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HomeMy WebLinkAboutBuilding Permit #109-13 - 401 STEVENS STREET 8/8/2012 BUILDING PERMIT RT TOWN OF NORTH ANDOVER 00 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 04Ar..spa �5 �SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page 177'".,Ylt`.)t VA X-i- 1-Print I'V 2.4 q llag Machine yes' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential t--<ew Building vOne family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other 0. ters- t Cl 71�'�I�— DESCRIPTION OF WORK TO BE PREFORMED: dentiffication. Please ype or Print Clearly) OWNER: N a:MEel,,: Phone:J Address: S -T! 4 "h-hP -o -X nnp rta JTRAQ-T e!, o 4 'Exp riq, .-S C i'§trudti6hrbigen,s .X040- e;- Home mp 6-v en6lifib-dr�s Ei ' ARCHITECT/ENGI NEER Phone: ?-7Y--V5eP Address: � Reg. No. FEE SCHEDULE.BULDING PERMIT:VZOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3/,r,, eea FEE: $ e4l,. Check No.: Receipt No.: NOTE: Persons contracting * unregistwead contractors do not have access e g4uara4nnd w" S ibh�tb�b 6f Signature of A-7-6S 3-0- Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales I 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 g COMMENTS n � CONSERVATION Reviewed on b g 1 Si nature L COMMENTS . T/ l C� 7 r HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature&D4mm ate Dnv 2 i T DPW Town Engineer: Signature:(6ew- &-u�rwms � ' a e 84 s ood Stre _ - f lea. -. :.�'i;. - t�,a;•.^,`.. �..r t. r. s w�• ,a rid+ d; FIRE'DEPARTMENT -;Temp Dumpster-on site` yes } snot ., ; 1 , r• Loca`tetl at124�Man S rt @2t " tgr ,rFs 'r:{ ;� ?"^( fit > �. a � .; •sss:.--,a�.�y �. i'r Fire Department is gnature/dat -1""': *, r � 3 � '� -� ,'.t� r rr •� � � r rt' `�';< -t -, � `�-R a ^+^i 1 _ "r-�s-�*.,— '�' r �°+. r`.,,P II Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions.W-314V Total land area, sq. ft.:�_6S�,.Z 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 i NOTES and DATA— (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2008 Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT g COMMENTS .54 P&'n rev�o� CONSERVATION Reviewed on b g 1 Si nature L J��— U. t�lCOMMENTS - �il lY 7 Y HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments f � � Water & Sewer Connection/Signature &Dated Dnv 2 It DPW Town Engineer: Signature:(6ee-- &-u?�-r a e 84 s ood streef rF +y: t f E. 1 Spa t 'FIR ;DEPARTMENT€ ,Temp Dumpster•on t ''1�k+ R'`\ _,.�..f .;.,{ Loc-_attediat�124*MainStreet= Fi�eDepaitment'signature/date � x .: Af ,. Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing g, 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 En ineered products t g 9 9 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit E 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) o 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) i w/ Building Permit Application w/ Certified Proposed Plot Plan R/ Photo of H.I.C. And C.S.L. Licenses @/ Workers Comp Affidavit w' Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract m Mass check Energy Compliance Report ia' Engineering g _ g Affldavlts 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 thenget 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 �� � � � �,�� �� i �+ �� ��� NORTH Town of , _ s E -Andover 0 Zip . q No. — t - , h ver, Mass, cocKic"IWICK �01• S V BOARD OF HEALTH PERMI� T T LD Food/Kitchen tic Sys em THIS CERTIFIES THAT ....... .. .: ��....... �f . �s.v.. ......r�7.. °I. .................................. , BUILDING INSPECTOR has permission to erect ...... ............ buildings on ..f-,.r.:.l.... ............ ... ........ .. ...................... -� 40 6 to be occupied as ........... .... ........................... ....... ........... .. ............. C ney provided that the person accepting this permit shall in every respect conform to the terms of the application Final d on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBI II SP,E OR f /�L L G�•G.VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough / z ,llr=U/?+ Zy,,,�j Final . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS 42 ,V� 16-/s-/2- . Service 4' )fj /'S—/2- ................ .� I" �t1'.`.'..