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HomeMy WebLinkAboutBuilding Permit # 8/23/2016 ----------------- BtAORTHUILDING PERM17 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 5 :,�2 9 ­z (V Permit No#:-.S9 y I Date Received1. 4 Date Issued: IMPORTANTLApplicant must complete all items on this page LOCATION 42 W4)°r4ct,&,e Print PROPERTY OWNER Print' 100 Year Structure yes no MAP 07�5 PARCEL: ZONING DISTRICT: kll� Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building 1­10 e family —----- E Addition Xwo or more family I-] Industrial ❑Alteration No. of units: 0 Commercial El Repair, replacement E Assessory Bldg El Others: [.1 Demolition 0 Other 3a -7/7-7-­7/77,--- ,/ --- xy h Apt' ti W 77 .7- h 4 F8 r Of- DESCRIPTION OF WORK T BE PERFORMED: 74e jstg 6 L eo v A, Poe Identification- Please Type or Print Clearly OWNER: Name: ee-,l k:41e Phone: Address: -Dej I ViF, 416U-," LVeog , 0� 14 &I Frf.S-- Contractor 6­oot) Phone: 6'68 H&30 Contractor KP--yt.'.,Me ow T— A�d­dress:--&2 A2.e ee 4 Supervisor's Construction License: --c S 0-7,6-302- Exp. Date: /A /41 t(0 Home Improvement License: Exp. Date: ARCH ITECT/ENGI NEER�+Aeeqce Ck-bcool _ Phone: 97c6-50a- - .3'176' Address: (;e0ec, Reg. No 71 M 4 ,177( b FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 00; FEE: Check No.: 5)q: Receipt No.: NOTE: Persons coni to With as1 gist(-,redcontretetoro)lllt,;,IdolLot have ss to tuarantyfund t/Ownef­ ------ 19 ntra Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ fPublic PE OF SEWEEAGE DISPOSAL Sewer Tamffig/Massage/B ody Art ❑ Swimtning fools ❑ ll ❑ Tobacco Sales ❑ Food PackagineSales ❑ vate(septic tank,etc. ❑ Permanent Dumpstex on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN ®FF - U FORM PLANNING DEVELOPMENT Reviewed On 7 o i Signature COMMENTS /CONSERVATION Reviewed on * Si nature COMMENTS ,, , HEALTH. Reviewed on" Signature COMMENTS___N Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Gomments Water& Sewer Conn "on/sl nature Date �-- � Drivewa Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE "DEPARTMENT Temp Dumpsfer Qn.site, ;yds na Lacateet at 124 Main Street F�re?Depar#men#��gatureldate COMMENTS Town of = _ aT: 6 ndover 0 No. i-11 All yy T Z b O � h ver, Mass, 4 A°cocM"icNRwIcK 4ATED S U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System s BUILDING INSPECTOR THIS CERTIFIES THAT .........�6,0.:....+�.r.J... �.. ...�N��/..................................................... has permission to erect . . ......... buildings on ......44. .6,0..��NfA�.9A Foundation � ',I � �Z Rough t0 be occupied as ... r7irt!......rr . .. ....t•...... 1................................................... Chimney provided that the person accepting this permit shall in every respect 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 q� Final PERMIT EXPIRES l 6 MONTHS ELECTRICAL INSPECTOR' LESS C ST TI® Rough Service .. ..... ,... .......... ... .,. Fina BUILDING IN ECT R GAS INSPECTOR Occupancy Permit Required t® ®ccupV Buiddina Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall 1 o Be® Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Home Property HERS Key Lime, Inc - Ben Osgood Rating Type: Projected Rating Certified Energy Rater: Steve Weglarz 80 Mayflower Dr, duplex Right Rating Date: 8117/2016 Rating Number: TBD North Andover, MA 01845 Registry ID: Pr -ed Ratio sed � - u r � Estimated Annual Energy Cost of c Use MMBtu Cost Percent HERS Index: 56 Heating 18.2 $990 39% General Information Cooling 5.1 $102 4% Conditioned Area 1497 sq. ft. House Type Duplex, single unit Hot Water 3.0 $335 13% Conditioned Volume 12288 cubic ft. Foundation Unconditioned basement LightslAppLiances 18.5 $1013 40% Bedrooms 2 Photovoltaics -0.0 $-0 -0% Service Charges $72 3% Mechanical Systems Features Total 44.9 $2512 100% Heating: FueL-fired air distribution, Propane, 96.1 AFUE. Water Heating: Instant water heater, Propane, 0.97 EF, 0.0 Gal. Criteria Cooling: Air conditioner, Electric, 13.0 SEER. This home meets or exceeds the minimum criteria for the following: Duct Leakage to Outside 59.00 CFM25. Ventilation System Exhaust Only: 29 cfm, 12.0 watts. 