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HomeMy WebLinkAboutBuilding Permit #818-12 - 25 HIGHLAND VIEW AVENUE 5/14/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ?/00 / Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 1 l P,w Print PROPERTY OWNER__3 LtC Print ,'MAP NO: PARCEL: �� ZONING DIST RICT: Historic. District Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Reside Non- Residential Buildi One fami Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic `-` Well _ Floodplain Wetlands Wa`teirshed District atL . DESCRIPTION OF WORK TO BE PREFORMED: G i ► -19 c -R m I'f 7-0 A Al P ICrTQ 1) e77JP X - K) P 476 Identification Please Type or Print Clearly) OWNER: Name: :ILD LLQ. Phone: � I -E- 4 s7 -Z6S Address: l I c,- C ac4 r- 5k(4 QOGJ , N •AJtkie,1r, m A CONTRACTOR Name:Ze�� ji,IL( • _ - Phone: 72Y-1 Address: Supervisor's Construction License: Exp. ,Date: _%6�z Home Improvement License: Exp. Date: ARCHITECT/ENGINEER L4wrc&,,e Phone: q, ?g-3.IrZ- Address: Ge 1 i Aj Reg. No. Z77A ' FEE SCHEDULE: BULDIN ERMIT: $12.00 ER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 5t�NoTej) Total Project Cost: $ 3 Z,61925D - FEE: $ 31L&_ (a- c- 0 1q;+'- f:= >J 6\06) Check No.: /023 Receipt No.: �� NOTE: Persons contracting with unregistered co actors do not have access to the gu ranty fu�a'd Signature of Agent/Owner Signature of contractor 4ii imitte 14 Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL ublic 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 CONSERVATION COMMENTS HEALTH COMMENTS Reviewed o 11 Signature f Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE.DEPARTMENT Temp Dumpster on site yes 'no Located at 924 MainStreet =Fire`Department signature/date COMMENTS Dimension Number of Stories: 2 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) Pra C S 1 Z1 2 SS 261 S 12S =3 4t 4F, LUd - oD. ❑ 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 ❑ 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location ar/,// 941(11 y' �� lAle No. /f—/ Z Date 5A /Z Check # 1023 25299 TOWN OF NORTH ANDOVER Certificate of Occupancy $ 06) Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $tel% Av Building Inspector O� KO oTN .� 00 Y f Y �aS�cHust� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 818-12 on 5/14/2012 Date: October 9, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 25 Highland View Avenue 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: Tara Leigh Development, LLC 115 Carter Field Road North Andover, MA 01845 Building Inspe for Fee: Prepaid Receipt: 25299 Check : 1023 s'. c c m c c � o = 16- rY o_ y cc C O V V Uo W �,od � m N -m C a s p H W ri m C eyv mom~ +_.+ == LL .y AD o H m r-. CL O.e t C .y v .0 y Co, OCA C 0-0 Vi O. 4D O 0 •= H Z 0 C \:CL. - ca O O C3 PQ U)ami o •a � � ° � � U W ® u �� �_ Ln ► O G Q o w° Cf) w �°' w ci) tki mQ cn cn c c m c c � o = 16- rY o_ y cc C O V V Jym c o a :Cy 0 roZ .o ci p, C CL � m N -m C a s p C y W m C eyv mom~ +_.+ == LL .y AD o H m r-. CL O.e t C .y v .0 y Co, OCA C 0-0 Vi O. 4D O 0 •= H Z 0 C \:CL. - ca O O C3 � y co m� �_ Ln ES o Jym c o a :Cy 0 roZ .o E d. yZ... fA Mv y C cm m 12 cm `o C" C N O Z O Z 0 O T I -M U O P4 a, 2 V O O E L _ O O v Z co CL O y � C CD CY) C C Q .� ca 0� O 'E m m CD 0 CD t O � O � � CD 0 0 O d a cm< S CO) c ev ev J 'v C2. 0.2 C Z a) CL V y C R. �. ice+ m CO2 0 CO) ce W w W U) ci Q = � m N -m C a s p y W C 0 eyv mom~ +_.