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
pursuant to this statute,an rotployee is defined as"...every person in the service of another under any contract of hire,
eapress or implied,oral or written."
.An employer is defined as"an individual.partnership,association,corporation or other legal entity,or any two or more
Of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein.or the occupant of the
dwellingrsons to do maintenance,construction or repair
ork on such dwelling house
he grounds or building appurtenather who employsnt thereto shall not because of such employment be deemed or ondeemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shag withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificatc(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers'compensation insurance. if an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or own that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the approLnate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom.
of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant.
i'loase be sure to till in the p.:rmit/licetse number which will be used as a reference number. In addition,an applicant
that must submit multiple permltilicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or
town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
l'hu Otiice of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please du not hesitate to give us is call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
O®ee of Investiptlens
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 5-26-05 www.mass.gov/dia
EI1'�tOF -
7
PUBLIC PROPERTY
`Q' DEPARTMENT
YI.eFM nv....er.v.
MAYOR 130 W UUP&=W a�l�sr
�tb1f �/AtaAOrLSkTis 01970
APPLICATION FOR THE REPAIR. RENOVATION,CONSTgUCnorq,
DEMOLMON, OR CHANGE OF USE OR OCCUPANCY, Fog ANy FMSTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: Bui dkW
---- property Address:------
p►oper -
ff�I�2�%J•o,v �U�-
ty is kxated in a;Conservation Ares YM Historic Dk old YM
2.0 OWNERSHIP INFORMATION
4.1 Owner d Land //,4/,,/ Auk! /t�! rV
Name:
Address:
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN
UILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated field CQ 6100
Change in Use New Uf�l
Demolition Existing �S�D
Approximate year of
tor floor (st) Renovated
construction or renovation � i
of existing building New ®(Jo
Bret Description of Proposed Work:
/jjd (f) STmy ao-o eX�sTiw6 4u,:-1d'w(
CONveK 7' To Ca� fQeSi dewfi}/ UNC TS
----------Mail Permit to• i Gh16LL � --- - ._ -
SV v
What is the Current use of the Bui e-
Material of Building? )lA"- ' VE G;oOd If dwelling.how many units?
win the Building Conform to Law?
Asbestos? ,UB (-)Seer+) ReFwal/e ()
Archfiads Name e ;J ir`�clruQs� 1 7/7/
Address and Phone ( ) �¢�7� t
Meehank's Name wk 6 e .Pia
Address and Phone yUv L- lf
C.M.,Z. Supervisors lUeenae* O 6 d O 6 OOHIC Regtetration N
Estimated Cost Of Project$ Permlt Fee Calculation
Permit Fee$ Estimated Cost X$7/$1000 Residential
b, cr`f �diwN/Cr`ry Estimated COst X$41/$1000 Commercial------
An Additional $5.00 Is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby appy for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury /\..,
Date
t7' N
s � �
~ �
F �5
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