2012 IECC Duct Leakage Requirement} Programmable Thermostat Heat=Yes; Coot=Yes 2012 IECC Requirement - Infiltration < 3ACH50" 2012 IECC Whole House Ventilation Requirement* Building Shell Features MA Base Code HERS Rating Performance requirement' - Ceiling Flat R-40.1 Slab None Compliance is determined by the rater. Seated Attic NA Exposed Floor R-30.0 Vaulted Ceiling NA Window Type U-Value: 0.300, SHGC: 0.290 Above Grade Watts R-23.0 Infiltration Rate Htg: 2.90 CLg: 2.90 ACH50 Foundation Watts R-0.0 Method Blower door test Advanced Building Analysis, LLC 2 WoodLawn St. Lights and Appliance Features Amesbury, MA 01913 Percent Interior Lighting 91.00 Range/Oven Fuel Propane 603 502-1914 Percent Garage Lighting 80.00 Clothes Dryer Fuel Electric www.advancedbuiLdinganaLysis.com Refrigerator (kWh/yr) 691 Clothes Dryer EF 3.01 Dishwasher (kWh/yr) 270 Ceiling Fan (cfm/Watt) 0.00 Certified Energy Rater: Ae--11� REK/Rate- Residential Energy Anal sis and Rating Software;14.6.3 This information does not constitute any warranty of energy cost or savings. a 1985-2016 Noresco, Boulder, Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. Home nergy Rating Property HERS Key Lime, Inc - Ben Osgood Rating Type: Projected Rating Certified Energy Rater: Steve Weglarz 78 Mayflower Dr, duplex Left Rating Date: 8/17/2016 Rating Number: TBD North Andover, MA 01845 Registry ID: Projected Rat- e sed I- - F C use MMBtu ® � � r � Estimated Annual Energy Cost Cost Percent HERS Index: 55 Heating 18.4 $996 40% General Information Cooling 4.9 $97 4% Conditioned Area 1497 sq. ft. House Type Duplex, single unit Hot Water 3.0 $335 13% Conditioned Volume 12288 cubic ft. Foundation Unconditioned basement Lights/Appliances 18.5 $1013 40% Bedrooms 2 Photovoltaics -0.0 $-0 -0% Service Charges $72 3% Mechanical Systems Features Total 44.8 $2514 100 Heating: Fuel-fired air distribution, Propane, 96.1 AFUE. Water Heating: Instant water heater, Propane, 0.97 EF, 0.0 Gal. Criteria Cooling: Air conditioner, Electric, 13.0 SEER. This home meets or exceeds the minimum criteria for the following: * Duct Leakage to Outside 59.00 CFM25. Ventilation System Exhaust Only: 29 cfm, 12.0 watts. 2012 IECC Duct Leakage Requirement* Programmable Thermostat Heat=Yes; Cool=Yes 2012 IECC Requirement - Infiltration < 3ACH50* 2012 IECC Whole House Ventilation Requirement* Building Shell Features MA Base Code HERS Rating Performance requirement* Ceiling Flat R-40.1 Slab None * Compliance is determined by the rater. Sealed Attic NA Exposed Floor R-30.0 Vaulted Ceiling NA Window Type U-Value: 0.300, SHGC: 0.290 Above Grade Walls R-23.0 Infiltration Rate Htg: 2.90 Clg: 2.90 ACH50 Foundation Walls R-0.0 Method Blower door test Advanced Building Analysis, LLC 2 Woodlawn St. Lights and Appliance Features Amesbury, MA 01913 Percent Interior Lighting 91.00 Range/Oven Fuel Propane 603 502-1914 Percent Garage Lighting 80.00 Clothes Dryer Fuel Electric www.advancedbuildinganalysis.com Refrigerator (kWh/yr) 691 Clothes Dryer EF 3.01 Dishwasher (kWh/yr) 270 Ceiling Fan (cfm/Watt) 0.00 Certified Energy Rater: &-L401 REWRate- Residential Enery Analysis and Rating Software ,14.6.2 This information does not constitute any warranty of energy cost or savings. 