HomeMy WebLinkAboutBuilding Permit #791-12 - 20 EMPIRE DRIVE 5/2/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 7q% —/
IMPORTANT: Applicant must
Date Received
all items on this
ATION lv *2- #, /�C-
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-nD nuT71? TV OWNER O 9C '�[ " f Lf— 14 C L—&C Unit
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MAP NO: 1A 74- PARCEL&j 77ZONING DISTRICT•
TYPE OF IMPROVEMENT
Olew Building
❑ Addition
❑ Alteration
❑ Repair, replacement
❑ Demolition
PROPOSED USE
Historic District yes
Machine Shop Village yes d9
100 year-old structure yes 0
Non- Residential
['One family
❑Two or more family El Industrial
No. of units: ❑Commercial
❑ Assessory Bldg ❑ Others:
❑ Other _.
DESCRIPTION OF WORKTO BE
S
(Identification Please Type or Print Clearly)
OWNER: Name:
C_
M
CONTRACTOR
3
Address: x-77 W4�Sly11ti1 TN MA- 0 f PUY
Supervisor's Construction License:
'�� Z� Exp. Date: 3 Z
Home Improvement License:
l V�z� Exp. Date:
EN Phone: 9�8"3S2 -F3/ g
ARCHITECT/ENGINEER
s - o / aIUAJ S3 Reg. No. 776 5
Address: �6Q —�
FEE SCHEDULE: BULDING PERMIT -'$12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BAS N $125-00 PER S.F.
Total Project Cost: $
FEE: $ 6
Check No.:
/0bs' Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fun, d
A-sfk
;.
t-&-- S Signature of contractor; - to J
Signature_of Agent/Owner: �..
a
Location /,— ��/�� f %v" / L F
No. 7 //— �2-
Check # ?JOU
25256
Date 16—
AZIZ
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$ J b
1
Building Inspector
Plans Submitted I/
Plans Waived ❑
Certified Plot Plan Stamped Plans 9/1
TYPE OF SEWERAGE DISPOSAL
Public Sewer V
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 - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
c Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comm
Water & Sewer Con neetion/Sia naftwe & Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp D �er on sityes no
Located at 124 Main Street
Fire Department sign tune/date cNk
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.$10041000 fine
r%ATA /C..v A'M"f IIQOl
NV 1 to anu uH i A — rvl u�
a• �••.�..�
❑ Notified for pickup -
Date
Doc:.Building Permit Revised 2011 June/mi
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
o 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
o 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
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit
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
Doe: Doc.Building Permit Revised 2008mi
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 791-12 on 5/2/2-12 Date: July 24, 2012
THIS CERTIFIES THAT
Orchard Village, LLC
THE BUILDING LOCATED ON 20 Empire Drive — Lot #2
MAY BE OCCUPIED AS a single family home IN ACCORDANCE WITH THE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER
REGULATIONS AS MAY APPLY.
Certificate Issued to: Orchard Village, LLC
277 Washington Street
Groveland, MA 01834
Bui ding In pector
Fee: $100.00
Receipt: 25256
Cheek: 2905
III
0%
LOT
122
LOT2
26' / LOT 3
FOUNDATION L OCA TION
CLIENT.' ORCHARD VILLAGE, LLC
THIS CERTIFICATION IS MADEAND LIMITED TO THEABOVE CLIENT
LOCATION: 20 EMPIRE DR. NORTHANDOVER,MA.
DATE - 511112 SCALE)"=30'
12'
OFI�q�S�
S9
O=ff MICHAEL OyG
z 3' N
2 SERGI m
O
O No.33191
y
ESS%O�O�
SURV�
THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY
PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXCEPT WITH
THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC.
FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY
OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS
PROHIBITED. CHRISTIANSEN & SERGI TAKES NO RESPONSIBILITY
FOR THE UNAUTHORIZED USE OF THIS DRAWING ORANY
INFORMATION CONTAINED HEREON.
BASED ON SCALED DATA ONL Y THE PRIMARY STRUCTURE
SHOWN IS NOT LOCATED IN A FLOOD HAZARD ZONE AS SHOWN
ON FEMA FLOOD INSURANCE RATE MAP. COMMUNITYNO.: 250098
0008C DATE.'8!211993 ZONE X
PROFESSIONAL ENGINEERS & LAND SURVEYORS
CHRIS T/A NSEN & SERGI, INC.
160 SUMMER STREET, HAVERHILL, MASSACHUSETTS 01830
WWW. CSI-ENGR. COM TEL. 978-373-0310 FAX 978-372-3960
4
D WG. NO.: 06029.001.047
0L
APPLICATION FOR CERTIFICATE OF OCCUPANCYYANSPECTION
BUILDING PERMIT #
�SSACHUSEt
ADDRESS/LOCATION OF PROPERTY: -4 240 6-mpl g& Ogg U&-
Map %P C Parcel 14 /1 Z Lot Number.
SUBDIVISION: D ACLIAC-tq l'l LL As,,t-7
DATE REQUESTED FILED/READY FOR INSPECTION: 25 `Z1
J
CLOSING DATE ON PROPERTY:
36 1) Z' -
FIVE
FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A
REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE CODES.
APPLICANT SIGNATURE
Permit Issued to: OfZC1190 U► L L A G,&- L Lx
Address -e2 r A_■ ♦tj '� /
ROUTING
TOWN ENGINEER, SITE PLAN — DRIVE -WAY REVIEW
CONSERVATION t� 7' ), S � 4�
PLANNING 04
DPW -WATER METER
SEWER CONNECTION
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
DP �A
File: Application for OC form revised Jan 2007/2011
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MAScheck COMPLIANCE REPORT
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 2
CITY: North Andover
STATE: Massachusetts
HDD: 6322
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 5-1-2012
DATE OF PLANS: 7/30/09
TITLE: The Willow
PROJECT INFORMATION:
Orchard Village, Lot 2, #20 Empire Drive
COMPANY INFORMATION:
Orchard Village,'LLC
COMPLIANCE: PASSES
Required UA = 450
Your Home = 233
Permit #
Checked by/Date
Area or
Cavity
Cont.
Glazing/Door
Perimeter
R -Value
R -Value
U -Value
UA
-------------------------------------------------------------------------------
CEILINGS 1258
38.0
0.0
38
WALLS: Wood Frame, 16" O.C. 2115
21.0
0.0
121
BSMT: Conc. 8.0' ht/7.0' bg/0.0' insul 0
0.0
0.0
0
GLAZING: Windows or Doors 140
0.350
49
DOORS 79
0.000
0
FLOORS: Over Unconditioned Space 768
30.0
0.0
25
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.
Builder/Designer Date
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 2
The Willow
DATE: 5-1-2012
Bldg.I
Dept.I
Use I
I CEILINGS:
[ l I 1. R-38
Comments/Location
I
WALLS:
[ ] I 1. Wood Frame, 16" O.C., R-21
Comments/Location
I
BASEMENT WALLS:
[ ] I 1. Conc. 8.0' ht/7.0' bg/0.0' insul, R-0 (uninsulated)
Comments/Location
I
I WINDOWS AND GLASS DOORS:
[ ] I 1. U -value: 0.35
I For windows without labeled U -values, describe features:
I # Panes Frame Type Thermal Break? [ ] Yes [ ] No
I Comments/Location
I
I DOORS:
[ ] i 1. U -value: 0
I Comments/Location
I
FLOORS:
[ ] I 1. Over Unconditioned Space, R-30
I Comments/Location
I
I HVAC EQUIPMENT:
[ ] I 1. Furnace, 96.0 AFUE or higher
I Make and Model Number
[ ] I 2. Air Conditioner, 13.0 SEER or higher
I Make and Model Number
I
I AIR LEAKAGE:
[ l I Joints, penetrations, and all other such openings in the building
I envelope that are sources of air leakage must be sealed. When
I 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
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.
MATERIALS IDENTIFICATION:
Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R -values, glazing U -values, and heating and
cooling equipment efficiency must be clearly marked on the building
plans or specifications.
DUCT INSULATION:
Ducts shall be insulated per Table J4.4.7.1.
DUCT CONSTRUCTION:
All accessible joints, seams, and connections of supply and return
ductwork located outside conditioned space, including stud bays or
joist cavities/spaces used to transport air, shall be sealed
using mastic and fibrous backing tape installed according to the
manufacturer's installation instructions. Mesh tape may be
omitted where gaps are less than 1/8 inch. Duct tape is not
permitted. The HVAC system must provide a means for balancing
air and water systems.
TEMPERATURE CONTROLS:
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.
HVAC EQUIPMENT SIZING:
Rated output capacity of the heating/cooling system is
not greater than 1250 of the design load as specified
in Sections 780CMR 1310 and J4.4.
SWIMMING POOLS:
All heated swimming pools must have an on/off heater switch and
require a cover unless over 20% of the heating energy is from
non-depletable sources. Pool pumps require a time clock.
HVAC PIPING INSULATION:
HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F must be insulated to the following levels (in.):
HEATING SYSTEMS:
Low pressure/temp.
Low temperature
Steam condensate
COOLING SYSTEMS:
Chilled water or
refrigerant
PIPE SIZES
TEMP (F) 2" RUNOUTS 0-1"
201-250 1.0 1.5
120-200 0.5 1.0
any 1.0 1.0
(in.)
1.25-2" 2.5-4"
1.5 2.0
1.0 1.5
1.5 2.0
40-55 0.5 0.5 0.75 1.0
below 40 1.0 1.0 1.5 1.5
CIRCULATING HOT WATER SYSTEMS:
Insulate circulating hot water pipes to the following levels (in.):
PIPE SIZES (in.)
NON -CIRCULATING I CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F): RUNOUTS 0-1" 1 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 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/Organizatior/Tndividual): C-96 9-D \J i LLAG, LLC—
Address:vP%-7 V) A -St! DJ') S7`F9-r-C.
City/State/Zip6/l ooe AyilQ �� A � ® fes phone #: 3 /70
Are you an employer? Check the appropriate box:
L ❑ I am a employer with
4. ❑ I am a general contractor and I
,_"employees (full and/or part-time).*
have hired the sub -contractors
2. VI am a sole proprietor or partner-
listed on the attached sheet
ship and'have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] f
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
I Homeowners who submit this affidavit indicating they aie 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 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 requiredunder 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
Investigations of the DTA for insurance coverage verification.
I do hereb rider thepains
and penalties of perjury that the information provided above is true and correct.
S�nature: / (_''"�_ � e:� Date: -2—
Official
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 ofhire,•
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal 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 repair work 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 of public 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) name(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. If an LLC or LLP does have
employees, 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 if you 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 permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license 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 permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum 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 Commonwealth of Massachusetts
Department of Industrial .Accidents
Office of Investigatitons
600 Washington Street
Boston., MA 02111.
TeX. # 61.7-727-4900 ext 406 or 1-877,7MASSAFB
Revised 5-26-05 Fax 0 617-727-7749
v vw-mass,gov/dia