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HomeMy WebLinkAboutBuilding Permit # 5/17/2016 BUILDING PERMIT o� �eoRTy �tLeo ib � TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �SS9C HUS��t Date Issued: I� i IMPORTANT: Applicant must complete all items on this page LOCATION n,C, t0.CC_. T Print PROPERTY OWNER_&k _t'+`I CQ I Print 100 Year Structure yes MAP PARCEL: '31ZONING DISTRICT: Historic District yes (no Machine Shop Village yes �o j 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 f.._ .��' ' ' '�u'r„,. 'rfr'za'`' � ' ''L-�.s. nom,- "W�tr.Sled'D�,uc''` ,> „; e er Se evil r �Foad I tnW�etland P DESCRIPTION OF WORKO BE PERFORMED: v �c C) ` ) Identificat'on- Please Type or Print Clearly e OWNER: Name: V �. CoPhone: 17I )977� Address: Contrac or Narnel me S 4 O,1(6 f Phone: ( Email: � C 16C c 2 7�c c r�� A 0, Address: 2 0 S A; ( ° Pn cy'` Supervisor's Construction License: , co 03 Exp. Date: 11 Home Improvement License: 7 1 �'� Exp. Date: a ARCHITECT/ENGINEER Phone: Address: 0 4EReg. No. FEE SCHEDULE:BULDING P MIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED bOST BASED ON$925.00 PER S.F. Total Project Cost: $ 1 `"S FEE: $ Check No.: Receipt No.: NOTE: Persons c ac 'tg with'u registered contractors do not have access to the guaranty fund y 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 m U FORM PLANNING & DEVELOPMENT Reviewed On 51 Signature_ � I 4Uuij� COMMENTS� Gr, jctt I 1� �i 1. ��(I 1�� 1 j i► CONSERVATION Reviewed on Si nature �— kLl COMMENTS ( Z� HEALTH Reviewed on Signature COMMENTS ,'oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments 4 Water & Sewer Connection/Si nature& Date DrivewaV Permit DPW Town Engineer: Signature: -� � L`���z 7-4 c ed 384 Osgood Street Rim, .7,,ARTMENT Temp Dumpster on site f no r "g-" rza3, r K,^r r .€ 3✓ r aaa',s Locatedlat 12,4 MainStreet F�reDepartm�ntsignature/dater �� � s ' ���s�,h xr a s rt fir~ f r ` ... �7A EI� c COMMTS's f .;;,', , ✓ .c r <" JG� �, ' , t t%®RTH Town of ndover ® ® -` a C �AK� h ve>t'y SSS, i &-i COC LCHIWICK 1' 14 ggr�o �4a�'<'5 LI BOARD OF HEALTH Food/Kitchen PER, T L D Septic System THIS CERTIFIES THAT ....................... .....IMT,, BUILDING INSPECTOR ................. .... ................. ........ ..... ...®... ..,,.,,. ,. Foundation has permission to erect......................4ildings on .... .. ..... . ....... ..4`�.. ... ...................... . . .. :.m Rough tohe occupied as ...... .R. . . . .... .......®. ... .......... ........... ....w ..... .... . ........ .. ....... Chimney provided that the person acce ' g this permit shall in ry respect conform to the erms of the applic on 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe. Building Inspector. Burner Street No. Smoke Det. The Coninionwealth of Massachusetts Department of Industr'ialAecidents 1 Congress Street, Suite 100 Boston, MA 02119-2017 www.mass.gov1dia Worlters'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED Wl'1'li THE PERr171TTING AUTHORITY. Applicant Information ( Please Print Lelzibi Name (Business/Organization/ludividual): V� t Q� ��- Com- Address:Address: �� Q� l✓1 ��' City/State/Zip:�W10q-Q.K ,A 618) 0 Phone #: 91 1`1 7 (o Are you au employer?Check the appropriate box: Type of )• ct(required): 1.n I am a employer with A employees(frill and/or part-time).