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Home My WebLink AboutBuilding Permit #2 - 26 MOLLY TOWNE ROAD 7/1/2009 BUILDING PERMIT NORTh o�ttt•° 16q�o TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION Permit NO: ^° �y Date Received ATeo �SSACH�1`-+�� Date Issued: TAIJRORTANT:Applicant must complete all items on this page i LOCATION �o ,��)•tT��n 2 ROS, Print PROPERTY OWNER O et. (�O ' Print MAP NO: PARCEL:.,A J ZONING DISTRICT: �Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family b-"- Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: CdNST-rJ L,) (41-, -TAree C'AQ. _C�_f&g&0 ,1 n Pa 7r i a-) sou,aet 1-'007jP�,-e Ll 5c Z:) IdentificaJ�'on Please Type or rint Clearly) OWNER: Name:�� LIQ,r�o�IpP- Zec,[-L 6o f Q Phone: �17Q q )9- o -;716 Address: CONTRACTOR Name ft CAt'CD Phone: '7 9-R 7 7,6 Address:l IR4J ( Supervisor's Construction License:("–\ /_3 5�O Exp. Date:/11 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER jKZ tip h Phone: IS Address: 2oAa (SqReg. No. 61 FEE SCHEDULE:BULDING,,PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S. . Total Project Cost: $ Dorm,) FEE: $ L-- 75-6 —� SV Check No.: Z�Zy Receipt No.: !-: L ' NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Signature of Agent/Owner MV ignature of contractb- - - Plans Submitted Plans Waived Certified Plot Plan v 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 CONSERVATION Reviewed on G9 11 Signature U L COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments nfWater & Sewer Connection/Si nature& Date �Drvi ewa Permit DPW Town Engineer: Signature: j ocated 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes r` no Located at 124 Main Street . Fire Department signature/date I 6 9 4MENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 3. 53-7 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 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 Dl� Revised 2.2008 Location MOI/L, Towle i No. Date �oRTh TOWN OF NORTH ANDOVER O?O•t",o I•,MO w � A • � ; , Certificate of Occupancy $ SACN tom' Building/Frame Permit Fee $ Foundation Permit Fee $ � Other Permit Fee $ _ TOTAL Check # 22io: Building Inspector IAORTH Andover. :. - . TONM of 0 No. Z, '-_ Cc% !20 LA E over, Mass., W COCHICHEWICK ORATED Ph' S BOARD OF HEALTH Food/Kitchen PERMIT T D Sep I tic System BUILDING INSPECTOR THIS CERTIFIES THAT....4A�.^16TS1... ....... ........ ........Tr.4.4.11! . .......................................... Foundation has permission to erect........................................ buildings on ...... .M.O.I.I.N. ................... Rough • Chimney to be occupied as.. ........ .0. .....f *W40.4. .........*...... is permit -erms o the on file in provided that the person accepting �11 respect conform t�'l Ipplicatift& Final this office, and to the provisions of the Codes and By- ws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final Oro • PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough .............. ................................................................ ........................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. Massachusetts The Commonwealth of - Department of Industrial Accidents t z Qjf1ce of Investigations . 600 Nlashington Street too" Boston, X4 02111 www massgov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ARRAicant Information Please Print Leeibl Nagle(Business/Orgartization4ndividual): ove r �ee�1 or Address: ��J 9 Q s-�- �3 r o o. d 0 a City/state/zip: F{gUerA i M Q of S 3 Phone#: . �7g'• y 7g. • 2 745 A�ou an employer?Check.the appropriate box: I. I tin a employer with 4. ❑ I am a general contractor and I T prefect{require: employes(full and/or part-time).* have biired the sub-comactors b Now construction 2.❑ I am.a.sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and have no employees These suh-contractors have 8. working for me in an act workers' comp.insurance. . ❑Demolition Y capacity. 