HomeMy WebLinkAboutBuilding Permit #699-11 - 16 EMPIRE DRIVE 4/18/2011 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: `� (� Date Received
Date Issued:
ORTANT: Applicant must complete all items on this page
LOCATION C lJCc re
n Print
PROPERTY OWNER U IU�A G:- G-LC-
Print
MAP NO:A0 [PARCEL: /j ZZONING DISTRICT• Historic District yes no'
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building XOne family
❑Addition ❑Two or more family 0 Industrial
[I Alteration No. of units: 0 Commercial
0 Repair, replacement 0 Assessory Bldg 0 Others:
0 Demolition 0 Other
0 Septic ❑'Well 0 Floodplain . 1]Wetlands D Watershe.istncf .
DESCRIPTION 017 WORK TO BEP RFORMED:
� - A im 1 11 A)G Fou&2 t)) /b/U C9N L
j� Identification lease Type or Print Clearly)
OWNER: Name:(�rC�A D V' i .LAG A-I LLC Phoneq' -
Address:�t `1 ��9N b Ir i U CUX X012 b A q 2-1
CONTRACTOR Name: b ` E vls j/vim Phone Z
Address `1 A�F�4� /�/� N Iy C3�� p MA
`A
i .
Supervisor's Construction License: /O2q 3 I Exp. Date: Z
Home Improvement License: */j `7 Exp. Date:
ARCHITECT/ENGINEER _ Phone:g7c?-3S2— 83 J Ff
Address: S . O 03 Reg. No.-#,:;�-7 7 to S
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$1225.00 PER S.F.
Total Project Cost: $ 3C-9- FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Si nature of=A 'ent/Owner Si natia.re:of cont�aetor: ; Li�
Location,//0,
No. Date
MORTM TOWN OF NORTH ANDOVER
O
f
Certificate of Occupancy $
100 --
'��sskst� Building/Frame Permit Fee $
Foundation Permit Fee $ —i —
Other Permit Fee $
TOTAL $ q-76 d�.
Check # tl SL-
24tJ '/- 0
Building Inspector
Dimension
Number of Stories:_Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— For department use
El Notified for pickup - Date
Doc:.Building Permit Revised 2008
Plans Submitted Plans Waived ❑ Certified Plot Plan K Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/MassageBody 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 - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on , 1� � � 67�U � Signature
r
COMMENTS , I `� l'� l v
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/si na tureARDat Drivewav Permit
DPW Tovvn)Esrgineer: Signature: _
Located 384 Osgood Street
FIRE DEPARTMENT -Temp Dumpst on site yes no
Located at 124 Main Street
Fire Department signature/date `!
COMMENTS
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations-(If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
MOTE: All durnpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Tin all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
ORTFi ,
TO" of
over
o over, Mass., qj�
SAKE
�� COC K ICKEWICK\y '
ADRATED PPp5
SS BOARD OF HEALTH
Food/Kitchen
Septic System
PERMIT TBUILDING INSPECTOR
r , ( ..AA ...........
CERTIFIES THAT..... .. `�.�•►•• •l.� Foundation
THIS CE ".............................................
...... .. ... . .................. _
r 1
(IO• ..�il[•�.�1.1��.. .....✓.W...� 4..d 1...� Rough
. buildings on ...... "' " " ""
has permission to erect..............:....................... 9
� y
t0 be Occupied as.... s. 1.... . ! �........ . . .. . .... . ............ .. ..................h ..........cat
... ..... .ile' .. 1 n
. ................ ........ ... . .
Chimney
provided that the person aide pting this permit shall in eve respect conform t the terms of the application on file in Fina
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of PLUMBING INSPECTOR
Buildings in the Town of North Andover.
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMITT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTR O S�T�
Rough
........ _ Service
.......... .......................................
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
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.
SEE REVERSE SIDE
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BOard h �'tts
of 8111./ —VP;Itt
Cp dips meat°t. o
License:pstru�ti p� �t"Isl io t
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Restricts CS dor sand Sta
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R p d to; 1G 293j s License ndtrds
Bp GREAT pESSiNA
XFpRD M a�9 RLVE
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1029,31 2
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MAScheck COMPLIANCE REPORT I I
Massachusetts Energy Code I Permit # I
MAScheck Software Version 2.01 Release 2 I i
I i
Checked by/Date I
f i
CITY: North Andover
STATE: Massachusetts
HDD: 6322
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 4-12-2011
DATE OF PLANS: 6/9/10
TITLE: The Kingston Lot 1
PROJECT INFORMATION:
Orchard Village, Empire Drive
COMPANY INFORMATION:
Orchard Village, LLC
COMPLIANCE: PASSES
Required UA = 556
Your Home = 332
Area or Cavity Cont. Glazing/Door
Perimeter R-Value R-Value U-Value UA
-------------------------------------------------------------------------------
CEILINGS 1425 38.0 0.0 43
WALLS: Wood Frame, 16" O.C. 2505 20.0 0.0 148
BSMT: Conc. 8 .0' ht/7.0' bg/0.0' insul 0 0.0 0.0 0
GLAZING: Windows or Doors 307 0.350 107
DOORS 70 0. 000 0
FLOORS: Over Unconditioned Space 1025 30.0 0.0 34
HVAC EQUIPMENT: Furnace, 96.0 AFUE
HVAC EQUIPMENT: Air Conditioner, 13.0 SEER
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plans, specifications, and other calculations
submitted with the permit application. The proposed building has been
designed to meet the requirements of the Massachusetts Energy Code.
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 1250 of the design load as specified in
Sections 780CMR 1310 and J4.4.
i
Builder/Designer Date
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 2
The Kingston Lot 1
DATE: 4-12-2011
Bldg. ]
Dept. l
Use I
I
I CEILINGS:
[ ] I 1. R-38
I Comments/Location
• I
WALLS:
[ ] I 1. Wood Frame, 16" O.C. , R-20
Comments/Location
I
I BASEMENT WALLS:
[ ] I 1. Conc. 8 .0' ht/7 .0' bg/0.0' insul, R-0 (uninsulated)
Comments/Location
I
WINDOWS AND, GLASS DOORS:
[ ] I 1. U-value: 0.35
For windows without labeled U-values, describe features:
I # Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
I
DOORS:
[ ] I 1. U-value: 0
Comments/Location
I
FLOORS:
[ ] I 1. Over Unconditioned Space, R-30
Comments/Location
I
I HVAC EQUIPMENT:
[ ] j 1. Furnace, 96.0 AFUE or higher
I Make and Model Number
[ ] I 2. Air Conditioner, 13.0 SEER or higher
Make and Model Number
I
I AIR LEAKAGE:
[ ] I Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. When
installed in the building envelope, recessed lighting fixtures
I shall meet one of the following requirements:
I . 1. Type IC rated, manufactured with no penetrations between the
I inside of the recessed fixture and ceiling cavity and sealed or
I gasketed to prevent air leakage into the unconditioned space.
2 . Type IC rated, in accordance with Standard ASTM E 283, with no
I more than 2 .0 cfm (0. 944 L/s) air movement from the the
I conditioned space to the ceiling cavity. The lighting fixture
I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
I difference and shall be labeled.
I
VAPOR RETARDER:
[ ] I Required on the warm-in-winter side of all non-vented framed
► ceilings, walls, and floors.
I
MATERIALS IDENTIFICATION:
[ ] I Materials and equipment must be identified so that compliance can
I be determined. Manufacturer manuals for all installed heating
I and cooling equipment and service water heating equipment must be
I provided. Insulation R-values, glazing U-values, and heating and
► cooling equipment efficiency must be clearly marked on the building
I plans or specifications.
I
DUCT INSULATION:
[ ] I Ducts shall be insulated per Table J4.4.7.1.