* 7. New construction 2.[:]I am a sole proprietor or partnership and have no employees working for me in $• Remodeling any capacity.[No workers'comp.insurance required.] J. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 [j Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.# 6.❑We are a corporation and its officers have exercised their right of exemption per MGI,C. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Army applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ICoutractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am are employer that is providing)Porkers'compensation insurance for ney employees. Belo)v is the policy and job site lnfoe7nation. Insurance CompanyName: ►. j _li �+`� 1 m Q S Policy#or Self-ins.Lic.1h �" - ` 3 t4 0, —00�Apiration Date: 3 Job Site Address: C� City/State/Zip: " ©V_6 YILA 0(s)V5 Attach a copy of the workers' compensation policy deck •ation page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forte of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here certify rut ler the pains and penalties of pmejuey that the information provided r Bove i trete find correct. Si natt 1 K� Phone q7 9^ 7 Official use only. Do not write in this area,to be completed by city or toms official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/ToNvn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ACC>RU CERTIFICATE OF ii 9 INSURANCE DA7E(N1ti1lDIaYYYY) [THIS CERTIFICATE IS IS$UED AS A MATTftR OF 1IdFCJRI{�ATItatV ONLY ANO CONFERS NO RIGHTS UpaN THE CERTIFICATE NOL[�EI4 THISERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY +�dlEND, EXTEND CSR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED EPRESENTATIVE OR PRODUCED,AND THE CEWIFICATE HOLDER. IMPORTANT: If t11e cern Icate holder is an ApE11170NAL INSURED, the i9olicy(tes) must be a»dorsad. If SUBROGATION 15 WAIVED,subject to the terms end corn liens aurhfth@ laoliey,certain policies It�y require an endorsement. A statement an this Certificate does not confer rights to the certi5ca#e holder'in lieu ofsUch er�tvrsem PRODUCER T4.P, Ro}cert$ Tnsuraz�ce Agency rON TIA T Saudi Munroe 1060 Osgood Street 978) 683-8073 North Andover, MA 61.845 : sartdi@MProb�artsinsurance.cam INSUIU iE 3)AFFORDINGGOV@RAGIE NAICR, A_Essex InsNORTH ANDOVBR RZALTy CORP k-_PjQrchsnta MutualZnsur nc$ +va C/O CHARLIE DROLL C:�g9a@i 3�@!� EHl�DVr3Z912 MA.RTINGATp, LANE n; -P.3Y�107I1`,R, IIA OZ810 E:C01/ERAGI=S F: — — CERTIFICATE NUMBER: THIS IS TO CERTIFY TI-!AT THE ROLICIES rOF INON NUMBER: SURANCE LISTED 6 i v HAVE BEEN 1S5UED TO THE INSUR t)NAMREVISIEp BOVE FOR TME POLICY PER)Qp INDICATED. NOTVVITHSTANDING 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 6Y TI E POLICIES pESCR113ED HEREIN IS SUBJECT I ALS THS TERMS, T CLUSIONS ANl7 CONDITIONS OPSUCH POLICIES.LIMIT$SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. RYx -AM us TYPE 4F fN8UR/aNCE _ .... . POUGYNUMCER ROLIL EFE""POLJGYIjj(p A 4.4NERAL,LIABWTY MIDprc GA7/DgYYYY LINATS �D �95 8/21/15 $/21/15 EACHOCCURRENCE g Ix CCMMERCIALGENERALI,IABILITy _��QQQf(�Qa II � DAIM Et�TQ gENTED CLAIMS�IADF Lx_1 OCCUR P_REMl9.r5(Ea_Qssd,t�n�e}_ 100,000, _ME 1)F,Xp(Any Qr*pefscn) 51_0 00 _ PERSQNAL&ADVINIUIiY � ?.,0t)0,00 0 GEN'LAGGREGATELUITAPPIJESPER GENERAL AGGREGATE I$ 2 QaQ QQQ ��_) Q— X POLICY PRO- L4C _PRODUa, -COMR P ACC -$ p0 O Q 0 Q r-- $ AUTOMOBILE LIABILITY S MCA7015484 6/73/15 6/13/16 Eaac�) 'LEL r ANYAu , _ s 3, 000,a _Q AL NEO X SCHEDULED BODILY INJURY(Per pd�on) $ AUTOS HIRED ABODILY INJURY(Pgr accident)AUTOS X NON- ED I'ROP1; Y DAMgr,E R _Peracci nt -- UMERE0LALIA6 OCCUR —•— .� - ERCES6 LIAR $ -�.• CLAIA9$-M4r>E EACH OCCURRENCE DED RETENTION$ AGGRF,GATE r — WORKER$COMPENSATION — _— ANDEMPLOYERS'LIADILITY YIN WCC501073401-2016,E 3/13/16 3/13/17 k. WCSTATu- orW- ANYPROPRIETOR1pARTNER/EXL•CUT7VE S4RY41Nt)IS E OFFICERM1frMBER F.XCLLOFp� 7 N!A IMa p1DryinNH) 1111 G1,17ACHAOCIEGNt $,•--X00,000 Ilyyed tlm arlbaurxier � _— .--- — DE$ RIPTIpNOFpPEPATIONSBoIov E.L_DISF,q$E•FA.WPI, YEE_$ SQp,QOQ E.L•DISEASE-POWYLIMIT $ 50 000 JU9CR TION OF OPERATIONS I LOCATIONS!VEHICLES (AHheh ACORN 107,Adotlrntal Renfsrkg SdMdul6,If mere B�Fg Ia frigtlpgtl) ,OT , REGENCY PLACE, 14ORTH ANDOVER MA, 01945 'ERTIFI ATE HOLDER C AN CELLATI O N SHOULD ANY OP THr ABOVE nr;sORlr3r�4 PeIQIES PE CANCELLED BEFORE 'XOWN OF NORTH ANT)OVER THE EXPIRATION DATE THEREOF, NOTICE; WILL BE DELIVERED IN BUILDING DEPT, ACCORDANCE WM THE POLICY PROVISION$, NORTH ANDOVRR, %A 01845 AUTHORIZED ESE TAT1Vr ,OR 25(241 W05) ©'I$SS-244Q AC0121 CORPpRATIOid. All rights rerervod. Tho ACORD name and logo are registered marks of ACORD Qne; Fax: (97 8) 655-4760 E-Mail: Registry ID: JZ Rating Number: E*0716 � r � Certified Energy N�NoRegencyP��d?|�3a u' Rating Date: 5M3C2016 L-aaRegency PI/Rd -m��' RatinSOrdenad For North Andover,mAU1845 Estimated Annual Energy Cost Projected Rating 5 Stars Plus use MMam Cost Percent Projected Heating 14aS �2O�a o5Y6 ������� B���� o� P|g�m, Fie|� C�om�mmation �����imo� � un�o,mEnergy Ra� Cooling 17 889 2Y6ngSyntem snv,Sy��ixien� � � ��� �� Hu����r 22�3 ��14 8%� �r � s�p� c�m z���s a�� na�mp� ��m *�mp� o�m nS�m�� � / � | | / ��— Lights/Appliances 37.3 $1841 3496 � 500-401 400-301 300-251 uoo�o� �nn �m ���m� �oo�� | ��ns | ou�� � 70 or/ � Photovoltaics ~0.0 $_o '096 *ERS Index: 53 Service Charges $190 4% General Information Tota/ 205.2 $53*8 100Y6 � Conditioned Area: 5752 sq.ft. nouselype: Single-family detached _ Conditioned Volume: 51472cubic ft. Foundation: More than one type This home meets o,exceeds the minimum Bedrooms: 5 ur�ehafor aUofthe following: �ecxam�ausy��ms�e��ures Heating: Fuel-fired air distribution,Natural gas,85.OAFUE. Heating: Fuel-fired air distribution,Natural gas,Sb.DAFUE. Cooling: Air conditioner,Electric,13.8SEER. Duct Leakage toOutside: 81u0CRw25. � Ventilation System: Exhaust Only:1O3cfm.15.Owatts. Programmable Thermostat: Headng:Yes CooUng:Yes Building Shell Features Ceiling Flat: R'38�O Slab: R-O.O Edge, R-OD Under Qea|euAttic: NA Exposed Floor: R-30-0 Vaulted Ceiling: NA Window Type: U-Value:O.3OO.GnGC:0.180 Above Grade Walls: R-2 1.0 Infiltration Rate: Htg:5�OOC|g:5.00ACM5O Foundation Walls: R-18.0 Method: Blower door test Lights and Appliance Features Ian Rex Percent Interior Lighting: 100D0 Range/Oven Fuel: Natural gas The Energy Hound Percent Exterior Lighting: 15D0 Clothes Dryer Fuel: Electric 11Broadway,Suite 3 Refrigorator(kVVhlyr): 310.00 Clothes Dryer EF: 3.01 BevedyMAO1815 Dishwaaxer(kVVh/yr): 279D0 Ceiling Fan(dm88auV: 0.00 978'233-1433 The Home Energy Rating Standard Disclosure for this home is available from the rating provider. REM/Rate'Residential Energy Analysis and Rating Software vi4.o.n This information does not constitute any warranty of energy cost o,ouvmoo U @ 1aas'2n1owoneoon'auume�oo|o��v Certified EneRater AIR LEAKAGE REPORT Date: May 13,2016 Rating No.: EH0716 Building Name: NAND RegencyP/Rd?I L-3a Rating Org.: The Energy Hound Owner's Name: Phone No.: 978-233-1433 Property: L-3a Regency PI/Rd Rater's Name: Ian Rex Address: North Andover,MA01845 Rater's No.: 1454792 Builder's Name: J Carroll Construction Weather Site: North Andover,MA Rating Type: Projected Rating File Name: NAND RegencyPRdl L-3a.blg Rating Date: 5/13/2016 Blower door test Whole House Infiltration Heating Cooling NaturalACH: 0.42 0.34 ACH @ 50 Pascals: 5.00 5.00 CFM @ 25 Pascals: 2734 2734 CFM @ 50 Pascals: 4289 4289 Eff.Leakage Area: [sq.in] 235.5 235.5 Specific Leakage Area: 0.00028 0.00028 ELA/100 sf shell: [sq.in] 2.20 2.20 Duct Leakage Leakage to Outside Units Basement Attic CFM @ 25 Pascals: _ -- 40 — 51 0.0355 0.0619 CFM25/CFA _ fan _ } 0.0110 0.0242 CFM per Std 152: N/A N/A CFM per Std 152/CFA: N/A N/A CFM @ 50 Pascals: 63 80 Eff.Leakage Area: [sq.in] 3.45 4.39 Thermal Efficiency: N/A N/A Total Duct Leakage Units CFM251CFA CFM25/CFA Total Duct Leakage: 0.0548 0.0475 Ventilation Mechanical: Exhaust Only ASHRAE Sensible Recovery Eff.(%): 0.0 62.2-2010 Total Recovery Eff.(%): 0.0 Rate(cfm): 103 103 Hours/Day: 24.0 24 Fan Watts: 15.0 Cooling Ventilation: 1 Natural Ventilation Regarding ASHRAE 62.2 Ventilation Compliance Mechanical ventilation is not required for this home. REM/Rate-Residential Energy Analysis and Rating Software v14.6.3 This information does not constitute any warranty of energy cost or savings. ©1985-2016 Noresco,Boulder,Colorado. CS-.063503 !11 JAMES 4A P,>ARtwOLL 21 JOHNSON CARCLE A 01lW2017 (}C'Iwa°r eiR"4't�u^�u¢au��rv�;°afu�auu�oa"4r 4xwu y�rr�ar�.'0t��g4auR�wGliaar� HC1M1: 61VIf" C7h8ir`6`r�Nl�V6 N`V:R:)C�fl n R/'vC,,'TOR Rogistratiow 171."k"6 i9fG':cu t-xpimtion: V t 11 M n r6 rirlEa;al C,-AR),',(.11...1..,V. IAIV9FS (;t117NOI fl. JAWS 11 i1v1Cl"COf1d( II'I GI.I�f NO ANI)()\/4` �, IVIA01€44"`i Construction Supervisor Restricted to: Unrestricted -Buildings of any use group which contain less than 36,000 cubic feet(991 cubic nneters)of enclose(j space, Failure to possess a current edition of the Massy cl-,flsetts State Building Code is cause for revocation of this Hcense.. UPS Licensing information visit: WWVV.MASS.G()V/DPS License or registration valid for 41dividmO us'e.Oaly before the expiration date. If fOURd rctl"-11 to: Office of Consumer Affairs,-d tlsssines, Regulation 1() Park I'laza-Suite 5170 llosion,AIA 02116 Not valid without ;j6fjlalurc