�:.......................... P_ 1 BUILDING INSPECTOR AEc l2-t --tZ � CW GAS INSPECTOR Occupancy Permit Required to Occupy Building Ro "`" ' ° C1�6/1L � �� 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. ��-�,�' `�•-�� o SEE REVERSE SIDE Smoke Det. GENERAL BUILDING NOTES/CHECKLIST- NOT LIMITED TO ITEMS BELOW POST ALL LOT NUMBERS, ADDRESS, AND PERMIT(COPY 0K)..or no inspections INSPECTIONS: (Minimum) Excavation , Footing, Foundation, Frame, Insulation, Final. FOOTINGS: Continuous Full 2x4 Keyway Continuous strip footings for interior columns FOUNDATION: Rebar as required Anchor bolts or straps Damproofing Foundation drain-pipe/stone/fabric filter/cover and outlet connection. FRAME:Fireblock-over girts/plates between floor joist Penetrations for plumbing, heat,elec, etc. Walls at stair stringers. Windbrace corners and center bearing partitions. Size ridge to provide full bearing at rafter cuts. Hip and Valley rafters-watch bearing at walls. Ridge&Hip- Provide proper connections. Cathedral roof rafters provide proper connections and use"Hurricane Clips"tie to plate. Stair stringers-watch cuts and heal support. Joist hangers-fully nailed w/hanger nails. Sill plates 2-2X6(1 PT)w/sill seal. Girts-solid brick or steel plate bearing at foundations '/2"air space at sides in foundation pockets. Lateral bracing at ends. Certified calculations. required for Beams/LVL's Trusses. Solid bearing support for Headers/Beams etc. • Check headroom clearances-stairways, under beams Attic Access. (min.22x30 w/3' headroom above). 1 . Crawl space access. (min. 18x24). Bath exhaust fans to have metal duct to exterior(not in soffit). f Firecode S/R wood frame of"0"clearance fireplaces&stoves Window Schedule or Every Habitable Room Must Have: Natural light equal to 8%of floor area. 'A of required glazing shall be openable. Bedrooms required min.20x24 egress window or door. Vent attic spaces-"proper vent", soffit and required ridge vents. Firecode under stairs if used for storage FIREPLACES: Separate permit required. Inspections at Footing-Smoke Chamber-Finish Smooth parging, clean joints, 8"solid @ combust. DECKS: Lag to house, provide flashing. Rails min. 36" high, Baluster max space 4"on center. Over 8'above grade, use 6x6 posts w/lateral bracing. Lag all posts and rails. Pier footings down 48", Conc. pad at stair base. FINISH: Handrails returned to wall/newall post. Guardrails required alongside open cellar stairs. Exterior grading complete. Certificate or occupancy required prior to occupying structure. Temporary Stairs required for inspection. Re-inspection fee- $30.00(Be Ready). Certificate of occupancy required prior to occupying structure. NORTH own of EAndover O ,� y 0 E No. h h ver, Mass, ��- 11 cocHIc„ewIcw �1 ��S RATED 1'Pa,`'�5 V BOARD OF HEALTH Food/Kitchen PERMI' T T LDtic Sys em THIS CERTIFIES THAT ��' .......��.` �::: .,�.441.!h......�1..'.' BUILDING INSPECTOR has permission to erect .......................... buildings on . .. ............................. .................................... � - ...� /4=? �; �r�°` .���s .�.."'. ..:............. `� Od00 to be occupied as ......... :.................... . ...... .. .. C ney .. provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and p Y g p Construction of Buildings in the Town of North Andover. PLUMBI I SPE OR Rough /� eat', VIOLATION of the Zoning or Building Regulations Voids this Permit. 1�/ Final, Z PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Service 4� J0, rS/2. n i .................. . r '. ... ..::Ca'e:.' :..:....................... BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. NORTH own of t ndover No. _ - IL Z " w. C' h ver, Mass, COCMICNl WICK �1' A0AATEO S V BOARD OF HEALTH Food/Kitchen PERMI� T T LD Mtic Sys em THIS CERTIFIES THAT ...... ���......: f'. .4Y� �..�j �� BUILDING INSPECTOR has permission to erect .......................... buildings on ........ ............................. .................................... to be occupied as C �iSi . . � /! / fi " ...� . .:... ..:............. ney ............ .. . P .................. ... � cp ......... . ........ provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and �I /� Construction of Buildings in the Town of North Andover. -, P.LLIMBI I SP.E OR f '. i"_ Rough ��, f,�� fk"'A c,�G. /4L VIOLATION of the Zoning or Building Regulations Voids this Permit. Final. / Z PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Service �� ��, /S'—f ................ �4: : €. .j.®.,� .......................... n I' ! BUILDING INSPECTOR V� GAS INSPECTOR Occupancy Permit Required to Occupy Building Rod�� o G/�6/iz �`T Display in a Conspicuous Place on the Premises — Do Not Remove Final L� No Lathing or Dry Wall To Be Done FIRE DEPARTMENT 1 Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke het. SEE REVERSE SIDE V,2 I,�r-1L2 NORTH f A CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 109-13 on 8/8/2012 Date: December 18, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 421 Stevens Street 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: Natalie Kindred and Matt Schiff P.O. Box 483 North Andover,v MA 01845 85 Bui ding Inspector Fee: Pre Paid Receipt: 25592 Check : 103 Taj Engineering Consulting Engineers 7 Montview Road Chelmsford, MA 01824 T: 978-430-4585 tajengg@aol.com To Whom It May Concern October 23, 2012 Reference: Single Family Dwelling 421 Stevens Street,North Andover, MA 01845 LVL Connections Structural Inspection At the request of Kindred Homes, Inc. we have inspected the structural connections of The LVL beams for the building located at the above referenced address. We found the installed LVL connections per the standard technical practice and procedures and per the recommended specifications. Please do not hesitate to call with any questions or clarifications. Sincerely, ` VA ' Taj Engineering ° TODD Todd L. T. Hedl PE � Ift 4M Associate NORTH own o t E : �, Andover O ^ �` 0 No. oLAK41 h ver, Mass, �J cocNu„!WICK �1 7,�A�R.tTED ►'Pa,��(5 S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �?%�...�.`X .�. �...... �' �� BUILDING INSPECTOR . �� SC� Foundation has permission to erect .......................... buildings on ..�7.1.-i°........... ................. .................................... �lJ�'I � � � ��! ✓�/�� ���� Rough to be occupied as ............�� S. ................/N ......................... ................... ............... Chimney ..... provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough ............ Service .................. .......'e���. .' .:✓A �r.'�:.............. Final I1 BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz; 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. Smoke Det. SEE REVERSE SIDE Bk 12774 Pg12 #755 140 Academy Road Map 96,Parcel 33 Land Disturbance Permit August 2,2011 p) A pre-construction meeting must be held with the developer, their construction employees, Planning Department and Building Department (and other applicable departments) to discuss scheduling of inspections to be conducted on the project and the construction schedule. I 4) PRIOR TO THE ISSUANCE OF A BUILDING PERMIT a) A Plot Plan for the lot in question must be submitted to include the following: a. Location of the structure b. Location of the driveway c. Location of all water and sewer lines d. Any grading called for on the lot e. Location of drainage,utility and other easements. f. Location of landscaping b) All appropriate erosion control measures for the lot shall be in place. c) All catch basins shall be protected and maintained with hay bales to prevent siltation into the drain line during construction. s d) The lot in question shall be staked in the field. The location of any major departures from the plan must be shown. e) Lot numbers,visible from all roadways must be posted on all lots. 5) PRIOR TO THE RELEASE OF THE PERFORMANCE BOND: a) The applicant is required to install a final pavement overlay on Stevens Street, starting at the last cross trench near Great Pond Road, extending to the existing sewer manhole in Stevens Street, approximately 300' northeast of the northern most point of lot b. This work must be inspected and approved by the Department of Public Works. b) The applicant shall submit an as-built plan stamped by a Registered Professional Engineer in Massachusetts that shows all construction, including storm water mitigation trenches and other pertinent site features. This as-built plan shall be submitted to the Town Planner for approval.The applicant must submit a certification from the design engineer that the site was constructed as shown on the approved plan. c) All activity,exclusive of maintenance required in perpetuity, permitted by the Land Disturbance Permit must be completed within two years of permit issuance.Extensions of time can be granted by the Planning Board upon formai written request by the applicant, in accordance with Section 160.5.M of Town of North Andover Bylaws,Chapter 160,Stormwater Management and Erosion Control Bylaw. I d) The Planning Board will issue a Certificate of Completion upon receipt and approval of final reports and documentation as outlined in the Regulations and/or upon otherwise determining that all work of the permit has been satisfactorily completed in accordance with the Stomrwater Bylaw. The Certificate of Completion shall be recorded at the Essex North District Registry of i 6 I L LT)Boise Cascade Quadruple 1-3/4" x 9-1/2" VERSA-LAM® 2.0 3100 SP Floor BeamT1301 BC CALC®3.0 Design Report-US 1 span No cantilevers 10/12 slope Wednesday,July 25,2012 Build 517 , File Name: BC CALC Project Job Name: /15K41b,'?e3 Description:FBO1 Address: Specifier: City, State,Zip: , Designer: Customer: Company: Code reports: ESR-1040 Misc: I I 12-06-00 BO B1 LL 4,000 lbs LL 4,000 lbs DL 1,617 lbs DL 1,617 lbs I Total of Horizontal Design Spans= 12-06-00 Live Dead Snow Wind Roof Live Trib. Load Summary Tag Description Load Type Ref. Start End 100% 90% 116% 133% 925% 1 Standard Load Unf.Area(psf) L 00-00-00 12-06-00 40 15 16-00-00 Controls Summary Value %Allowable Duration Case Span Disclosure Pos, Moment 17,553 ft-lbs 62.9% 100% 1 1 -Internal Completeness and accuracy of input must End Shear 4,840 lbs 38.3% 100% 1 1 - Left be verified by anyone who would rely on Total Load Defl. U304(0.494") 79.0% 1 1 output as evidence of suitability for Live Load Defl. 0427(0.351") 84.4% 1 1 particular application.Output here based 0.494" 49.4% 1 1 on building code-accepted design Max Defl. Span J Depth 0.49 1 properties and analysis methods. p p n% Installation of BOISE engineered wood products must be in accordance with Notes current Installation Guide and applicable Design meets Code minimum (0240)Total load deflection criteria. building codes.To obtain Installation Guide or ask questions,please call Design meets Code minimum(U360)Live load deflection criteria. (800)232-0788 before installation. ' Design meets arbitrary(1") Maximum load deflection criteria. Minimum bearing length for BO is 1-1/2". BC CALCa,BC FRAMERO,AJSTM 4 Minimum bearing length for B1 is 1-1J2'. ALLJOIST(D,BC RIM BOARDT"' BC19), i Entered/Displayed Horizontal Span Length(s)=Clear Span+ 1/2 min. end bearing+ BOISE GLULAMT'" SIMPLE FRAMING 1/2 intermediate bearing SYSTEMS,VERSA-LAME,VERSA-RIM PLUS®,VERSA•RIM@, VERSA-STRANDS),VERSA-STUDS are Connection Diagram trademarks of Boise Cascade Mod Products L.L.C. a : I c i a minimum=2" c=5-112" b minimum=2-1/2"d =24" Beams 7 inches wide will be assumed to be either top-loaded only,or equally loaded from each side. Bolts are assumed to be Grade A307 or Grade 2 or higher. Member has no side loads. Connectors are: 1/2 in. Staggered Through Bolt Page 1 of 1 t REScheck Software Version 4.4.3 Compliance Certificate Energy Code: 2009 IECC Location: North Andover,Massachusetts Construction Type: Single Family Building Orientation: Bldg.faces 315 deg.from North Conditioned Floor Area: 2544 ft2 Glazing Area Percentage: 12% Heating Degree Days: 6322 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: 421 Steven st Powder Hill Development Corp Eric Kline North Andover,MA PO Box 131 J&J Heating and Air Conditioning Boxford,MA 01921 17 Arlington st Dracut ma,MA 01826 Compliance:1.8%Better Than Code WPM 'fit'.. �' C•T>'�.. Ceiling 1:Flat Ceiling or Scissor Truss 1064 38.0 0.0 32 Ceiling 2:Cathedral Ceiling 416 38.0 0.0 11 Floor 1:All-Wood Joist/rruss:Over Unconditioned Space 1064 30.0 0.0 35 Wall 1:Wood Frame,16"o.c. 800 21.0 0.0 35 Orientation:Front Window 1:Vinyl Frame:Double Pane with Low-E 165 0.280 46 SHGC:0.22 Orientation:Front Door 1:Solid 21 0.300 6 Orientation:Front Wali 2:Wood Frame,16"o.c. 568 21.0 0.0 31 Orientation:Right Side Window 2:Vinyl Frame:Double Pane with Low-E 30 0.280 8 SHGC:0.22 Orientation:Right Side Wall 3:Wood Frame,16"o.c. 800 21.0 0.0 38 Orientation:Back Window 3:Vinyl Frame:Double Pane with Low-E 99 0.280 28 SHGC:0.22 Orientation:Back Door 2:Glass 26 0.300 8 SHGC:0.27 Orientation:Back Wali 4:Wood Frame,16"o.c. 448 21.0 0.0 26 Orientation:Left Side Furnace 1:Forced Hot Air 95 AFUE Air Conditioner 1:Electric Central Air 13 SEER Compliance Statement: The proposed building design described here is consistent with the building plans, P lans,s ecifications and other calculations submitted with the permit application.The proposed building has been designed to meet the 2009 IECC requirements in REScheck Version 4.4.3 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title: Report date:07/26/12 Data filename: Untitled.rck Page 1 of 4 I REScheck Software Version 4.4.3 Inspection Checklist Energy Code: 2009 IECC Location: North Andover,Massachusetts Construction Type: Single Family Building Orientation: Bldg.faces 315 deg.from North Conditioned Floor Area: 2544 ft2 Glazing Area Percentage: 12% Heating Degree Days: 6322 Climate Zone: 5 Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation Comments: ❑ Ceiling 2:Cathedral Ceiling,R-38.0 cavity insulation Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: ❑ Wall 2:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: ❑ Wall 3:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: Cl Wall 4:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: Windows: ❑ Window 1:Vinyl Frame:Double Pane with Low-E,U-factor:0.280 For windows without labeled U-factors,describe features: #Panes_Frame Type Thermal Break?_Yes_No Comments: ❑Window 2:Vinyl Frame:Double Pane with tow-E,U-factor:0.280 For windows without labeled U-factors,describe features: #Panes_Frame Type Thermal Break?—Yes—No Comments: ❑ Window 3:Vinyl Frame:Double Pane with Low-E,U-factor.0.280 For windows without labeled U-factors,describe features: Wanes_.Frame Type Thermal Break?_Yes_No Comments: Doors: I ❑ Door 1:Solid,U-factor:0.300 Comments: ❑ Door 2:Glass,U-factor:0.300 Comments: Floors: ❑ Floor 1:All-Wood JoistlTruss:Over Unconditioned Space,R-30.0 cavity insulation l Comments: I` � Project Title:. ---Report date:07/26/12 Data filename: Untitled.rck Page 2 of 4 I - - — - r i 2009 IEC C Energy [efficiency Certificate Ceiling/Roof 38.00 Wall 21.00 Floor/Foundation 30.00 Ductwork(unconditioned spaces): £d r.. - Window 0.28 0.22 Door 0.30 0.27 Forced Not Air Furnace Electric Central Air Conditioner Water Heater: Name: Date: Commanta: TOWN OF NORTH ANDOVER MASSACHUSETTS NORTH ANDOVER OLD CENTER. HISTORIC DISTRICT COMMISSION October 6,20 10 TO W-IOM IT N-11GHTCONCERN: Please be advised that the land owned by Robert Steven consisting of 5 buildable lots on Stevens is not in the historical District and consisting does not need commission approval. Any questions please call me at 978 685 5000. Sincerely: George H. Schruender,Jr. Chairman North Andover Old Center Historical District Commission 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): Address: City/State/Zip: j--Phone#: AYana u n employer?Check the appropriate box: Type of project(required): 1. a employer with D 4. ❑ I am a general contractor and I 6. ❑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. # E]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.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]i employees. [No workers' 13.❑ 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 employees. Below is the policy and job site information. Insurance Company Name: Sz'eC Policy#or Self-ins.Lic.#: �;t6/r,2_ Expiration Date: Job Site Address: ,3A3 City/State/Zip: (/4<�2/i��i�/�fL� 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 certtf der the pains and penalti of rjury the information provided above is trite and correct. Si nature: 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,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 Commonwealth 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 www.mass.gov/dia '���tr CERTIFICATE OF LIABILITY INSURANCEDATE2012(MM,DDNYYY) 7/20/ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement Astatemefd on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAME: M P Roberts Insurance Agency Inc A/CC.N Ext): 978-683-8073 wc,Ne):978-683-3147 1060 Osgood Street ADOREss: Sandi@mprobertsinsurance.com North Andover Ma 01845 INSURER(S) AFFORDING COVERAGE NAIC/ INSURER A: ESSEX INSURANCE CO INSURED RED TAIL DEVELOPMENTCORP A/0 NORTHEAST INSURER B: ASSOCIATED EMPLOYERS INS CO DEVELOPERS LLC A/0 KINDRED HOMES INC INSURER C: P.O. BOX 483 INSURER D: NORTH ANDOVER, MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILN R TYPE OF INSURANCE POLICY FAP POLICY NUMBER (MM/DDM Y1� (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 50,000 ====r CLAIMS-MADE I=,OCCUR MED EXP(My one person) $ EXCLUDED A 3DG4119 7/22/117/22/122 PERSONAL&ADV INJURY $ 1,000,000 3DJ8068 7/22/127/22/13 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ EXCLUDED POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY UOMBINEU SINGLE LIMIT Ea accident _ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ H — I $ NON-OWNED PROPERTY D AGE HIRED AUTOSAUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION WC S A IJ OTH- AND EMPLOYERS'LIABILITY Y/N / TORY UMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A WCC5008521012011 8/1/11 8/1/ 12 E.L.EACH ACCIDENT $ 500,000 B (MandatoorykIn NH)E(cLUDED7 WCC5008521012012 8/1/12 8/1/13 E.L.DISEASE-EA EMPLOYEE is 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AttachACORD 101,Addhional Remarks Schedule,if morespaceis required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER NORTH ANDOVER MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE / THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REP IVE Ito to It f ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD