HomeMy WebLinkAboutBuilding Permit #851-11 - 36 EMPIRE DRIVE 6/14/2011lit
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
ps� — /j Date Received
Permit NO: p
Date Issued:
IlVIPORTANT: plicantraust complete all items on this
LLC -
PROPERTY OWNER print
ZZONING DISTRICT_ Historic District yes
MAP NO: � pARCEI & Machine Shop Village yes na
TYPE OF IMPROVEMENT
)& New Building
❑ Addition
❑ Alteration
❑ Repair, replacement
❑ Demolition
Q"Wei
�❑ septic
DESCRIPTION OF WORK TO BE
OWNER: N
PROPOSED USE
Residential
J$One family
❑ Two or more family
No. of units:
❑ Assessory Bldg
❑ Other
D Floodplaili Wq s
plo
yr
tification Please Type or Print Clearly)
Non- Residential
❑ Industrial
❑ Commercial
❑ Others:
'M WdtershedL1.
Distr
AQ
997-3J&?---
Address:
9%`,7 f &?---
Address:
�� S'SllU 19' Phone:
CONTRACTOR Name: ,nuns--'-/- Jam,,/ /�
. .. I n ' 4- If/ �t 1� f 1u-11 P.P �U'T�a �rAAA al5z/
Address: 3� I
1d2�3 Exp. Date:
Supervisor's Construction License:
corf � S2� Exp. Date:
Home Improvement License: � g l
/ENGINEE Y ►J
Phone:�7t�"3 2� 3
ARCHITECT
.. _ - - - , AL r' I M) AA ii- 6 I?33Zeg. No.
Address' -/-a
TED COST BASED $125.00
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMAPER S.F.
�,� U FEE: $ U
Total Project Cost: $ a5
Receipt No.:
Check No.:
OTE: Persons contracting with unregisteYe�l contractoYs do not have access to the guaranty fun
- -o Ci,Gl� Signature of;contractor
7
e
Location -.1) /1 /-,V / & /
No. I-FrI - // Date
,&ORTN TOWN OF NORTH ANDOVER
o"q
Certificate of Occupancy $
Building/Frame Permit Fee $ -3 76, 2-
4CMU
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # �20 7 9
24� S%,) A
/d*Jifding Inspector
ti
Plans Submitted ❑
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑Swimming
Tanning/MassageBody Art ❑
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 t ,, / I q /
COMMENTS NO -► aW � K
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
t
Planning Board Decision:
Conservation Decision:
Water & Sewer Connection/Si
DPW Town Engineer: Signature:
Comments
_Comments
i y 1 E
4 Located 384 Osgood Street
FIRE DEPARTMENT - Temp D�eron yes no
Located at 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 department use
® Notified for pickup - Date
Doc:.Building Permit Revised 2008
-- - -- -- - -- - r
Plans_Su.h—;.,-.__,-r:-1-
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 of Bldg permit
❑ Engineering Affidavits for Engineered products
Department prior to issuance
NOTE: All dumpster permits require sign off from
- 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 Contractrinkler Plan And
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sp
Hydraulic Calculations (If Applicable)
❑ Mass check Energy compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
' sign issuance of Bldg Permit
NOTE: All dumpster permits require gn off from Fire Department prior to
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 Affidavitrinkler Plan And
❑ Two Sets of Building Plans (One To Be Returned) to Include Sp
Hydraulic Calculations (If Applicable)
� ❑ Copy of Contract
❑ Mass check Energy Compliance Report
D ❑ Engineering Affidavits for En olff from Deproducartment prior to issuance of Bldg Perr
Fl NOTE: All dumpster permits require sig
stamp Appeals
Lc p and roof of recordir
In all
cases if a variance or special permit was required the Town Clerks office Re ist y of Deeds. copy the )Bpoard of
Fi ghat the appeal period is over. The applicant must then get this recorded at t g
must be submitted with the building application
CO;
Doe: Doe.Building permit Revised 2008mi
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APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION
Building Permit # ?5 / — //
ADDRESS/LOCATION OF PROPERTY 43,bl e�--iylP/,e6-
Map /D 7C Parcel 160A112 Lot Number
SUBDIVISION C:,). &-,LtAP, I). `l I LLA6 ,Lz--
DATE REQUESTED FILED/READY FOR INSPECTION
CLOSING DATE ON PROPERTY:
ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE-
INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE
DOES NOT MEET ALL APPLICABLE CODES
Peiinit Issueii : (22CH A•F—e Il I LLAT zZ•c
Address 029 7
CONSERVATION
PLANNING'
DPW, WATER METER
SEWERIWATER CONNECTION
NOTE
W.
ROUT_
UJ
DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO
SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST
DPW
Signature
Fite: Application for OC form revised Jan 2007
y
ke
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Q
84.0'
EASEMENT
i
LOT8
LOT6
11.5'
II
FOUNDA TION LOCA TION
CLIENT.- ORCHARD VILLAGE, LLC
THIS CERTIFICATION IS MADEAND LIMITED TO THEABOVE CLIENT
LOCA TION: NOR TH ANDO VER, MA.
X22 '
l EASEMENT
/ \,,H OFAtq
MICHAEL 9�
J
SERGI
No.33191sN�
y
/ FESS10
(\ �"VD SURVE�O�
THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY
PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXCEPT WITH
THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC.
FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY
OF CHRIS TIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS
PROHIBITED. CHRISTIANSEN &SERGI TAKES NO RESPONSIBILITY
FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY
INFORMATION CONTAINED HEREON.
DATE.•6/10/11 SCALE.•1"-30' BASED ON SCALED DA TA ONL Y THE PRIMARY STRUCTURE
SHOWN IS NOT LOCATED INA FLOOD HAZARD ZONE AS SHOWN
ON FEMA FLOOD INSURANCE RATE MAP. COMMUNITYNO.: 250098
0008C DATE.•61211993ZONE.X
PROFESSIONAL ENGINEERS & LAND SURVEYORS
CHRIS TIANSEN & SERGI, INC.
160 SUMMER STREET, HAVERHILL, MASSACHUSETTS 01830
WWW.CSI-ENGR.COM TEL. 978-373-0310 FAX 978-372-3960
D WG. NO.: 06029.001.047
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 2
CITY: North Andover
STATE: Massachusetts
HDD: 6322
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 6-8-2011
DATE OF PLANS: 08/08/09
TITLE: The Foxbrook lot 7
PROJECT INFORMATION:
Orchard Village
36 Empire Drive
North Andover, MA
COMPANY INFORMATION:
Messina Development Co., Inc.
COMPLIANCE: PASSES
Required UA = 574
Your Home = 567
Permit #
Checked by/Date
Area or
Cavity
Cont.
Glazing/Door
Perimeter
-------------------------------------------------------------------------------
R -Value
R -Value
U -Value
UA
CEILINGS 841
38.0
0.0
25
WALLS: Wood Frame, 16" O.C. 2729
21.0
0.0
156
BSMT: Conc. 8.0' ht/8.0' bg/8.0' insul 0
0.0
0.0
0
GLAZING: Windows or Doors 239
0.320
76
DOORS 69
0.310
21
FLOORS: Over Unconditioned Space 1240
0.3
0.0
289
HVAC EQUIPMENT: Furnace, 96.0 AFUE
HVAC EQUIPMENT: Air Conditioner, 13.0 SEER
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building
design described
here is
consistent with the building plans, specifications,
and
other
calculations
submitted with the permit application. The
proposed building
has been
designed to meet the requirements of the Massachusetts
Energy
Code.
The heating load for this building, and the cooling load if appropriate,
has been determined using the applicable Standard Design Conditions found
in the Code. The HVAC equipment selected to heat or cool the building
shall be no greater than 125% of the design load as specified in
Sections 780CMR 1310 and J4.4.
Builder/Designer Date
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ceilings, walls, and floors.
MATERIALS IDENTIFICATION:
Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R -values, glazing U -values, and heating and
cooling equipment efficiency must be clearly marked on the building
plans or specifications.
DUCT INSULATION:
Ducts shall be insulated per Table J4.4.7.1.
DUCT CONSTRUCTION:
All accessible joints, seams, and connections of supply and return
ductwork located outside conditioned space, including stud bays or
joist cavities/spaces used to transport air, shall be sealed
using mastic and fibrous backing tape installed according to the
manufacturer's installation instructions. Mesh tape may be
omitted where gaps are less than 1/8'inch. Duct tape is not
permitted. The HVAC system must provide a means for balancing
air and water systems.
TEMPERATURE CONTROLS:
Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict or shut off the heating
and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
Rated output capacity of the heating/cooling system is
not greater than 1250 of the design load as specified
in Sections 780CMR 1310 and J4.4.
SWIMMING POOLS:
All heated swimming pools must have an on/off heater switch and
require a cover unless over 20% of the heating energy is from
non-depletable sources. Pool pumps require a time clock.
HVAC PIPING INSULATION:
HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F must be insulated to the following levels (in.):
CIRCULATING HOT WATER SYSTEMS:
Insulate circulating hot water pipes to the following levels (in.):
PIPE SIZES (in.)
NON -CIRCULATING CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+"
PIPE
SIZES
(in.)
HEATING SYSTEMS:
TEMP (F)
2" RUNOUTS
0-1"
1.25-2"
2.5-4"
Low pressure/temp.
201-250
1.0
1.5
1.5
2.0
Low temperature
120-200
0.5
1.0
1.0
1.5
Steam condensate
any
1.0
1.0
1.5
2.0
COOLING SYSTEMS:
Chilled water or
40-55
0.5
0.5
0.75
1.0
refrigerant
below 40
1.0
1.0
1.5
1.5
CIRCULATING HOT WATER SYSTEMS:
Insulate circulating hot water pipes to the following levels (in.):
PIPE SIZES (in.)
NON -CIRCULATING CIRCULATING MAINS & RUNOUTS
HEATED WATER TEMP (F): RUNOUTS 0-1" 0-1.25" 1.5-2.0" 2.0+"
Massachusetts Energy Code
MAScheck Software Version 2.01 Release 2
The Foxbrook lot 7
DATE: 6-8-2011
CEILINGS:
1. R-38
Comments/Location
WALLS:
1. Wood Frame, 16" O.C., R-21
Comments/Location
BASEMENT WALLS:
1. Conc. 8.0' ht/8.0' bg/8.0' insul, R-0 (uninsulated)
Comments/Location
WINDOWS AND GLASS DOORS:
1. U -value: 0.32
For windows without labeled
# Panes Frame Type
Comments/Location
DOORS:
1. U -value: 0.31
Comments/Location
U -values, describe features:
Thermal Break? [ ] Yes [ ] No
FLOORS:
1. Over Unconditioned Space, R-0.3
Comments/Location
HVAC EQUIPMENT:
1. Furnace, 96.0 AFUE or
Make and Model Number
2. Air Conditioner, 13.0
Make and Model Number
higher
SEER or higher
AIR LEAKAGE:
Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. When
installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated, manufactured with no penetrations between the
inside of the recessed fixture and ceiling cavity and sealed or
gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated, in accordance with Standard ASTM E 283, with no
more than 2.0 cfm (0.944 L/s) air movement from the the
conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure
difference and shall be labeled.
VAPOR RETARDER:
Required on the warm -in -winter side of all non -vented framed
I 170-180 0.5 I 1.0 1.5 2.0
140-160 0.5 I 0.5 1.0 1.5
I 100-130 0.5 I 0.5 0.5 1.0
I
----NOTES TO FIELD (Building Department Use Only)-------------------------
The Commonwealth of Massachusetts
Department of IndustrialAccidems
Office of Investigations
600 Washington Street
Boston, MM 02111
Ur. www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le�><bly
Name (Business/Organization/Individual):—Dk,'/, j A r h 011 11 / IA% f= l/
Address:
City/State/Zip o�p �, qZI Phone #: ` 7p- 641--31a 2. -
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2.W I am a sole or
have hired the sub -contractors
listed
proprietor partner-
on the attached sheet. t
ship and have no employees
These sub -contractors have
working for mein any capacity.
[No workers' comp. insurance
workers' comp, insurance.
5. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their'
right of exemption per MGL
myself. [No workers' comp.
C. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
.�,U n1l UUL me seion below showing their workers'
HomecOmPensation owners icy inrmation.
who submit this affidavit indicating they are doing all work and then hire outside contractors mast submi a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #:
Expiration Date:
Job Site Address: City/State/Zip-
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as 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.
____1_7_1>A _L M -- - -
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):
I. Board of Health 2. Building Department 3. City/Town Clerk
6. Other
1.9
4. Electrical Inspector 5. Plumbing Inspector
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, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers', compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy; please call the Department at the number listed below. Self-insured companies should enter their
,self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)" A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn 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 Gomu-nonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
IXA- m r maeo rsn—h4-