+ == LL .y AD o H .E O.e t C .y v .0 UW V Co, OCA C 0-0 Vi O. 4D O 0 •= H Z Q y aim E d. yZ... fA Mv y C cm m 12 cm `o C" C N O Z O Z 0 O T I -M U O P4 a, 2 V O O E L _ O O v Z co CL O y � C CD CY) C C Q .� ca 0� O 'E m m CD 0 CD t O � O � � CD 0 0 O d a cm< S CO) c ev ev J 'v C2. 0.2 C Z a) CL V y C R. �. ice+ m CO2 0 CO) ce W w W U) 0 O z 41 s•; JNmm c In, c o Q rt+ N m O 4< U A 10, I e W rJ o ccC �i VO V W W p, C LL ,I A A 'p.= O C .N ;= O co CF ti •• c 0-0 C O:S m O = = `lroa� 0 y _ Cox � ,:mom = a N LC m O O v LE C/) to O o G ii to O G i. w G cn bo (( rx \ m o rn cn JNmm c In, c o Q rt+ N m O C � v �2 N C O Q 22 L `-mc _CD ccC H VO V W .2 C p, C LL N N A A 'p.= O C .N ;= O co CF ti •• c 0-0 C O:S m O = = `lroa� 0 y _ Cox � ,:mom = a N LC m O r OJ �•ca N \ C" cq m CO) W N E ,�cmo JNmm c In, c o Q rt+ N m O 0 co O CD L O Z °D O H � C I Com_ COD Q d9 O O .co)FE m m CL Mr O G O O a ZL tmQ C.* C �v cc .v .w C Z CD CL C3 NA C C•— !D C. COD v �2 Q m `-mc _CD C H W .2 C LL ym A A 'p.= .N C = � m•N V m !E cm O Q 0-0 C O:S N O = = O 0 y _ F— = �0.. O. r=.. m 0 co O CD L O Z °D O H � C I Com_ COD Q d9 O O .co)FE m m CL Mr O G O O a ZL tmQ C.* C �v cc .v .w C Z CD CL C3 NA C C•— !D C. COD p'�ttED !6*ANO 0c O ' CA APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION BUILDING PERMIT ADDRESS/LOCATION OF PROPERTY:2 Z I�yj4 1 � �%,, &g Map (97- Parcel 11 Lot Number SUBDIVISION: DATE REQUESTED FILED/READY FOR INSPECTION: 10 11 7 10/ CLOSING DATE ON PROPERTY: 10 111 FIVE 5 DAYS NOTICE PRIOR TO CLOSING DA IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLET D ITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($2 .0 WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICA$LE CODES. APPLICANT SIGNATURE Permit Issued to: 7-1-.D L, L C, Address: ( l ROUTING TOWN ENGINEER, SITE PLAN - DRIVE -WAY REVIEW 6,,P- -7�)7V CONSERVATION NIA ❑ wbt)-TnAks-t>lt-TlowAi- PLANNING NIA ❑ C o � Fdf mw -i6 o W olffi-TW b WRY DPW -WATER METER Rr 0V_ -TTuI l p- S -f 2 SEWER CONNECTION 2�r b V -1-4V 10-15-1-2- DPW 0-5-12 DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW SIGNATURE File: File: Application for OC form revised Jan 2007/2011 %O --,S e / -z- 19.8' HIGH STOCKADE FENCE 142 S08°21852 "E LOT AREA I I 1.'� r)4_ q F + 33.4' 33.1' 6' HIGHSTOCKADEFENCE o 34.2' 33.8' N08°58'49"W 142.50' Hl GHL A ND VIE E W ZONING INFORMATION: ZONING DISTRICT : R4 MIN. BUILDING SETBACKS: FRONT: 30 FEET SIDE: 15 FEET REAR: 30 FEET I CERTIFY THAT THE FOUNDATION SHOWN WAS LOCATED BY AN INSTRUMENT SURVEY ON 5/3/12 AND THE LOCATION COMPLIES WITH THE ZONING SETBACK REQUIREMENTS FOR THE R4 ZONING DISTRJVT (SINGLE FAMILY) WITHIN THE TOWN OF NORTH ANDOVER` 1 .0 61.7' A VENUE 00 In TAX MAP 67 PARCEL 11 PLOT PLAN OF LAND 25 HIGHLAND VIEW AVENUE NORTH ANDOVER, MASS. PREPARED BY: SULLIVAN ENGINEERING GROUP, LLC 22 MOUNT VERNON ROAD BOXFORD, MA 01921 (978) 352-7871 SCALE: 1"=20' DATE: 5/3/12 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Qq fOCwK wwKw 7' T °R"TE°'pay�5 CHBUILDING PERMIT #_71S7 9SSAUS// nn ADDRESS/LOCATION OF PROPERTY: 2 S tbqq 'l J UteW TT1�2 MapA� Parcel 11 Lot Number ' SUBDIVISION: DATE REQUESTED FILED/READY FOR INSPECTION:_ CLOSING DATE ON PROPERTY: 1 0 I i l FIVE (5) DAYS NOTICE PRIOR TO CLOSIN ALL WORK AND SIGN -OFFS MUST BE COM: REINSPECTION FEE OF TWENTY DOLLARS DOES NOT MEET ALL APPLICABLE CODES. /WITHIN THIS TIME FRAME. A WILL BE CHARGED IF THE STRUCTURE APPLICANT SIGNATURE Permit Issued to: % D L, L �. Address:t l 5 ca -r-` t r Ro a � Aye f, '" w J_ ROUTING TOWN ENGINEER, SITE PLAN - DRIVE -WAY REVIEW