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HomeMy WebLinkAboutBuilding Permit #484 - 20 SAMUEL WAY 3/17/2009BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: %o / Date Received Date Issued:..? // vastLeD•hb=•NO\ TYPE OF IMPROVEMENT PROPOSED USE R%90A9====TNon- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septi Well Fioocfplan 'Wetlandsz Watersted District z. .. a _ UtSGKIP I IUN OF WORK TO BE PREFORMED: � L-5 r4 cT %k vysy�� C 1 Identification Please Type or Print Clearly) OWNER: Name: Phone:::Y7& -7 7— i'1 l� Address: r-4cY _::::r" CtONTRACTOR Name. Address-- 3'''1� y Supervisor's Construction License --.0L ' t ►rye: �? t xp fete: Home I►aprovementLicense: `Exp.`.Date: LAR=CHITECTENGINEER Phone: Address: Reg. No4 -t- > 4 l FEE SCHEDULE: BULDING��PppERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: ` % Receipt No.: NOTE: Persons contracting with unye*ft$qed c retractors do not have access tqi#eguarq9tJfund 2-C. Plans Submitted Plans Waived Certified Plot Plan Stamped Plans 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 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS Gam% CONSERVATION Reviewed on Signature COMMENTSI6 d�✓� - ���� GJ��-Fil j 116" /0 HEALTH Reviewed on Signature COMMENTS F i4 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments,,� Water & Sewer Connection/signature & Date f r<`i� Z D ewav Permit �: DPW Town Engineer: Signature: Dimension Number of Stories:_ Total square feet of floor area, based on Exterior dimensions. 046o 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) S ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 a 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/CrossectionfElevation 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 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 Doc: Building Permit Application Revised 2.2008 Location�%�� f No.%� �/ J Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I �� 21869 Building Inspector O = _. p Z O z a w O A W u -d . O w C/)✓ .� CL up cn cz U z ,� W C 0 C w n4 O u: 4 U w a p ua w p 4 Qr °° aG cz x a o w u c2 v cn w p a tw w G u. z a w a W4 C m 2 cn Q O cn o \ EQ :mom : D g J :� C CD CL N Ec o=CD ". C2 V r0. Ovm t\ co cm 3 C CD _ m Cc= : N !d m o ci m OQ C CD Mm Ci y O a Q w p = H m 0 d'="' W N O „O~ 4;ID r... C IL •N _m A •O d= = O •N LLJ V cm p O '.0 C 0.0 y CL CL O� = cc dr=...m m OLDt VJ 0 N C O cm O Of C m 0 cm C �C N O t O Z O O I as U O 0 C O �M.0 O O v Z CD d O y 0 c / O cm icm '0 CD ■� y_ O O CO m co C3 co F— = co_ C ® L ecv o a _ � cmcc co c o -0-0 c coCO) tsc CL. C2 CD c ai CD CL C.3 H cc c c� _cc COD�. cm REScheck Software Vers6on 4.1.4 Compliance Certificate Project Title: Edgewood Retirement Community Report Date: 08/21/08 Data filename: F:\DSA Project Files\Edgewood 0706\04. MA Energy Code Check\0706.00 Unit B.rck Energy Code: Massachusetts Energy Code 103 Location: North Andover, Massachusetts Construction Type: 1 or 2 Family, Detached Heating Type: Other (Non -Electric Resistance) Glazing Area Percentage: 23% 79 Heating Degree Days: 6322 108 Construction Site: Owner/Agent: Designer/Contractor: 575 Osgood Street 58 0.290 Dewing & Schmid North Andover, MA 01845 1725 38.0 0.0 30 Monument Square Suite 200B Concord, MA 01742 Compliance: 1.9% Better Than Code Maximum UA: 378 Your UA: 371 Basement: Solid Concrete or Masonry 1846 0.0 10.0 103 Wall height: 7.5' Depth below grade: 7.5' Insulation depth: 7.5' First Floor: Wood Frame, 16" o.c. 1854 21.0 0.0 79 Windows: Wood Frame:Double Pane with Low -E 361 0.300 108 Door: Solid 42 0.290 12 Door: Glass 58 0.290 17 Ceiling: Flat Ceiling or Scissor Truss 1725 38.0 0.0 52 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 Massachusetts Energy Code requirements in REScheck Version 4.1.4 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. 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 coo*building all be o eater an 125% of the design load as specified in Sections 780CMR 1310 and J4.4. r 0, Name - Title //�� Date Project Notes: Unit B WAT Project Title: Edgewood Retirement Community Report date: 08/21/08 Data filename: F:\DSA Project Files\Edgewood 0706\04. MA Energy Code Check\0706.00 Unit B.rck Page 1 of 1 !;r � _ _ _. _ :../`� Q6'ii?//�ZOOZC!/PCLGLdG 6�✓l�G�� C 1 BOARD OF BUILDING REGULATIONS s License. CONSTRUCTION SUPERVISOR f g e 3 {-Numbe SCS 094621 s. Birth ate,�i#��i0�-1970 I ; E�cps20,�0 Tr. no: 94621 OR=i Restr cce: all � rr 30 JORDAN ST BEVERLY, MA 01915 �ommissiorier R "P AC')RD CERTIFICATE OF LIABILITY INSURANCC� DATE(MM/DD/YYYY) OP ID B PRODUCER WINDO-4 11 03 08 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McLaughlin Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 828 Lynn Fells Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Melrose MA 02176 Phone: 781-665-2775 Fax:781-665-0295 INSURERS AFFORDING COVERAGE NAIL # INSURED INSURER A Aspen Specialty Ins. Co. Windover Construction, Inc. INSURERS: United specialty insurance Co. INSURER C: OneBeacon Insurance Grou Attn Karen Cochand 13 Elm street INSURER D: American Internat'l companies Manchester MA 01944 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INZ3K UL) LTR NSR TYPEOFINSURANCE POUCYNUMBER DATE MMIOD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY 000 EACH OCCURRENCE $1,000Ps-s222,0000 A X COMMERCIAL GENERAL LIABILITY ;71OCCUR GL000574-01 01/01/07 01/01/09 PREMISES HENTa a rence) CLAIMS MADE I MED EXP (Any one person) ED PERSONAL BADV INJURY 000 GENERAL AGGREGATE 000 GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 52,000 000 POLICY X JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Es accident) $1,000,000 ALL OWNED AUTOS C X SCHEDULEDAUTOS FBIE07908 BODILY INJURY 04/01/08 04/01/09 (Per person) $ X HIRED AUTOS X NON-OWNED AUTOS - BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GE LIABILITY AUTO ONLY - EA ACCIDENT S NY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ SS/UMBRELLAL11A HBX EACH OCCURRENCE $5000000 CCUR EI708 09/25/08 01/01%09 AGGREGATE $5000000 EDUCTIBLEETENTION S WORKERS COMPENSATION EMPLOYERS'LIABILITY - X TORY LIMITS ER D D ANY PROPRIETOR/PARTNER/EXECII 03 /20/08 03/20/09 E.LEACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? 1/ yes, dasalbeunder E.L.DISEASE-EAEMPLOYEE $500,000 SPECIAL PROVISIONS below OTHER E.LDISE ASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: Edgewood Retirement Community Renovation and Expansion, North Andover, MA. Bank of America, N.A., their subsidiaries, affiliates and parent companies; and their repective officers directors. trustees ,managers,members and employees are Additional Insured on all policies abover (except for WC & employers liability) for liability arising out of the operations of Windover CERTIFICATE HOLDER CANCELLATION EDGEW-21 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Edgewood Retirement Community DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 575 Osgood Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR N. Andover MA 01845 REPRESENTATIVES, AUTHOR[ZE PR NTA E P ACORD 25 (2001!08)©ACORD CORPORATION 1988 �0,.� qtr :{.