0 1985-2016 Noresco, Boulder, Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. FWC -500-500758-1-2015APRIOR NO. -500-5007581-2014A ITEM 1. The Insured: Key Lime Inc DBA: Mailing address: 10 Hepatica Drive FEIN:*'-**''1218 North Andover, MA 01845 Legal Entity Type: Corporation Other workplaces not shown above: 2. The policy period is from 09/15/2015 to 09/15/2016 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers`Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident Bodily Injury by Disease $ -1,0-0 policy limit Bodily Injury by Disease $ 1,000,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Hating Plans. All information required below is subject to verification and change by audit, Classifications Premium Basis Rates Code Estimated Per$100Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 285896 INTER SEE CLASS CODE SCHEDU E Minimum Premium $575 Total Estimated Annual Premium $575 GOV GOV Deposit Premium $579 STATE CLASS MA 5645 State Assessments/Surcharges $48.00 x 5.7500% $3 This policy, including all endorsements, is hereby count7 ersigned by -- - 07/3012015 riz Authoed Signatu _ re Date Service Office: M P Roberts Insurance Agency Third Avenue Bu 1060 Osgood Street Burlington MA 01803 North Andover, MA 01845 WC 00 00 01 A(7-11) FneFudes copyrighted material of the National council on compensation Insurance, used with its permission. The Commonwealth of Massachusetts x . F Department of IndustrialAccidents u 1 Congress Sheet,Suite 100 t Boston,MA 02114-2017 s; yet www.mass.gov/dia Workers,Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BR PILED WITH THE PERMITTING AUTHORITY- AP Information / Please Print Leazbly Name (Business/Organization/tndiv;idual): K� €c��r'►+v -j.Vve Address: 1 tv ye>0*A"t q- e= ✓ City/State/Zile: Phone#: Are you an employer?Check tlieapliiolrriatcbox: Type of rojeet(l'equired)* 1.❑I am a employerwith employees(full and/or part-time).* T Neter construction 2.[:]lam a sole proprietor or partnership and have no employees working for mein 8. 0 Remodolhig any capacity.(go workers'comp.insurance required.] ❑Demolition 3..0 I am a homeowner doing all work myself[No workers'comp,.insurance required.], 4. 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors withno employees. 12. Plumbing repairs or additions 5.[jjl�am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These snb-contractors have employees and have workers'comp,insurance t 6.Q We are a corporationo n and its pS�gers•have exercised their right of exemption perMGL c. Other ❑ 152,§I(4),and we have employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. I I-Iomeowners vko submr if tS is affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. #Contractors that check this boxmust-attached.an additional sheet showing the name of the sub-contractors and state whether ornot those entities ha_we employees. If the sub-coritractars Have employees,&,y must provide their workers'comp.policy number. Iain an employee'tli at is providing ivor-hers'compensation insurance for my employees.•,Below is the policy and•job site information. f _ I Insurance Company Name: iI��0,0+1h G Ccs Policy##or Self-ins.Lic.#: w GC,� $O©�^.�dd S��'"o�Al Expiration Date: ?//S- Job ate: I;SJob Site Address: 78 JJo �l�`I F40.0 0' 2 bQ+LU r- _ City/State/Zip: P0 K n c Xl&e, 414 Attach a copy of the worlters' compensation policy declaration 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 form 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 hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Si nature. / Date: Phone A9 79f Official use only. Do not write in this area,to be completed by city or town 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 S.Other Contact Person: phone#: 4Y Board of BuHding Rcgu�atior)., and Stan Ucense: CS-075302 BENJAMIN C os °OO 69 01 Village Inde 'Y IN r ��f or North Andover WA, Oto"" /o �r Expirafion CcrMfflissiovier 12/04/2016