I
I DUCT CONSTRUCTION:
[ ] I All accessible joints, seams, and connections of supply and return
► ductwork located outside conditioned space, including stud bays or
I joist cavities/spaces used to transport air, shall be sealed
I using mastic and fibrous backing tape installed according to the
I manufacturer's installation instructions. Mesh tape may be
I omitted where gaps are less than 1/8 inch. Duct tape is not
I permitted. The HVAC system must provide a means for balancing
► air and water systems.
i
TEMPERATURE CONTROLS:
[ ] I Thermostats are required 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 shall be provided.
I
I HVAC EQUIPMENT SIZING:
[ ] I Rated output capacity of the heating/cooling system is
I not greater than 125% of the design load as specified
I in Sections 780CMR 1310 and J4 .4.
I
SWIMMING POOLS:
[ ] I All heated swimming pools must have an on/off heater switch and
I require a cover unless over 20% of the heating energy is from
I non-depletable sources. Pool pumps require a time clock.
I
HVAC PIPING INSULATION:
[ ] I HVAC piping conveying fluids above 120 F or chilled fluids
I below 55 F must be insulated to the following levels (in. ) :
I
I PIPE SIZES (in. )
HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2 .5-4"
I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0
I Low temperature 120-200 0.5 1. 0 1. 0 1 .5
I Steam condensate any 1.0 1. 0 1.5 2 .0
I COOLING SYSTEMS:
► Chilled water or 40-55 0.5 0.5 0.75 1 .0
I refrigerant below 40 1.0 1.0 1.5 1. 5
I
CIRCULATING HOT WATER SYSTEMS:
[ ] I Insulate circulating hot water pipes to the following levels (in. ) :
' I
I PIPE SIZES (in. )
I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F) : RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2 .0+"
170-180 0.5 I 1.0 1.5 2.0
140-160 0.5 I 0.5 1.0 1.5
100-130 0.5 I 0.5 0.5 1 .0
I
----NOTES TO FIELD (Building Department Use Only) -------------------------
The Commonwealth of Massachusetts
Department oflndustrialAccidents
Office of Investigations
it 111's 600 Washington Street
f e l Boston,MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information . Please Print Legibly
Name(Business/Organization/Individual)-
Address• q oicwe
City/State/Zip {�/�. Q/� [�(�P�� Phone#:9-26'O It 7—3f Q �.
Are you aln employer?Check the appropriate box: Type of project(required):
1.❑ I am a er em to with 4. El am a general contractor and I
employer � have hired the sub-contractors 6. ❑New construction
einployees(full and/or part-time).
2.0 1 airy a sole proprietor or partner- listed on the attached sheet. # � E]Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for mein any capacity, workers'comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5- ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.❑ I ain a homeowner doing all work right of exemption per MGL - 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152, §1(4),and we have no 12.E]Roof repairs
insurance required.]T employees.[No workers'
comp.insurance required.] 13.❑Other
*Any 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.
(Contractors that check this box must attached an additional sheet showing the name of the sub-contractors aid their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site 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 MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the fonn of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance'coverage verification.
I do hereby eer7i under thepains and penalties ofperjury that flze information provided abo F71
and cory'ect
Si ature: �� � Date:
Phone#: - — Q
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
6.Other
Contact Person: Phone#:
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 of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other Iegal 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
dwelling house of another who employs persons to do maintenance,construction or repaVwork on such dwelling house
or-on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall 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 ofpublic 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-contractors)naine(s),address(es)and phone number(s)along with their certificate(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. I
e fan LLC or LLP does have
mploye'es,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 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 ifyou 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 appropriate 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.
Please be sure to fill in the pennit/lieense number which will be used as a reference number. In addition,an applicant
that must submit multiple�permitllicense 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 pennits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or pen-nit 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.
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 CQinmonwealth of Massachusetts
Dopar=.Rt of Industrial Accidents
(Office Of Investigations
600 Washington Street _
Boston,MA 021.11
Tel.#617-7274900 ext 406 or 1-877-MA.SSAFE
Revised 5-26-05 Fax#617-727-7749
www.mass.gov/dia