CONSERVATION N)IA ❑ W 6N ` SURS'tp I C-Tlo W Aj- PLANNING N I A ❑ 00 vO RY DPW -WATER METER©a f% i u� 10-6-1Z SEWER CONNECTION lG -5 •-12 DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW SIGNATURE File: Application for OC form revised Jan 2007/2011 "a —'s -- / Z. �-F• 19.8' HIGH STOCKADE FENCE 142.52' S08°08'21 "E LOT AREA 1 1 13.543 -'3-F-+ 33.4' 33.1' 34.2' 33.8' N08°58'49"W 142.50' Hl ('-`7HL A ND I I E W ZONING INFORMATION: ZONING DISTRICT : R4 MIN. BUILDING SETBACKS: FRONT: 30 FEET SIDE: 15 FEET REAR: 30 FEET I CERTIFY THAT THE FOUNDATION SHOWN WAS LOCATED BY AN INSTRUMENT SURVEY ON 5/3/12 AND THE LOCATION COMPLIES WITH THE ZONING SETBACK REQUIREMENTS FOR THE R4 ZONING DISTfWT (SINGLE FAMILY) WITHIN THE TOWN OF NORTH ANDOVER] I ..& �cj" OF As F Cl HIGHSTOCKADEFENCE o 61.7' A VENUE ►or-) 00 U) TAX MAP 67 PARCEL 11 PLOT PLAN OF LAND 25 HIGHLAND VIEW AVENUE NORTH ANDOVER, MASS. PREPARED BY: SULLIVAN ENGINEERING GROUP, LLC 22 MOUNT VERNON ROAD BOXFORD, MA 01921 (978) 352-7871 SCALE: 1"=20' DATE: 5/3/12 cue ow z CD C cm O•— ca Q -0 CD.— y O O 'E CO co CD 0 CD t O � O o Q o cc o d a ca y C *-0 C ccc CJ -J = "FL O co c Z CD C CL C-7 y c C C cc CLCO2 Q LLI 0 LU C4 V9 W LLI ujW C4 o v u a 0O U W W� ov � °�° a U m w U a a x r� '� w O U W U a W a°' U)w � 0: O x �+ w Z �.+ w v cn o z 8o cn Ca v cn CD C cm O•— ca Q -0 CD.— y O O 'E CO co CD 0 CD t O � O o Q o cc o d a ca y C *-0 C ccc CJ -J = "FL O co c Z CD C CL C-7 y c C C cc CLCO2 Q LLI 0 LU C4 V9 W LLI ujW C4 C � 41 C c �t: o � c O y C o, c cc o fA O CE m o n = E i7 y C m 3 O a �3 z := C C y A O E m occ CLU Jy� m m S =� ac o, + y. � dCt O O m y O Z O O O .� Of V m QO : y_O C C .O = m : m� 3 N CA) W CO eo 4; LL .y .. c +- A C Z E = M m .y O W V ® v � c, cm O m C C y d m ca o Co a�m� CD C cm O•— ca Q -0 CD.— y O O 'E CO co CD 0 CD t O � O o Q o cc o d a ca y C *-0 C ccc CJ -J = "FL O co c Z CD C CL C-7 y c C C cc CLCO2 Q LLI 0 LU C4 V9 W LLI ujW C4 —19.8' w O to O 0') F0 Z — 19.6' 14 HIGH STOCKADE FENCE --6 HI�HOSTOCKADE FENCE o 142.52' r S08'08'21 "E LOT AREA I I 1.1 54.-1 S F + 33.4' 33.1' 34.2' 33.8' N08 -58'49"W 142.50' HIGHLAND VIE W ZONING INFORMATION: ZONING DISTRICT : R4 MIN. BUILDING SETBACKS: FRONT: 30 FEET SIDE: 15 FEET REAR: 30 FEET I CERTIFY THAT THE FOUNDATION SHOWN WAS LOCATED BY AN INSTRUMENT SURVEY ON 5/3/12 AND THE LOCATION COMPLIES WITH THE ZONING SETBACK REQUIREMENTS FOR THE R4 ZONING DISTPfiT (SINGLE FAMILY) WITHIN THE TOWN OF NORTH ANDOVER{ I. -0 N D. ULCIVAN Ill CML No. 41686 61.7' A VENUE 7 ;::m _ 0� O Nj -rn 00 U) TAX MAP 67 PARCEL 11 PLOT PLAN OF LAND 25 HIGHLAND VIEW AVENUE NORTH ANDOVER, MASS. PREPARED BY: SULLIVAN ENGINEERING GROUP, LLC 22 MOUNT VERNON ROAD BOXFORD, MA 01921 (978) 352-7871 SCALE: 1"=20' DATE: 5/3/12 t W w S�q O E CD cc Z O n h y .E L O C O CD V cc CL CO3 O rA C40 O V O C _ca O. h D Q CD R 3� �o co Ca O O d cm< C � C CDCL h C 0 N ulN W W 19 W U) O 00 �o ZWA vcm mi E S vV o " ca x U a a or. cm CLC .c y W x z Q w° cn w aG U w w°' w a°' cn w OD w co in cn S�q O E CD cc Z O n h y .E L O C O CD V cc CL CO3 O rA C40 O V O C _ca O. h D Q CD R 3� �o co Ca O O d cm< C � C CDCL h C 0 N ulN W W 19 W U) O 00 �o '<c vcm mi E S vV :.- cm CLC .c y R R cc p p fq it E a C `4> s CD W �a D cm S�q O E CD cc Z O n h y .E L O C O CD V cc CL CO3 O rA C40 O V O C _ca O. h D Q CD R 3� �o co Ca O O d cm< C � C CDCL h C 0 N ulN W W 19 W U) O 00 '<c vcm mi E S O cm yk�3 m .c y =m p R r- 'E0 W �a = `-0 o cm C `. dV LID y m t >0 o cm cm 93 go 0. 2 c R •�' e o CD wo, =oc c c = o '023 N LL03 J C Rm =-.fl r=... F- W CIA* E o-cma o CL :ID 0CL,- .�`�3 Cia zip S�q O E CD cc Z O n h y .E L O C O CD V cc CL CO3 O rA C40 O V O C _ca O. h D Q CD R 3� �o co Ca O O d cm< C � C CDCL h C 0 N ulN W W 19 W U) Plans Submitted Plans Waived ❑ Certified Plot Plan -❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ( T=33nWassageBody Art ❑ Sw&w"ng Pools ❑ Well ❑ Tobacco Sates ❑ FoodPackagWSates ❑ Private (septic bi3X etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR:OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ COMMENTS} CONSERVATION Reviewed on O 2 Signature-€��-i COMMENTS HEALTH Reviewed on Signature COMMENTS-- MIA `-�` 6;� - Zoning Board of Appeals: Variance,, Petition Na Zoning DecisioNreceiptsubmitted yes Planning Board Decision: Comments - Conservation Decision: Comments Water & Sewer Connectic .i 7 l riveway Permit — DPW Town Engineer: Signature:�' ` Located 384 Osgood Street FIRE DEPARTMENT - Temp Dempster n site yes no Located at 124 Main Street Fire Department signatdreJdate 2 t• COA04ENTS � Ztassachusctts - Dcpartmcni of Public Safety Board of Building Rcgrulations and Standards COnsfruction Supervisor License License: CS 65417 Restricted.to: 00 THOMAS al ZAHORUIKO 115 CARTER RD N ANDOVER Mq 01645 ( �rmmi.±cioncr Expiration: 46=2 Tri: 21090 The Commonwealth of Massachusetts Department of rndmtriai Accid us Office of rizves4,padons -6.00 Wiwi, i -fon Street Boston, M4 02111 w:t W."Itassgov/dia Workers' Compensation besurance Affidavit: Builders/Contractor s/Eiectriciaus/Plumbers DDlimut 1-nfnrm*fine Name (Bwiness�atio &&vidud): Address: cris p: ,. �, v "ff . Phone Type of project (regnired):. 6. KNeul construction 7. [j Remodeling 8. ❑ Demolition 9. [] Building addition 10.❑ Electrical repairs oradditians I L[] Plumbing repairs or additions 12.0 Roof rte 13.[-] 06= Gm --=n who subma 4ha affdmvj and ztm fy M- duiug an wars and ' � w-- P=M" `�imMM mai d =* ells bm: muni atbmhed !nm hi m oomide s mart submit a new siat3avit in -aaama_>aba�mia�a� - - tea` �P- Pty I am as ea wkyer nitroitprnvidnig workers' °OmFR informadnn ULSWWWEf°T mJ' fees MOW is fire poky and job rue Irmrance Company Name: Policy # or Self -ins. Lic. Ezpitation Date: Job Site Address: . Attach a copy of the workers, compensafion policy dedaradene r Fannie to sexmre I?� (dwwi ng the policy number and eVirafion date). fine up in $1,S1,500.00 and/or one-year mupiisonmu�uu See nt 25A of MGL C. 152 can lead to a imposition of criminal pie of a , as weIl as Civilof up m S250.00 a day against ile violator. Be penalises in the form of a STOP WORK ORDER and a fine Investigation; of flue DIA "far instaamc;e a -copy of this sta#emeut may be fo warded to the Office of on Ido herely cen#y d�, pa ofPe7w' the of}ormadon P'O1'1i1°ba'eE is tare and correct Offzcigd um m* Do not smite in this area, to be completed by c&y or town official City or Toww Permit -/r -: ase - Inuingg Authority (circle omej: - L Board of .Health 2. Bnil&mb Department 3- City/Town Clerk 4. Eietxr ical 6. Other Inspector 5. Plumbing %uspecto r Contact PC -on: Phone f: Are You an employer? Check Ste appropriate box 1. ❑ I am a employer with 4. [] I am a general contactor and I cnPloYee B (fall andlorpart-time)_* 2- ® I am a sole pmpriew c r have hind the sob -cow listed paro=- ship and have no employees on the atached sheet t These sub -cotes have working for me in any capacity. [No workers' comp. instuance workMs= comp- instuance. 5. ❑ We are a corporaiicn and its requhr4 -J officers have eseacised their 3. ❑ I am a homeowner doing an work "& off!i=46M per MGI., myself [No woti=' comp. c.152, §1 (4), and we have no inJ%MUce m4°fix&] t employees_ [No woulM, bos-#? mused fM out �n cMV- mss .] Type of project (regnired):. 6. KNeul construction 7. [j Remodeling 8. ❑ Demolition 9. [] Building addition 10.❑ Electrical repairs oradditians I L[] Plumbing repairs or additions 12.0 Roof rte 13.[-] 06= Gm --=n who subma 4ha affdmvj and ztm fy M- duiug an wars and ' � w-- P=M" `�imMM mai d =* ells bm: muni atbmhed !nm hi m oomide s mart submit a new siat3avit in -aaama_>aba�mia�a� - - tea` �P- Pty I am as ea wkyer nitroitprnvidnig workers' °OmFR informadnn ULSWWWEf°T mJ' fees MOW is fire poky and job rue Irmrance Company Name: Policy # or Self -ins. Lic. Ezpitation Date: Job Site Address: . Attach a copy of the workers, compensafion policy dedaradene r Fannie to sexmre I?� (dwwi ng the policy number and eVirafion date). fine up in $1,S1,500.00 and/or one-year mupiisonmu�uu See nt 25A of MGL C. 152 can lead to a imposition of criminal pie of a , as weIl as Civilof up m S250.00 a day against ile violator. Be penalises in the form of a STOP WORK ORDER and a fine Investigation; of flue DIA "far instaamc;e a -copy of this sta#emeut may be fo warded to the Office of on Ido herely cen#y d�, pa ofPe7w' the of}ormadon P'O1'1i1°ba'eE is tare and correct Offzcigd um m* Do not smite in this area, to be completed by c&y or town official City or Toww Permit -/r -: ase - Inuingg Authority (circle omej: - L Board of .Health 2. Bnil&mb Department 3- City/Town Clerk 4. Eietxr ical 6. Other Inspector 5. Plumbing %uspecto r Contact PC -on: Phone f: 0 REScheck Software Version 4.2.1 Compliance Certificate Project Title: New Home Construction Energy Code: Location: Construction Type: Building Orientation: Conditioned Floor Area: Glazing Area Percentage: Heating Degree Days: Climate Zone: Construction Site: 25 Highland view Avenue North Andover, MA 01845 2006 IECC North Andover, Massachusetts Single Family Bldg. orientation unspecified 2128 M 15% 6322 5 Owner/Agent: Thomas Zahoruiko TLD LLC 115 Carter Field Road North Andover, MA 01845 978-687-2635 tzeke@comcast.net Design er/Contractor: G 1 ,e Passes ongl1'TkWE�# Ceiling 1: Flat Ceiling or Scissor Truss 1064 38.0 0.0 32 Wall 1: Wood Frame, 16" o.c. 2376 21.0 0.0 114 Orientation: Unspecified Window 1: Vinyl Frame:Double Pane with Low -E 347 0.330 115 SHGC: 0.30 Orientation: Unspecified Door 1: Solid 21 0.160 3 Orientation: Unspecified Floor 1: All -Wood Joist/Truss:Over Unconditioned Space 1064 30.0 0.0 35 Furnace 1: Forced Hot Air 90 AFUE Air Conditioner 1: Electric Central Air 13 SEER Compliance Statement. The proposed building design described here is consistent with the buildi lans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to a the 2006 IECC requirements in R//EScheck Version 4.2.1 and to omply with the mandatory requirements listed in the RESchec I pection Chey'1S't111I_Z' 1 Name - Title . ature Date Project Title: New Home Construction Data filename: Untitled.rck Report date: 05/14/12 Page 1 of 3 Ceilings: REScheck Software Version 4.2.1 Inspection Checklist ❑ Ceiling 1: Flat Ceiling or Scissor Truss, R-38.0 cavity insulation Comments: Above -Grade Walls: ❑ Wall 1: Wood Frame, 16" o.c., R-21.0 cavity insulation Comments: Windows: ❑ Window 1: Vinyl Frame:Double Pane with Low -E, U -factor: 0.330 For windows without labeled U -factors, describe features: #Panes — Comments: Frame Type Thermal Break? Yes No Note: Up to 15 sq.ft. of glazed fenestration per dwelling is exempt from U -factor and SHGC requirements. Doors: (3 Door 1: Solid, U -factor: 0.160 Comments: Floors: ❑ Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R-30.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Heating and Cooling Equipment: ❑ Furnace 1: Forced Hot Air: 90 AFUE or higher Make and Model Number: ❑ Air Conditioner 1: Electric Central Air: 13 SEER or higher Make and Model Number: Air Leakage: ❑ Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage are sealed. ❑ Recessed lights are either 1) Type IC rated with enclosures sealed/gasketed against leaks to the ceiling, or 2) Type IC rated and ASTM E283 labeled, or 3) installed inside an air -tight assembly with a 0.5" clearance from combustible materials and a 3" clearance from insulation. Sunrooms: ❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U -factor of 0.50 and the maximum skylight U -factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Vapor Retarder: ❑ Vapor retarder is installed on the warm -in -winter side of all non -vented framed ceilings, walls, and floors; or it has been determined that moisture or its freezing will not damage the materials; or other approved means to avoid condensation are provided. Comments: Materials Identification: ❑ Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. Project Title: New Home Construction Data filename: Untitled.rck Report date: 05/14/12 Page 2 of 3 o Insulation R -values, glazing U -factors, and heating equipment efficiency are clearly marked on the building plans or specifications. ❑ Insulation is installed according to manufacturer's instructions, in substantial contact with the surface being insulated, and in a manner i that achieves the rated R -value without compressing the insulation. Duct Insulation: ❑ Ducts in unconditioned spaces or outside the building are insulated to at least R-8. Ducts in floor trusses above unconditioned spaces or above the outdoors are insulated to at least R-6. Duct Construction: F1 Air handlers, filter boxes, and duct connections to flanges of air distribution system equipment or sheet metal fittings are sealed and mechanically fastened. L1 All joints, seams, and connections are made substantially airtight with tapes, gasketing, mastics (adhesives) or other approved closure systems. Tapes and mastics are rated UL 181A or UL 181 B. ❑ Building framing cavities are not used as supply ducts. Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Additional requirements for tape sealing and metal duct crimping are included by an inspection for compliance with the International Mechanical Code. Temperature Controls: Thermostats exist 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 is provided. Heating and Cooling Equipment Sizing: Cj Additional requirements for equipment sizing are included by an inspection for compliance with the International Mechanical Code. Circulating Hot Water Systems: Circulating hot water pipes are insulated to R-2. F1 Circulating hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: ❑ HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-2. Certificate: Lj A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R -values; window U -factors; type and efficiency of space -conditioning and water heating equipment. 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