9. Buildi [No workers'comp. iasurartce 5. ❑ We are a corporation and its ❑ addition 3.❑ required.] officers have exercised their I0.0 Electrical repairs or additions lam a homeowner doing all work right of exemption per MGL I I.[] Plumbing repairs or additions myself.[No•workers'comp. c 152, §1(4),and we have no insurance d.re uiret 12T7 Roof repairs 9 I .employees.[No workers' comp. insurance required_] 13.❑Other *Any applicant that Checks boz#I must also fit!out the section blow showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ars doing all work and than ham outside contractors must submit a reeve affidavit indicating such 4Contractona that check this box mustaftched an additional aheat show' trtg•the name of the sub-soumwtom and their workers'comp.-r•••.a:..y.•iii � hou. . •• f'm !arr.:rn nary l0yer that is prgwdutg:workersI compensator insurance or a 10 inforrnadort ii f m1' �+;P Y Below is the policy andjob site . Inns nce Company Name: 40-0'1 over 1 n-3 U tr a(I c--e- Policy#or Self-ins.Lie.#:-1W r— Q 03 —to a_—_3 V 314 hA 1 II Expiration Date: 3 - 1-3 - lb _ Job Site Address: 0E0 M1 D1l G f�(�1(�e. Pd Citj;/State/Zip: N • *1 d o eY a, 8 YY Attach a copy of the workers'�co pematiou policy d�Iar ation page(showing the policy number and expiration �� Failure to secure covers a as xp .tion date}. g required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,50000 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify unde thepains and penalties of perjury e inf that the om"on rovided ` P ve is a and correct Sire. 0 d�. Ph : S S [6-0ther :A: nly. do not write ur this area,m be completed by city or town offidd : Permit/License# rity(circle one): ealth 2.Building Department 3.City/Town-Clerk 4. Electrical Inspector S. Plumbing Inspector n• Phone#: Information a. nd Instructions Massachusetts General Laws chapter 152 requires all emp Ioyers 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,assodiation,corporation or other Ito entity,or any two or more of the'fomping 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 m 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 fieeusing agency shag withhold the issuance or renewal of a license or permit to operate a business or oto 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 complian=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):atnd phone number(s)along with their certificates)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,notthe 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 nurxtber listed below. Self-insured companies should enter their self insurance Iicensc number on the'appropriate line. City or Town OfMais 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 A-ill 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 in.formation(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of•the affidavit that has bem officially stamped or marked by the city or town may be provided to the applicant as proof that a valid af€idavtt is on file for future permits or licenses. A new affidavit must be filled out each year. When 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 Investiattions 600 Washington Street Boston, MA 02111 TeL#617-7274900 ext 406 or 1-8.77-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mam.gov/dia Uui ld/GUUd 1U;/0 PAA 11.1160603147 AI,r.KU h1t1'b 1NSLIKAiNCE wj U01 DATE(MMIDLYYYYY) A60 d CERTIFICATE OF LIABILITY INSURANCE 6/19/0-9 I THIS FIROER ONLY CANDFCONFERSICATE IS ISNOERIGHTSD AS A MUPONRTHE OF INFORMATION CERT FICATE Roberts Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Osgood Straet ALTER THE COVERAGE AFFORDED BY THE POL.IIth Andover, MA 01845 NAIL# INSURERS AFFORDING COVERAGE_jInc INSURERA. TPA Insurance enc INSURED NORTH ANDOVER REALTY CORP INSURER e3Hano'ver Ynsuzance 459 EAST BROADWAY INSURERC: HAVF.MILL, MA 01830 INSURER D. INSURER E' COVERAGES THE POLICIESOF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED..NOT BE ISSUEDIO MAY PERTAIN THE IN URANCE AFFFNORDEO BY ANY HE POLICIES DESCRIBED HEREIN S SUa1ECT 0 ALL THE OR OTHER DOCUMENT WITH RESPECT OTERMS TICH ERMS,EXCLUSIONS ANDTCON DITONS OF ISSUED pOLICIES,AGGREGATE LIMITS SHOWN 1I HAVE BEEN REDUCED BY PAID CLAIMS.uIM EFFE VE CY EXPIRATION LIMTS I SR POLICY NUMBER EACH OCCURRENCE- E GENERAL LIABILITY DAMAGE T RENTED E MISfR(E�7[CciJneO CCAIMERCIALGENE RAL LIABILITY MED EXP V orn S CLAIMS MADE OCCUR PER 90W�.L8AOVINJURY E GENERAL AO OREGATE S PRODUCTS•COMPfOP AOG $ GEN'LAGGREGATE LIMIT APPLIES PER POLICY IR LOC AUTOMOaLEUA9UTY COM6INEDSINGLELIMIT S (E a eccida rt) ANY AUTO BODIL�ALL OWNED AUTOS (Pore on) $ IPaP�6�) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY b (P er a cadent) NON O,A,M AUT 05 PROPERTY DAMAGE S (Pv�aeddent) AUTO ONLY-EA ACCIDENT S GARAGE LIABILITY E.AAOO $ ANY AUTO OTHER THAN AU'f00NLY; AGG S EACH OCCURRENCE S EXCESS 1 UMBRELLA LIABILITY AGGREGATE S OCCUR CL AIMS MADE 6 I DEDUCTIBLE TENTI INCSTATU, OTH- WORKERS COMPENSATION 11 AND EMPLOYERS LIABILITY Y 1 N - A Af,NPROPRIETOR/PARTNER/EXRCUTIVE WC 003-623434 3/13/09 3/13/10 E.L.EAcwACaI7:Nr E 500,000 OFFICER/MEMEEREXCLI-0607 E.L.DISEASE-EA EMPLOYEE E 500.000 ppwatDry In NH) 500 000 W,describe Under E.L.01&EASE-P LICY LIM T 5 0 A PROV;SION'08Ow OTHER B STREET OPENING BOND BLN1736861 7/11/06 7/11/09 CESCRWPTION OF OPERATIONS I LOCATIONS f VEHICLES I EXCLUSIONS ADDED BY ENDon EMENT f SPECIAL PROVISIONS FAX:978-4750942 CANCELLATION CERTIFICATE HOLDER SHOULD ANY OFT HE ABOVE DESCRIBED POLICIES 0E C ANC ELLE D BEFORE THE E XPIRATIO N DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRT-'EN TOWN OF NORTH ANDOVER NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,a U T FAILURE TO DO e 400 OSGOOD STREET IMPOSE NO OBLIGATION OR 1.1111 K ANY 0 UP E U ,ITS S OR NORTH ANDOVER, MA 01845 REPRESENTATIVES. AUTNORQEO REPRESENTATIVE ACORD 25(2009/01) (p 1988-2009 ACO RD CORPORATION. All rights reserved. The AC ORD name and logo are registered marks of ACORD REScheck Software Version 4.2.1 Compliance Certificate Energy Code: 2006 IECC Location: North Andover,Massachusetts Construction Type: Single Family Conditioned Floor Area: 1620 ft2 Glazing Area Percentage: 17% Heating Degree Days: 6322 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: Compliance: 1.7%Better Than Code Maximum UA:537 Your UA:528 Gross Cavity Cont. Glazing UA Assembly Area or R-Valub R-Value or D.. Perimeter U-Factor Ceiling 1:Flat Ceiling or Scissor Truss 2928 30.0 0.0 102 Wall 1:Wood Frame,16"o.c. 3044 19.0 0.0 147 Window 1:Metal Frame with Thermal Break:Double Pane with 525 0.310 163 Low-E SHGC:0.31 Door 1:Solid 63 0.310 20 Basement Wall 1:Solid Concrete or Masonry 1620 19.0 19.0 96 Wall height:8.0' Depth below grade:7.0' Insulation depth:4.0' 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 2006 IECC requirements in REScheck Version 4.2.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. 2 09 Name-Title ?gatu bate Project Title: Report date: 06/22/09 Data filename: Untitled.rck Page 1 of 3 REScheck Software Version 4.2.1 Inspection Checklist Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: Basement Walls: ❑ Basement Wall 1:Solid Concrete or Masonry,8.0'ht/7.0'bg/4.0'insul,R-19.0 cavity+R-19.0 continuous insulation Comments: Windows: ❑ Window 1:Metal Frame with Thermal Break:Double Pane with Low-E,U-factor:0.310 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: Note:Up to 15 sq.ft.of glazed fenestration per dwelling is exempt from U-factor and SHGC requirements. Doors: ❑ Door 1:Solid,U-factor:0.310 Comments: 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. Insulation R-values and glazing U-factors 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 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: Project Title: Report date: 06/22/09 Data filename: Untitled.rck Page 2 of 3 ❑ Air hanNers,filter boxes,and duct connections to flanges of air distribution system equipment or sheet metal fittings are sealed and mechanically fastened. F1 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. D 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: D 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. Certificate: ❑ 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. NOTES TO FIELD:(Building Department Use Only) Project Title: Report date: 06/22/09 Data filename: Untitled.rck Page 3 of 3 �J( 2006 IECC Energy Efficiency Certificate Ceiling/Roof 30.00 Wall 19.00 Floor/Foundation 38.00 Ductwork(unconditioned spaces): �.P-, �,.._ - .. M12 • Ott. Window 0.31 0.31 Door 0.31 NA Water Heater: Name: Date: Comments: i I. .' ."!}� �f12 �O hYlIY4IZC(/ECLGG/2 0�✓!/GCIQ�C�CILCC32f�4 �� 'f� oard of Building Regulations and Standards I, Construction Supervisor License Licegse:�CS 63503 Bi.rthdate:-7/1 9/1965 r Expiration:17/19,/2009 Tr# 1209 E Restrict16nr 6- JAM S -JAMES V CARROCL'-f 163 HIGHLAND RD ANDOVER,MA 01810 — Commissioner I 7 , I F' 6 kJ i'13/2009 14: 02 9783723960 CHRISTIANSEN & SERGI HAVE Ui/Ji EASEMENT LOT 7 �. x I, tik�X LOT 8 �'- EXISTING FOUNDATION ECEV.=21 s.2' LOT 9 f ZONING DISTRICT R--2 MIN. AREA = 21,780 S.F. MIN. L07 WIDTH - 100' MIN. FRONTAGE = 100' ' O MIN. FRONT SETBACK = 20' MIN. SIDE SETBACK+ = 20' " MIN. REAR SETBACK = 20' THE STRUCTURE MAY BE PLACED UPON A SIDE LOT LINE WITHOUT A SIDE SETBACK, PROVIDED THAT THE ADJACENT LOT TO WHICH THE ZERO SETBACK 15 LOCATED HAS THE REQUIRED SIDE YARD SETBACK.) PRImARY STRUCTURE SHOWN ccwows FOUNDATION TION LOCA TION PLAN 7HC MOp ONTALERIVY THATT HE SETBACK R£DUIREMEN S OF THE LOCAL TO ` APPUCABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCT4'D. (IN15 CERTIFICATION DOES NOT CONSIDER ANY OTHER RaFRIC71ONS SUCH AS COVENANTS,WETLANDS,EASEMENTS, ORDERS OF CONDITIONS,£TC.) CLIENT: NORTH ANDOVER REALTY THIS DRAWING SMALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXC,F,,,gT WITH THE OCHRISTIANSEN Hl _ MA WRITTEN PERMISSION OF CHRISTIANSEN k SERGI INC. Pt1RTH£RMORf THIS DRAWING IS THE COPYRIGHTED PROPERTY NE ABOVE CLIENT. OF CHRISTIANSEN A SERGI INC. AND ANY UNAUTHORIZED USE 15 PROHIBITED.CHRISTIANSEN h SER NO RESPONS1BJLITY FOR THE UNAUTHORIZED USE gF� }i OR ANY INFOR- CATION. MOLLY TOWN RD, NORTH MATION CONTAINED HEREON t�%� 1K DOVER, AIA. Ml ria ALE: 1" 60' . 07/15109 1 (' ti IX SERGI PROFESSIONAL ENGINEERS n QIP �. LAND SURVEYORS <qkD M� 160 SUMMER Sr. HAVSRNILL.uA. 01830 TEL. 978-373-0310 ®1009 BY CHRISTJANS£N .t Sf-"l INC. �RA4V NCi 970660 740a JAN-23-2010 06 :01 PM LARRY OGDEN 978 352 2858 P. 01 LAWRENCE ll. OGDEIV,P,E. ., 198 EAST MAIN STREET GEORGETOWN,MA 01833 978-352-8318 fix 978-352-2858 cell: 978-502-5921 January 23, 2010 I Mr, James V. Carroll North Andover]fealty Trust Highland Road North Andover, Ma. 01845 RE: Residence 26 Molly Towne Road,Lot 8 ,North Andover, Ma. Dear Mr. Carroll As you requested I visited the site with Mr.Bruno to review the installation of the Engineered Materials consist utilizers in the framing of the above project. These are shown on plans A-1 to A-7, prepared by G.J.Bnno Associates,Dated June 3, 2009,with sheets A.4, A-6,A-7 certified by me June 23, 2009. We met with Mr. Dan Chadwick, Based on the above site visit and based on what I could visibly see I can certify that to the best of my knowledge the LTI,Beams and Engineered floor Joist members utilized in the framing as shown on the drawings :"-e installed properly and meet the loading conditions of the Massachusetts State Building Code for 1812 Family Residences. This certification assumes that all other framing requirements of the code, including but not limited to materials and nailing schedules,were properly complied with by the licensed construction supervisor responsible for the project. I informed Mr. Chadwick that Blocking between roof rafters and Hurricane Clips need to be installed as shown on Detail B,A-7 and Section at&ave A-5. These are required per the Code Wali Bracing requirements to transfer the roof diaphragm loads to the Braced Walls. It was a pleasure working with you and your framer on this project as you took the effort to hold a pre-construction meeting with your subs, and brought any questions or requested revisions to my attention prior to proceeding. Should you have any questions please do not hesitate to call. � tw of Yours truly, LA � J wrence H. Ogden P.E. Structural 27765 /G.. . .. .. .. .. i NORTH pf 0 0*. TOWN OF NORTH/ANDOVER PERMIT FOR GAS INSTALLATION :qty �,SSACHUSE� This certifies that . . . . { ,. . . . . . . . . . . . . has permission for gas installation . . . ...Gr`' . ,r`! �1 e in the buildings of . . . . .. !�. . . �j� d� �!?. . . . . . . . . . . . . . at . . . . . . . . . .. !�!�!n. . . . . . . . , North Andover, Mass. Fee 416)n� . Lic. No::,IS /. . . . . . . . `.... . . . . . . . . . . . GAS INSPECTOR Check# � 70GJ 7 MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) Date &lr() NORTH ANDOVER,MASSACHUSETTS Building Locations ( /'J Permit# Amount$ Owner's Name h'rt New,�,.,.,,�N I Renovation ❑ Replacement ❑ Plans Submitted ❑ x w vI U a O '� x rA U U y y ° d U Oa z W > a Ga rA w a H ° o z W .4 H x w > W o z d a a o o W 9 o w H x O x w O 3 o v a U a > A a F O SUB -BASEM ENT B A S E M ENT 1ST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6 T H . F L O O R 7TH . FLOOR - 8TH . FLOOR (Print or type) 1 A ' /� y /a Check one: Certificate Installing Company Name Uv l / d � 11 Corp. Address �� ❑ Partner. K,)40'160 F]ess a ep one Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check on I have a current liability Insurance policy or it's substantial equivalent. Yes No❑ If you have checked Les,please indicate the type coverage by checking the appropriate box. Liability insurance policy � Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information—I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Codand Cap'h; 1 2 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber &L2 City/Town as Fitter LicenseNumber L.! Master R APPROVED(OFFICE USE ONLY) ❑ Journeyman The Commonwealth of Massachusetts Department of Fndustrial Accidents Office ofInvestigations 600 Washington Street Boston, A"-02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): "dress: City/State/Zip: Phone#: Are you an employer? Check the appropriate bog: Type of project(required): L❑ lam 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 in any capacity. workers' comp. insurance. 9. E]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 am a homeowner doing all work right of exemption per MGL 11-El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12,0 Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other `^«r YYlicaut that checks box;�1 m=also 811 oUt the section below showing their workers'compensation policy inform ation. 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employee& 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 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 DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 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 legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,of 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 aparfrnents 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 coveraee 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.Parinerships(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 perniits 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 fnvesfiptions 60.0 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877 MASSAFE Revised 5-26-05 Fax # 617-727-7749 mr"rw-mas .zov/dia _Date.'Ak* . . . NOR71y 3:�..� •�,;._'tiao� TOWN OF NOR ANDOVER PERMIT FOR PLUMBING US This certifies that . . .� l!j� . . . . ./�. . ... . . . . . . . . . . . . . . . . has permission to perform . . . . : 1:'. v!?v`< . . . . . . . . G plumbing in the buildings of . . . �.:t.�-:!��. . .(.hLSr/.!c J� ?. . . . . . at . . . . .1/O . . . . . . . . . . . . . ...North Andover, Mass. Feed`.�.�i. tG. .Lic. No. . . . . . . . . . ... . . . . . . . . . . . . . . . . . . PLUMBING INSPECTOR Check # 8312 ,r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or pmt) NORTH ANDOVER,MASSACHUSETTS Date 4 , Building Location 22 YM b Pernut# Amount Owner , i New Renovation Replacement Plans Submitted Yes No FIXTURES Summ B4WWW W l l 1S>E OIR / raRfm 3MIIOCR 4IH FLOM sW K00R 6M FUM 7MIIOCR sem[>H>tocxt (Print or type) Check one: Certificate Installing Company Name ❑ Corp. Address1:1pier. 0 Z Business Telephone / 0. — Firm/Co. Name of Licensed Plumber: I Insurance Coverage: Indicate the pe of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Plum ' g Code and 142 of the General Laws. By: Wgnatur off Lacensou Plumber Title Type of Plumbing License !�- Cit PRO rcense um Master � Journeyman ❑ APPROVED to�cE usE orrr,Y The Commonwealth of Massachusetts s , Department of Industrial Accidents. Office of Investigations 600 Washington Street Boston, A"-02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Naive (Business/Organization/Individual): Address: City/State/Zip: Phone #: - .o Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4: ❑ I am a general contractor and I 6, ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q, ❑ 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 am 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-❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *..:.y applicant,that checks box n:mu;.,Iso fill out the section below showing their workers'compensation policy infonnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors 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 workerscompensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie.#: 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: 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#: "°II1M AQ s + ♦ � 1, �+JACM1{+r CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 002 Date: May 23, 2011 THIS CERTIFIES THAT THE BUILDING LOCATED ON 26 Molly Towne Road, North Andover, MA MA 01845, a/k/a Autumn Chase subdivision North Andover Realty Trust MAY BE OCCUPIED AS _single-family IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Realty Corp. 459 East Broadway Haverhill,MA 01830 Building Inspect6r Fee: 100.00 previously paid Receipt: 22169 �10RTN OftCURD '�qr 0 w L 7 HO�f'r1J APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Buildinal Permit# ADDRESS/LOCATION OF PROPERTY : MaP („j� Parcel c�� ' Lot Number SUBDIVISION T� n ECA e DATE REQUESTED FILED/READY FOR INSPECTION 511o'111, t 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 1F THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued t0: r-I' an10V.a_r<eA(+V Addresse'f S`� I b - (lam.-i I y R o SIGNED ROU • � 1v �1 - CONSERVATION PLANNING DPW-WATER METER SEWER/WATER CONNECTION ® 4(3/t NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYHNSPECTION REQUEST 5 DPW 01,ZQ Signature r File: Application for OC form revised Jan 2007 NORTH 0 0 : over 0=11� 1- r1l No. _�- L A E = dover, IVMass., • �A COCHICHEWICK\�� DRATED PQM �� .44o t� deo ✓ Fc1 BOARD OF HEALTH .Food/Kitchen PERMIT T �D Septic Systeri THIS CERTIFIES THAT l �r�, DING INSPECTOR , INS :........... urdation . . has permission to erect. ........... g .. A.�. . ..' t ... ...... ugh �, � � L 1 to be occupied as. .; . ... ........ �► ....fLft..�.:. ... .... ! ................. y'� Chiu provided that the person accepting is permit shall i e respect conform'to th terms of the application on file in i a ' this office, and to the.provisions of the Codes and By- ws relating to the Inspection, Alteration and Construction of > Buildings in the Town of North Andover. `PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS i Finalc Oro ELECTRICAL=INSPECTOR UNLESS CONSTRUC STARTS 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. -' A— SEE REVERSE SIDE Smoke Det.