HomeMy WebLinkAboutBuilding Permit #285-2012 - 3 IRONWOOD ROAD 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
lAlPORTANT:Applicant must conwlete all items on this page
LOCATION
e V
PROPERTY OWNER (� V Print Unit#
Print
MAP NO:,&PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
100 year-old structure yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
11 New Building ❑ One family
Addition ED Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
S' -t •e" . — �.t,.r :�" yam— —� _e� _ - C . -
+®iSepti ��Well (]FloodplaintW-etlaricls 9%11. eTs � '
s 40ater/Sewed..__-_ ...a
DESCRIPTION O WORK TO BE P ORMED: _ ^nn
(1) 6a FAGLC 'raml
(IddentAcati n Please Type or Print Clearly)(I
OWNER: Name: (_-5Phone:
Address:
1 n
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CONTRACTOR Name: U \ \
Address:
Supervisor's Construction License: �� Exp. Date: f
w
Home Improvement License: �C��9 - Exp. Date: 7
i ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost:
Check No.: Receipt No.: 5
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
.Signature-_oLAgent/ caner :: :_signature of contractor:
Building Department.
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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
o 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 s
❑ 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
VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit
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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
:rust be submitted with the building application
Doc: Doc.Building permit Revised 2008mi
l.V1V11V11L1Y't'v - `� �
Plans Submitted V1\ Plans Waived ❑ Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑
i
Well ❑ Tobacco Sales Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ _ I'
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATEAPPROVED
PLANNING & DEVELOPMENT ❑ X ��
OMMENTS 1 ��l \-Z
f
SE VATION Reviewed on l Si nature Ti ;V �J
®N R I
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COMMENTS 04--1
c\ HEALTH Reviewed on Signature
V
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Wates' &Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT -Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS `"'
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA-- (For de partment use
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Notified for pickup - Date
Doc:.Building Permit Revised 2011 June/mi
I
1
Signafuh of contractor-:
Locationvr/
No. S Date
jORTh TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
24/14/
sACHUs<� Building/Frame Permit Fee $ 4-
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
24658
ACO Building Inspector
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I CERTIFY IF THE PROPOSED ADDITIONS ARE CONSTRUCTED WHERE
SHOWN ON THIS PLAN, THEY WILL COMPLY WITH THE ZONING BYLAWS
(DIMENSIONAL REQUIREMENTS) OF THE TOWN OF NORTH ANDOVER, MASS.
AS OF THIS DATE.
I FURTHER CERTIFY THAT THE STRUCTURE DOES NOT LIE IN THE FLOOD
HAZARD ZONE SHOWN ON THE F.E.M.A. MAP OF ESSEX COUNTY, MASS.
COMMUNITY PANEL NO. 2500980007. C
EFFECTIVE DATE. JUNE 2, 1998
DEED REFERENCE. BOOK 5937, PAGE 200
(ESSEX NO. DISTRICT REGISTRY OF DEEDS).
PLAN REFERENCE. PLAN NO. 10669
ASSESSOR'S REFERENCE. MAP 104C, PARCEL 144
IRONWOOD ROAD ZONING DISTRICT. R-1
�� 50.6' 159.7'
ryg SBDH (FND)
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D Az
m N PRO SED
ADDI ION o6,
bo PORCH
45.4'
O
PROPOSED 2 STORY �
ADDITIONS WOOD DWELLING
U 56.9'
m
LOT 8
43,698 S.F.f
PLOT PLAN OF LAND
3 IRONWOOD ROAD
OF MqS
s9 NORTH ANDOVER MASS
RUSSELL S
D OWNER: DAVID M. GRUBER AND LISA K. GRUBER
`o` WILSON `"+ 3 IRONWOOD ROAD, N. ANDOVER, MA 01845
No.34628
,o SCALE: 1 INCH = 30 FEET DATE: SEPTEMBER 27, 2011
Sssro�POQ R .WILSON & ASSOCIATES, INC .
LAND SURVEYORS AND CIVIL ENGINEERS
676 GREAT ROAD P.O.BOX 236 LITTLETON, MA 01460
J PHONE: 978-486-0203 FAX: 978-486-0644
FILE NO. 1846 DWG NO. 1846WP SHEET NO. 1 OF 1
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations '
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):--Be�I 1�-OC \Q
Address:
Cit /State/Zi
Y p� Phone#: �7a
Are you an employer?Check the appropriate box: Type of project(required):
1.�am a employer with 2- - 4. El am a general contractor and I 6 E]New construction
employees(full and/or part-time).* have hired the sub-contractors
2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0Electrical 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' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my empl yees. Below is the policy and job site
information.
Insurance Company Name: v
Policy#or Self ins.Lic.#: l 1 c I Expiration Date:
Job Site Address: G City/State/Zip: C7af
Attach a copy of the workers' compensation poli y 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 c tify u der th pain and p lties of perjury that the information provided bo a is true and correct.
Sign re:
Date:
Phone#: C D
\
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#:
REScheck Software Version 4.4.1
Compliance Certificate
Project Title: 33.5x18.5 kitchen/family room,26x22 master suite,6xl2 mudroom
Energy Code: 2009 IECC
Location: North Andover,Massachusetts
Construction Type: Single Family
Glazing Area Percentage: 16%
Heating Degree Days: 6322
Climate Zone: 5
Construction Site: Owner/Agent: Designer/Contractor:
3 ironwood rd mike bushnell
no.andover,MA bushnell const.
Chelmsford,MA
Compliance:5.7%Better Than Code Maximum UA:264 Your UA:249
The%Better or Worse Than Code index reflects how dose to compliance the house is based on code trade-off rules.
It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home,
Ceiling 1:Flat Ceiling or Scissor Truss 294 30.0 0.0
Ceiling 2:Flat Ceiling or Scissor Truss 853 38.0 0.0 26
Wall 1:Wood Frame,16"o.c. 1713 21.0 0.0 79
Window 1:Vinyl Frame:Double Pane With Low-E 281 0.320 90
Door 1:Solid 40 0.250 10
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 576 38.0 0.0 15
Floor 2:All-Wood JOlst/TruSs:Over Unconditioned Space 571 30.0 0.0 19
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 2009 IECC requirements in
REScheck Version 4.4.1 and to comply with the mandatory requirements listed in the REScheck 1 ction Checklist.
C1— 1a— I,
Name-Title Signature Date
Project Title:33.5x18.5 kitchen/family room,26x22 master suite,6x12 mudroom Report date:09/18/11
Data filename:C:\Users\Owner\Documents\REScheck\3ironwood.rck Page 1 of 4
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RESchec Software Version 4.4.1
Inspection Checklist
Ceilings:
❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation
Comments:
❑ Ceiling 2: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.0.320
For windows without labeled U-factors,describe features:
Wanes—Frame Type Thermal Break?_Yes—No
Comments:
Doors:
❑ Door 1:Solid,U-factor:0.250
Comments:
Floors:
❑ Floor 1:All-Woof Joist/Truss:Over Unconditioned Space,R-38.0 cavity insulation
Comments:
Floor insulation is installed in permanent contact with the underside of the subfloor decking.
❑ Floor 2:All-Wood Joist(fruss:Over Unconditioned Space,R-30.0 cavity insulation
Comments:
Floor insulation is installed in permanent contact with the underside of the subfloor decking.
Air Leakage:
❑ Joints(including rim joist junctions),attic access openings,penetrations,and all other such openings in the building envelope that are
sources of air leakage are sealed with caulk,gasketed,weatherstripped or otherwise sealed with an air barrier material,suitable film or
solid material.
❑ Air barrier and sealing exists on common walls between dwelling units,on exterior walls behind tubs/showers,and in openings between
window/door jambs and framing.
❑ Recessed lights in the building thermal envelope are 1)type IC rated and ASTM E283 labeled and 2 sealed with a9 asket or caulk
between the housing and the interior wall or ceiling covering.
❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated(without insulation compression or
damage)to at least the level of insulation on the surrounding surfaces.Where loose fill insulation exists,a baffle or retainer is installed
to maintain insulation application.
❑ Wood-burning fireplaces have Basketed doors and outdoor combustion air.
Air Sealing and Insulation:
❑ Building envelope air tightness and insulation installation complies by either 1)a post rough-in blower door test result of less than 7
ACH at 33.5 psf OR 2)the following items have been satisfied:
(a)Air barriers and thermal barrier:Installed on outside of air-permeable insulation and breaks or joints in the air barrier are filled or
repaired.
(b)Ceiling/attic:Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed.
(c)Above-grade walls:Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier.
(d)Floors:Air barrier is installed at any exposed edge of insulation.
Project Title:33.5x18.5 kitchen/family room,26x22 master suite,6x12 mudroom Report date:09/18/11
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(e)Plumbing and wiring:Insulation is placed between outside and pipes.Batt insulation is cut to fit around wiring and plumbing,or
sprayed/blown insulation extends behind piping and wiring.
M Comers,headers,narrow framing cavities,and rim joists are insulated.
(9)Shower/tub on exterior wall:Insulation exists between showers/tubs and exterior wall.
Sunrooms:
Sunrooms that are thermally isolated from the building envelope have a maximum fenestration LI-factor of 0.50 and the maximum
skylight LI-factor of 0.75.New windows and doors separating the sunroom from conditioned space meet the building thermal envelope
requirements.
Materials Identification and Installation:
0 Materials and equipment are installed in accordance with the manufacturer's installation instructions.
Q Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value.
Lj Materials and equipment are identified so that compliance can be determined.
Li Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided.
Insulation R-values and glazing LI-factors are dearly marked on the building plans or specifications.
Duct Insulation:
LI Supply ducts in attics are insulated to a minimum of R-8.All other ducts in unconditioned spaces or outside the building envelope are
insulated to at least R-6.
Duct Construction and Testing:
Building framing cavities are not used as supply ducts.
Lj All joints and seams of air ducts,air handlers,filter boxes,and building cavities used as return ducts are substantially airtight by means
of tapes,mastics,liquid sealants,gasketing or other approved closure systems.Tapes,mastics,and fasteners are rated UL 181A or
UL 181 B and are labeled according to the duct construction.Metal duct connections with equipment and/or fittings are mechanically
fastened.Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three
equally spaced sheet-metal screws.
Exceptions:
Joint and seams covered with spray polyurethane foam.
Where a partially inaccessible duct connection exists,mechanical fasteners can be equally spaced on the exposed portion of the
joint so as to prevent a hinge effect.
Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa).
Lj Duct tightness test has been performed and meets one of the following test criteria:
(1)Postconstruction leakage to outdoors test:Less than or equal to 91.8 cfm(8 cfm per 100 ft2 of conditioned floor area).
(2)Postconstruction total leakage test(including air handler enclosure):Less than or equal to 137.6 cfm(12 cfm per 100 ft2 of
conditioned floor area)pressure differential of 0.1 inches w.g.
3 Rough-in I
� ( ) total leakage test with air handler installed:less than ore equal to 68.8 cfm 6 m r 1
9 9 q ( cf per 00 ft2 of conditioned floor area
when tested at a pressure differential of 0.1 inches w.g.
(4)Rough-in total leakage test without air handler installed:Less than or equal to 45.9 cfm(4 cfm per 100 ft2 of conditioned floor area).
Heating and Cooling Equipment Sizing:
Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code.
0 For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial
Building Mechanical and/or Service Water Heating(Sections 503 and 504).
Circulating Service Hot Water Systems:
Circulating service hot water pipes are insulated to R-2.
Circulating service hot water systems include an automatic or accessible manual switch to tum 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-3.
Swimming Pools:
0 Heated swimming pools have an on/off heater switch.
Pool heaters operating on natural gas or LPG have an electronic pilot light.
Timer switches on pool heaters and pumps are present.
Exceptions:
Where public health standards require continuous pump operation.
Project Title:33.5x18.5 kitchen/family room,26x22 master suite,6x12 mudroom Report date:09/18111
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Where pumps operate within solar-and/or waste-heat-recovery systems.
Lj Heated swimming pools have a cover on or at the water surface.For pools heated over 90 degrees F(32 degrees C)the cover has a
minimum insulation value of R-12.
Exceptions:
Covers are not required when 60%of the heating energy is from site-recovered energy or solar energy source.
Lighting Requirements:
Cj A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following:
(a)Compact fluorescent
(b)T-8 or smaller diameter linear fluorescent
(c)40 lumens per watt for lamp wattage—15
(d)50 lumens per watt for lamp wattage>15 and—40
(e)60 lumens per watt for lamp wattage>40
Other Requirements:
Snow-and ice-melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting
off the system when a)the pavement temperature is above 50 degrees F,b)no precipitation is falling,and c)the outdoor temperature is
above 40 degrees F(a manual shutoff control is also permitted to satisfy requirement's').
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.The certificate does not cover or obstruct the visibility
of the circuit directory label,service disconnect label or other required labels.
NOTES TO FIELD:(Building Department Use Only)
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Project Title:33.5x18.5 kitchen/famity room,26x22 master suite,6x12 mudroom Report date:09/18/11
Data filename:C:\Users\Owner\Documents\RESchedd3ironwood.rck Page 4 of 4
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2009 IECC Energy
[efficiency certificate
Ceiling/Roof 38.00
Wali 21.00
Floor/Foundation 38.00
Ductwork(unconditioned spaces):
3@..
Window 0.32
Door 0.25 NA
.�� .. ROOM
Heating System:
Cooling System:
Water Heater:
Name: Date:
Comments:
L
q "°""�icnusctts - Department of Public S
r� Board of Buildin. Regulations and Standards
Construction Supervisor License
License: cs 58872
Restricted to: 00
MICHAEL BUSHNELL
89 MEADOWBROOK RD
N CHELMSFORD, MA 018630
t
• �� Expiration: 3/31/2012
- C'o nnn lar/un er
- Tr#: 18684
i
_ Office
of Consumes Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Chit actor Registration
Registration: 108952
} -- Type: DBA
BUSHNELL CONSTRUCTION l4' Expiration: 8/27/2012 Tr# 204013
- �
Mlchael Bushnell =`
89 MEADOWBROOK RD. s
Chelmsford, MA 01863 i • /K
Update Address and return card.Mark reason for change.
DPS-CAI 0 50M-04/04-G1012I6 ❑ Address E] Renewal [,i Employment F—] Lost Card
Office of ConsumerAffairsAffairr&Bu"sinessR gulat���n� License or registration valid for individul use only `
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: ;=s 108952 Type: Office of Consumer Affairs and Business Regulation
Expiration: 8127%2012 DBA 10 Park Plaza-Suite 5170
BU Boston,MA 02116
HNELL CONSTRUCTION
Mlchael Bushnell
89 MEADOWBR00K�RD-3
Chelmsford, MA 01863
Undersecretary
li gnature