Loading...
HomeMy WebLinkAboutSINGLE FAMILY HOME (6) TOWN OF NORTH ANDOVER " APPLICATION FOR PLAN EXAMINATION PermitNO: �° Date Received Date Issued:zml �_._..._ I ORTANT App icant must corn-plctc all items on this page LOCATION ' P ✓ .3(01,:?,V h4oAgAe.4 Sellvile .� Print PROPERTY OWNER g Unit#_ .v_._.:. .... Print MAP NO: PARCEL: ZONING DISTRICT: 11je Historic District yes na Machine Shop Village yes o 100 year-old structure yes no TYPE (QF IMPROVEMENT PROPOSED USE —____-- Residential Non- Residential _ New Building ❑ ©,.�e family [I Addition `'Two or more family CJ Industrial ❑Alteration No. of units: 0 Commercial Ll Repair, replacement ❑Assessory Bldg C:] Others: ❑ Demolition ❑ Other ❑ Septic 11 Well n Floodplain Cl Wetlands ❑ Watershed District El Water/Sewer /,,.DESCRIPTION OF WORK TI BE PERFO E _ Pw� entilacaUon Please'Type or Print Clearly) OWNER: Name: ke Phone: Address: /0 ®� CONTRACTOR Name: 30,yiAow Address: y-� ep/ ,. Supervisor's Construction License: ;,4 Exp. Date: / /"a _ Home Improvement License: / ` Exp. Date: ;'/.p 1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000. 0 THE TOT L ESTIMAT - OST BASED ON$?25.00 PER S.F.Total Project Cost: $ - . ,:i FEE: ., Check No. ��� _ Receipt No,- NOTE: Persons contracting r`th unregistere contractors do not have access to the guaranty fund Signature ofAgent/Ow ___�._ __ _�_.0 , ignature of contracto Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans D TYPE OF SEWERAGE DISPOSAL Swimming Pools Public Sewer Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales D Food Packaging/S'ales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY —INTERDEPARTMENTAL SIGN OFF ® U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT F1 Z, 2VD�) COMMENTS & QNSERVATION Reviewed on i nature l NTS Q HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: -comment Comments ' Conservation Decision: Driveway Permit Water & Sewer Connection/Signature &,Date "411 "4 DPW Town Engineer: Signature:--- , ) Located 384 Osgood Street FIRE DEPARTMENT - Temp Dempster on site yes- no Located at 124 Main Street Fire Department signature/date COMMENTS � owe. of � Andover 0 �. - r 0 No. — 17 h ver, Mass, OW% 1� COc+eCnl w.Crc ti Ll BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System .... j THIS CERTIFIES THAT ............ BuiLDING INSPECT OR Foundation has permission to erect .......................... buildin on ...., .. ...:......................... Rough tobe occupied as ........... ;. ....... '........................... ... .. .... ..... ......................................... Chimney provided that the person accepting ' permit shall in every resp'e'ct 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR BION .' ; , ' Rough T y Service ........... ....... ..... . Final BUILDING 1 'SPEC R GAS INSPECTOR Occupancy Permit Required to Occupy BuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. tjORT� Town of 2 ndover. ® lkc, 2n 7� b, t (a, • � �Y~ 'v No. 174 . - t : Lwµe h ver, Mass, COC.4ICMtWICK A0"SATED S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ...........PERhk! T . .... .. ... ...^ .......... .,......,.................. BUILDING INSPECTOR ::�. Foundation has permission to erect.......................... build' on ...... ........ .... , .. . ..............,.... .. Rough to be occupied as ....,...,... 0-1-i ......... .. ..'.. .. ... `.... . ...,..... ..,.....:.: :.................................... Chimney provided that the person accepting permit shall in every resect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST ® r Rough Service .. .............. ..... ,..... ....... Final BUILDI F NSPECTOR GAS INSPECTOR Occupancy Permit Required to OccupV Buil int Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. MassAchusetts Department of Public Safety Board of Building Regulations and Standards License: CS-075302 Construction Supervisor BENJAMIN C OSGOOD 69 OLD VILLAGE LANE �1 NORTH ANDOVER MA 09846 r.,,�./1ZU CA— Expiration: Commissioner 92/04/2098 I Home Energy Property HERS Key Lime, Inc- Ben Osgood Rating Type: Projected Rating Certified Energy Rater: Steve Weglarz 78 Mayflower Dr, duplex Left Rating Date: 8/17/2015 Rating Number: TBD North Andover, MA 01845 Registry ID: ' jectRating: Plans - llConfirmationu�_ . MMBtu Cost Percent Estimated Annual Energy Cost j Use HERS Index: 55 Heating 18.4 $496 40% GeneralInformation 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% Total 44.8 $2514 100% Mechanical Systems Features Heating: Fuel-fired air distribution, Propane, 95.1 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* wilding Shell Features MA Base Code HERS Rating Performance requirement* Ceiling Flat R-40.9 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 503 502-1914 Percent Garage Lighting 80.00 Clothes Dryer Fuel Electric www.advancedbui[dinganaLysis.com Refrigerator(kWh/yr) 691 Clothes Dryer EF 3.01 Dishwasher (kWh/yr) 270 Ceiling Fan (cfm/Watt) 0.00 Certified Energy Rater: IRat Res aa ne ; Analysisa _ and Rating Software v 4.63 This information does not constitute any warranty of energy cost or savings. Q 1985-2016 Noresco, Boulder, Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. -ate mome Energy RatingCertiffiko. 1%0 Property HERS Key Lime, Inc- Ben Osgood Rating Type: Projected Rating Certified Energy Rater: Steve Weglarz 80 Mayflower Dr, duplex Right Rating Date: 8/17/2016 Rating Number: TBD North Andover, MA 01845 Registry ID: ot Rating: Based Plans Feld C -mat- R r . Estimated Annual Energy Cost Use MMBtu Cost Percent HERS Index: 56 Heating 18.2 $990 39% j 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 Lights/Appliances 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 Neat=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.advanc-edbuiLdinganatysis.com Refrigerator (kWh/yr) 691 Clothes Dryer EF 3.01 Dishwasher(kWh/yr) 270 Ceiling Fan (cfm/Watt) 0.00 Certified Energy Rater: =:' at -Residentiaz Energy Analysis and Izati'g'Softwar e v14.6.3 This information does not constitute any warranty of energy cost or savings. (D 1985-2016 Noresco, Boulder, Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. Me Commonwealth of Massachusetts .Department of fndustrialAccidents h 1 Congress Street, Suite.700 Y d2017 Boston,MA 02114 www.mass gov/dia fi • d'Iy 5JYP Wo~<kers' CompensationinsuraneeAffiidavit:Builder•,s/Contractorsl ecfrxc�ansl'Iumbe�rs. TO BEPILUDWITH THE PERWT,INGAUTSOR3�St. pLblP A • icantlaformation Nall o (Rusiness/(5tgaljhat-ionllndividual): r �o' r1 WWAddress: P to Phone City/State/Zip: Are you an employer?Cl}esltize approprlatebox: Type of project(veq�uired): 1.❑I am a employer with employees(full and/or part time). 7, onstriiotion 2-ElS a�n a sole proprietor or partnership and have no employees Fvorking for me in $, Remodeling any capacity.[No workers comp.Insurance required.] 9, LI Demolition S am ahomeowner doing all workmysel£(Noworkers'comp.insurancerequired.l t 10 F1 Building addition 3.❑ 4.❑I am a homeowner and will be hiring contractors to conduct all work on my Property. will al repairs or additions' .[�Electricons ensure that all contractors either have workers'cornpezlsation insurance or are sole 12�[�plUlbillg repairs or additions proprietors with no einplbyees. SI am.a general coni�actor and I have hired the sub-cozxtracfozs listed on the attached sheet. Roof repairs l 3. ] "These sub-contractors have employees and have workers'camp.insurance� 14. ' Other 6.0 We are a corporation and its.officers have exercised their right of)Xcmption per MGL o. 15e re,a o x-PM have no employees.po workers'comp.insuranco required.] k Anout the section y applicant that checks bnx01Pust dav t indicaltingthey are doangall work andthanhire outside c ntrac ours must submit taa now affidavit indicating such It Homeowners who submit thus•, tContractors that check this box roust attached en-additional mus she rot shoving ovide heirfworkaers'cotm�p spolicy number.�d state whether o�not those entities have employees. Ifthe sub-contractors have employees, Y 1? Yarn an employer thatisprnvidingworkers'compensation insurancefor my erasployees. below is tliepolicy atadjol�site information. � Cd Insurance Company Name: --' / / Expiration Date: 1/0 policy#or Self ins.Lic. I►�( / r +��I r city/State/zip: Job Site Address. S / and Attach a copy of the workers' caanpextsation Po ed lzcy declaration page(shoving the policy punishablenumber b e a��up pto$1,500-00 nal violation Failure to secure coveragerisannrenteas well as aiviMp penalties inthe form ofaSTOP WORK ORDER anquud as fiine ofup to $250.00 a and/or one-year imp day against the violator.A copy of this statement may be for warded to the office of Tizvestiga#ions of tTzo DIA for insurance coverage verification. S do hereby cert under•the pains and pe es of per' iTaat the information provided ab o a is true ai?d correct. Date: 0 0 Si aturo: Official use only. Do not write iit ads area,to be carnpleted z1y city or'torvrz of ciaZ permit/Licenge# City or Towzi.z Issuing Authority(circle one): 5.Plumbingxnspector 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector G.Other Phone#: Contact Person: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/5/16 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: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS �subjoctto 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(s). PRODUCER COMA NAME: AMY ROBERTS M.P. Roberts Insurance Agency UNh I—Oki 78 AR-A—PA71 683-3147 A(C (978) 1060 Osgood Street rMAI L -C_ North Andover, AOREss: AMY@mprobertsinsurance.com MA 01845 COVERAGE NAIC 4 . ......... RR A, SI SEX NSURANQE INSURED I KEY LIME INC IN��URERB:Agsocia�ted Z�fnp;2yqrs Insurance 10 HEPACTICA DRIVE JNSURER_q: NORTH ANDOVER, MA 01845 JNPqRERQ_.*_____ ....... _INSU JIRER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 13 TO CERTIFY THAI'THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN—ISSUED To THF'INSURED NAMED ABOVE FOR THE 1�0—LICYPERIOD ­ 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. INSRSU — ADDIL SUBRI -00LICY-E"IFF "POLICY­EXP `" LTR TYPE OF INSURANCE IM WVD POLICY INUISER fMM/DD/YYYY) IMM/DDIYYYY) LIMITS A GENERALLIABJUTY 3EE0820 6/15/16 6/15/17 EACH OCCURRENCE 1.000,000 D AG X LCOMMERCIAL GENERAL LIABILITY DAMA�TO7_ MIS REN[fEb SMOW-., CLAIMS-MADE Lx�OCCUR _MED EXP Ary one person) $ EXCLUDED --—_---- PERSONAL&ADVINIURY .__.._....._.^_.... GENERAL AGGREGATE $ 9000 000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY JGIRODUCTS-COMPIOPA G $ EXCL ED _-] ?___ _ OPRO- R JF(?- LOC 'TE . _ " _ _ _ ­ — $AUTOMOBILELIABLTY MB'�rDSIG[ffLf9Traccer ANYAUTO �BOofYIN URY(Per1son)ALLOWNED SCHEDULED m AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED ATOS PR6PF IY�bAMAGE Peracoident — $ UMBRELALIAB OCCUR EACH OCCURRENCEEXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY WCC50050075812016A9/15/16 5/15/17 WC STATU- OTH- ANY YIN PROPRIEIORJPARTNERIEXECUTfVE -- ___ RY-U&ILI&I.----... ER--,...—,-.--, OFFICERIMEMBER EXCLUDED? NIA __g.L-EACH ACCI DENT (Mandatory in NH) Li lfge d �cribeunder - -A D $u E1DPTASEEA EMPIf N OF OPERATIONS below - 0 N._,o 0 0 \ E.L.DISEASE-POL ]MIT S 1000 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (AffachACORD 101,Additional Rernark;Schedule,if more space is reqLired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED TP,U�IES BECANCELLED BE �ORE 'OTI THE DATE THEREOF, NOTi r= SAMPLE CERTIFICATE ACCOREDANCEXPIRATION WITH THE POLICY PROVISIONSWl", BE DElUvERkD IN. AUTHORIZED REPRESENTATIVE W, MICHAEL P ROBERTS @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: