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HomeMy WebLinkAboutBuilding Permit #610 - 163 MAIN STREET 3/22/2007 BUILDING PERMIT 0114 p°RTN 1 TOWN OF NORTH ANDOVER 'i"I . 0 APPLICATION FOR PLAN EXAMINATION Permit NO: l o Date Received S , ��SSwG HUSE�,�S Date Issued: 'a �- IMPORTANT: Applicant must complete all items on this page j LOCATION_ I Nva Irl (� A)6 qr&V,,0 PROPERTY OWNER �7L'U1��Val Print 'I cle Printf MAP NO: PARCEL: ZONING DISTRICT: HISTORIC DISTRICT yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: nommercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Public ❑ Sewer ❑Water ❑ Floodplain n Wetiands - ❑ Watershed District DESCRIPTION OF WORK TO BE PREFORMED: "oti s7rc,LT XL-,z cTEL c ( 13y)'Icl6wc A s �Ee/- 2- 434 Identification Please Type or Print Clearly) JJ OWNER: Name:- )eVe ��ui�l Yl, �I die Phone' Address: UUIa F09A LID anim CONTRACTOR Name: d}�0 rT ("t_,JA i, Phone` T 7k 9' Address: 26Cx✓-cx4 F\ttc Supervisor's Construction License: z �" ' Exp .Date: 6-7 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER a-Id ,✓- lkx� Phone: 175' 32z/ o5y Address: a,7,, l�`�� ST, A V-u�.'�1 i/AA Reg. No. L/r,f Z 7 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ,Gy FEE: $ Check No.: / So Receipt No.:_ NOTE: Persons contracting with r rste contractors do not have acce=tountyfun Signature of Agent/Owner ature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ C�' /Z G COMMENTS f ,•ti, lZ-�Le-�- Tj D TE REJECTED DATE APPROVED CONSERVATI COMMENTS , ,'P11 � J DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS 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 ❑ Zoning.Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plannin'j Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Si nature& Date Driveway Permit�� Located at 384 Osgood Street 3-5-D7 3-s -6J FIRE DEPARTMENT Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date ` COMMENTS 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 ❑ Notified for pickup - Date ............................................................._....................................................................................._.................._............................................................................................ .............._............................................................................................................_...................... ... 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 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 New Construction (Single and Two Family) Building Permit Application c Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit j� Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan /And Hydraulic Calculations (If Applicable) c�/ Copy of Contract a/"Mass check Energy Compliance Report jZ ,Engineering Affidavits for Engineered products In 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:INSPECTIONAL.SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 12- Location� 1;k4'/0;' 'tr No. �i�0 Date NORTH TOWN OF NORTH ANDOVER O�t �ao ,a,•S.Q • � s � (� . i • ; Certificate of Occupancy $ 6#- Building/Frame Permit Fee $ • swCMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Sv Check # 2066 . Building Inspector NORTM 0 s 41 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Temporary 30 days Permit Building Permit Number 610 3/22/07) Date: October 4. 2007 v THIS CERTIFIES THAT THE BUILDING LOCATED ON 163 Main Street MAY BE OCCUPIED AS Office Building_ IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Insurance Agency Inc. 163 Main Street North Andover MA 01845 1161 Building Inspector a � .tkORTH Town of No. � /o - _ - o dover, Mass., • Z Z .0 d:�. COC MIC EWICK y1' OR-ATED S BOARD OF HEALTH PERMIT T Food/Kitchen Septicq System �• 7-BUILDING IN w ECTOR THIS CERTIFIES THAT........3.. �. ..!�........� .. � z�-.... - � ���•� t�J�?,, �,���d�R- ........... .............. �F a on 1 . has permission to erect........................................ buildings on .. .... !. ..... 1.. .. ....... .. .................................. Rough • n �1St1/c��brt • to be occupied as.:........ ..... ......... VA...� Ih.. ... shim provided that the person accepting this ermit shall in every respect confo to the terms of the application 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. 2 Ga Zoo` "' Q 3 Z PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. ou � �f PERMIT EXPIRES IN 6 MONTHS r 0� ELECTRICAL INSPECTOR 710 �� � UNLESS CONSTRUCTIO STARTS �o� 01 1 ............ ........ ....... ........ Service BUILDING PECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR ou 4 7/a 5—/d Display in a Conspicuous Place on the Premises — Do Not Remove j2ga W*) I7 ,- No Lathing or Dry Wall To Be Done FIRE DEPARTM T Until Inspected and Approved by the Building Inspector. BurnerC Street No. 7 SEE REVERSE SIDE Smoke Det. / d ON.�,. OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER '• CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE: N44�� APbove2- Z7-N5L/ieANGF_ PROJECT LOCATION: l 3 (A A I N �►�-��� /JO/L7f Amo o tlC-/ ,1117 NAME OF BUILDING: NATURE OF PROJECT: e-_d N STl2-UGT(0 N OF WOOD F A-f-Mi✓0 'TWO 5 Ty pj O�F(ce 13 U(t'PI NCS IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, Xo N P,L D 41 -A L-0 moi' REGISTRATION NO. -46,1-2 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 0 ARCHITECTURAL STRUCTURAL MECHANICAL 0 FIRE PROTECTION 0 ELECTRICAL 0 OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY , A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION.A14D READINESS OF THE PROJECT FOR OCCUPANCY. SIGNATURE SUBSCRIBED D S O O BEFORE NILE THIS�DAY OF OTARY PUBLIC COMMONWEALTH of MASSACHUSETTS NO RY PUBLIC - MY COMMIS EXPWIESmmISSIONEXPIRES AUGUST 9,2007 February 26, 2007 Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 To Whom It May Concern: This letter will serve to confirm that the second floor of 163 Main Street will be used for employee only space. Customer service areas will be confined to the first floor. Signed, Michael J. Foster Stephe li Owner 163 Main Street North Andover, MA Date..... ° e ,40RTH'1 3r0.t�`` "ao� TOWN OF NORTH ANDOVER Iwo PERMIT FOR WIRING + t _ CHusE� Thiscertifies that ....... .....:.... ..........................................................� has permission to perform .......................................'..,,................................. 7 r wiring in the building of. ..:* - -.- " ....../-............. ....�.......'::�.! ............................ ,North Andover,Mass. a Fee91 U.70......... Lic.Noh.z' . ........ ° ELECTRICAL�,R�t�ECTOR Check # �b._1'�� U 7541 ' Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked ' .. [Rev. 1/07] leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) ZK3 Owner or Tenant/7/_ TelepUtNo.z:P," Owner's Address 9 IIAN��✓ Is this permit in conjunction with a budding permit? Yes �1(�o ❑ (Check Appropriate Box) Purpose of Building Q'/�/�G --eG Utility Authorization No. R,517© j Existing Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters New Service 204' Amps /20 / z j ,e Volts Overheadrd nd g ❑ No.of Meters / Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion o the ollowin table maybe waived by the Inspector of Wires. No.of Recessed Luminaires 3 u No.of Ceil.-Susp.(Paddle)Fans No•of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires /j Swimming Pool Above ❑ In- 1:3o.o mergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets 70 No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches 3 U No.of Gas Burners No.ofDetection and Initiatin Devices No.of Ranges No.of Air Cond. TonTots l Z No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons K No.of Self- ontamed Totals: � Detection/Alertine Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of Devices or Equivalent Heaters KW No.of No.of Si ns Ballasts Data Wiring: No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 7— Z5 G 7 Inspections to be requested in accordance with MEC Rule 10,and upon completion. " INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) Icertify,under the pains andpenalties ofperjury,that the information on this application is true and complete. FIRM NAME: lG l LIC.NO.: ",$- �� Licensee: / Signature LIC.NO.: JFf 3 (If applicable,e er "exempt"in the license member line.) Address: asel. No.'b-P7 *Per M.G.L c. 147,s. 57-61,security work requires Department-6f Public Safety"S"License: Alt L cl.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Inveshgations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(BusinessiorgmizadoMndividual): Address: City/State/Zip: Phone.#: Are you an employer?Check the appropriate box: L❑ I am a employer with 4. 111 am a general c]ra ctor and I Type of project(required):, employees(full and/or part-time).* have hired the sntractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attsheet. 7. ❑Remodeling ship and have no employees These sub-contrhave working for me in any capacity. employees and orkers' g• ❑Demolition (No workers'comp.insurance comp.insurance9. ❑Building addition 3.❑ required.) S. ❑ We are a corporand its 10.❑Electrical repairs or additions I am a homeowner doing all work officers have exd their myself.[No workers'comp. right of exemptiMGL 11.❑Plumbing repairs or additions insurance required.]t c. 152,§1(4),anave no 12❑Roof repairs employees.[No rs' 13.❑Othercomp.insurance ed.] Any applicant that checks box#1 must also fill out the section below showing their workers•compansaNan policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside con tConttactore that check this box must attached an additional sheet showing the name of the s side c tracto ld state must submit ita n w not those entities have. employees. If the sub-contractors have employees,they must providb their workers'comp.Policy number. 1 an 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: Attach acopy of the workers'compensation policy declaration page(showingtthe policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi vations of the DIA for insuran a covers a verification 1 do hereby certify under the pains and penalties of perjury that the Information provided above is true and correct. Si afore• • Date: Phone#• _ Official use only. Do not --------------- write!n this area,to be completed by city or town oJj?clal 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#: v � • s r I I I I ���,,.�` ���d�� �� `��� -� 7� T �� � � �. a�^�7 �� , �rha 27 September, 2007 Gerald A. Brown Building Department Town of North Andover 1600 Osgood Street North Andover,MA 01845 Re: New Building at 163 Main Street for North Andover Insurance,North Andover,MA Mr. Brown, I have been monitoring the work on a regular basis. The project is substantially complete. The building has been constructed according to plan and to the Mass State Code requirements. Please call with any u ' ns. it1t(D A#C1 Sincerely, ec MAY r Ronald Henri AIA,�J Architect ronald henri alhert,aia-architect 262 mill street, haverhill,ma 01830 978-374-0547 978-374-4092 fax 09/28/2007 11:08 9783723960 CHRISTIANSEN & SERGI PAGE 02/02 CHRISTIANSEN & SERGI, INC. PROFESSIONAL ENGINEERS AND LAND SURVEYORS 160 SUMMER STREET-HAVERHILL,MASSACHUSETTS 01830.8318 (978)373.0310 FAX:(978)3723960 Project No.•o6io September 28,2007 Mr. Lincoln DaleyA X : 9 7 6 88- Town of North Andover Planning Department 1600 Osgood Street North Andover,MA 01845 Rig: Certificate of Occupancy 163 Main Street Dear Mr.Daley: Please consider this a request for the certificate of occupancy for the newly constructed two-story office building at 163 Main Street in accordance with condition 7A of the site plan special permit for the aforementioned project. The building, landscaping, lighting and site layout are substantially completed and comply with the approved plans with the exception of the following: 1. The final plantings and landscaping on the Sturbridge Arms property has not been completed. The Applicant has an agreement with Sturbridge Arms to perform this work. 2. The parking area has not been striped. The applicant has contracts in place for the completion of this work. I The fence along the northerly lot line has not been installed. A work order has been supplied indicating that the fence will be installed by Fences Unlimited on Monday October x,200j The Applicant has committed to completing these remaining items by October 12, 2007. I trust this information will be sufficient to enable you to issue a certificate of occupancy. Should there be any questions or concerns please contact me at the number listed above. Regards, h G.Christiansen,P.E. Kenneth Alley P.E. 100 Cardigan Road Tewksbury Ma. 01876 978-851-3607 July 9, 2007 Mr. Ronald H Albert AIA 262 Mill St. Haverhill,MA. 01830 Subject: 163 Main Street North Andover MA. June 29 h Structural Site Visit Dear Mr. Albert, At your request I met with yourself and the builder at the site to view the ongoing structural framing. At that time all but some minor framing around the stairs was complete and open for inspection. Upon inspection I found that all framing was in accordance with the contract documents, pre-engineered wood and Massachusetts Building Code construction requirements. In response to a query about designating some areas for storage I offer the following. All levels were designed for office loading(50 pso. The floor framing at all levels will achieve that loading and restrict floor deflection and bounce to within generally acceptable industry guidelines. The floor framing members are, however, capable of additional loading (up to 75 pso with a corresponding increase in deflection and bounce beyond those industry guidelines. A floor load of 75 psf is suitable for some controlled storage but not dense storage. Storage density and layout should be evaluated for storage rooms that cover a significant area. enneth Alley P.E. N of &f,4 w z KENNETH ALLEY 9 0.27761 AAOF /STEP F F A = T : rJl 4L `AmStd APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Buildina Permit# ADDRESS/LOCATION OF PROPERTY : Map D Parcel ID Lot Number SUBDIVISION tel/ Z4 DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE(5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGED IF THE STRUCTURE r DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: Address SIGNED RO TING CONSERVATION t PLANNING DPW-WATER METER CK SEWER/WATER CONNECTION F--" NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW . AAA &kP4 Signature Fite: Application for OC form revised Jan 2007 G r 3 C'lie�o m�;���e..eall� a��.,2�z,raoo/u�aelt i BOARD OF BUILDING REGULATIONS I License: CONSTRUCTION SUPERVISOR Number: CS 056629 Birthdate: 06/29/1962 _€ Expires:06/29/2007 Tr.no: 13423 Restricted: 00 ROBERT A CUNNINGHAM 26 GREENFIELD DR PLAISTOW, NH 03865 N Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 153526 Expiration: 12/7/2008 Tr# 253572 Type: IndiV'idual ROBERT CUNNINGHAM ROBERT CUNNINGHAM 26 GREENFIELD DRIVE, PLAISTOW,NH 03865 Administrator ti COMcheck Software Version 3.3.1 Envelope Compliance Certificate Massachusetts Commercial Code Report Date:02/20/07 Data filename:Untitled.cck Section 1: Project Information Project Title: North Andover Insurance Agency, Inc Construction Site: Owner/Agent: Designer/Contractor: 163 Main Street Mike Foster Ronald Albert North Andover,MA 01845 North Andover Insurance Agency,Inc Ronald Henri Albert,AIA-Architect 9 Waverly Road 262 Mill Street North Andover,MA 01845 Haverhill,MA 01830 978-686-2266 978-374-0547 michaelfoster@onceanddone.com mnalbertaia@comcast.net Section 2: General Information Building Location(for weather data): North Andover,Massachusetts Climate Zone: 13a Heating Degree Days(base 65 degrees F): 5641 Cooling Degree Days(base 65 degrees F): 678 Project Type: New Construction Vertical Glazing/Wall Area Pct.: 13% Building Type Floor Area Office 3504 Section 3: Requirements Checklist code.Envelope PASSES:Design 35%better than Climate-Specific Requirements: Component Name/Description Gross Area Cavity Cont. Proposed Budget or Perimeter R-Value R-Value U-Factor U-Factor Roof—I.-All-Wood Joist/Rafterrrruss 1283 30.0 0.0 0.035 0.060 Exterior Wall 1:Wood Frame,Any Spacing 5880 19.0 0.0 0.068 0.091 Window 1:Wood Frame:Double Pane with Low-E,Reflective, 694 — — 0.330 0.603 SHGC 0.32 Door 1:Glass,Reflective,SHGC 0.32 98 — — 0.340 0.603 Basement Wall 1:Solid Concrete or Masonry—8",Furring:None, 1890 — 16.0 0.058 0.115 Wall Ht 7.0,Depth B.G.6.0 Floor 1:Slab-On-Grade:Heated,Depth 4 ft. 148 — 6.0 — — (a)Budget LI-factors are used for software baseline calculations ONLY,and are not code requirements. (b)Certain building use types require continuous under-slab insulation(see Massachusetts Code Section 1304.2.7 and 1304.2.8). Air Leakage,Component Certification,and Vapor Retarder Requirements: Lj 1. All joints and penetrations are caulked,gasketed,weather-stripped,or otherwise sealed. Lj 2. Windows,doors,and skylights certified as meeting leakage requirements. 3. Component R-values&LI-factors labeled as certified. 4. Insulation installed according to manufacturer's instructions,in substantial contact with the surface being insulated,and in a manner that achieves the rated R-value without compressing the insulation. North Andover Insurance Agency, Inc Page 1 of 2 K / Ll 5. Vapor retarder installed. Section 4: Compliance Statement Compliance Statement: The proposed envelope design represented in this document is consistent with the building plans,specifications and other calculations submitted with this permit application.The proposed envelope system has been designed to meet the Massachusetts Commercial Code requirements in COMcheck Version 3.3.1 and to comply with the mandatory requirements in the Requirements Checklist. JPI641-D &JUR,/ 41,8&Ar- /�2CN. /�1 Gest '3 0 O 7 Name-Title Signature Date North Andover Insurance Agency, Inc Page 2 of 2 The Commonwealth of Massachusetts UTDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Q ���5�<' L_L. Address: City/State/Zip V3&0P e Phone.#: � k)J Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance. t 9. E]Building addition required.] 5 We are a corporation and its 10.[1 Electrical repairs or additions officers have exercised their 3.El am a homeowner doing all work 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.[1 Other employees.[No workers' comp.insurance required.] *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 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 an employer that is providing workers'compensation insurance for my employees. Below is thepolicy 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 form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investijzations of the DIA for insurance coverage verification. Ido hereby c ify u er the pains d penalties of perjury that the information provided above is true and correct. Si a Date: _ Phone eL Official use only. Do not write in this area,to be completed by city or town offlciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NORTH Town of : Andover O ,����� 'Yy���• Ott No. o. over, Mass., 3 • Z Z •��' 11 COC NIC NE WICK V ADRATED �`IT BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System o�b BUILDING INSPECTOR 000 THIS CERTIFIES THAT........s.. .......%. !R............. ........ ........r! ....... Foundation has permission to erect........................................ buildings on.. ....4 f.....401*40..r?.......6...i.......................... Rough • to be occupied as........../ � Vq...t .Rh.. im •. Ch ney provided that the person accepting thls ;e�$Tsohtli m every respect confo to the terms of the application on file in Final 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. �� ?Oo�i .. O 3 Z PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough /O v IT Final r DO PERMEXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough . ... . .. ... ....... .................. Service BUILDING ..PECTOR 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. SEE REVERSE SIDE Smoke Det.