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HomeMy WebLinkAboutBuilding Permit #Exception - 407 WOOD LANE 5/1/2018 BUILDI VG PERMIT o`"°oT b qti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION y h O LnN Permit No#: Date Received �SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION. Print PROPERTY OWNER q/ Print 10D Year Structure yesAno MAP _. -_PARCEL: _ p -- ZONING DISTRICT _ _-Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well 0 Floodplain p Wetlands ❑ Watershed bisttict ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: I Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: .,--,Phone,--. 86 ,. Address: Supervisor's Construction License: -2-_1 LJ 3 Exp. Date: Home Improvement License:-L3-,C3/.Z 1Exp. Date:_ _ .,_a- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: eipt o.: Af NOTE: Persons contracting with unregistered contractors t e ac s to a uara and g g f Signature of Agent/Owner _ - Signat_ contra for I I� 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/Cross Section/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 Doe:Building Permit Revised 2014 I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE*OF SEWERAGE DISPOSAL Public Sewer X 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature/-'Ll COMMENTS 12i HEALTH Reviewed on Signature � r/ COMMENTS per_ S� . ,�— As Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood Street :FIRE DEPARTMENT - Temp Dumpster=on site yes _ _ no . Located!at 124-Main Street -- Fire'Department signature/date . t 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 4A---tj 6&� NOTES and DATA— (For department use) QIL LAI V%� 04-)V1Q i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 ��� C" ti �- q ���oew�Q hInformation Form {pient. If no insurance information is available lease fill int): *Required Fields +.of birth: * Age* re (Circle)* Female Pth Day Year Zip:* Phone:* and any letters that are part of that number umber:* Group ID Number: (if available) jrimary? Is Subscriber Employed? fes No Yes No complete the following: Subscriber's Date of Birth: * Sex: (Circle)* Male Female Month Da Year #Zip: * Phone:* r V NORTI� Town of ndover O No. ti ffi h ver, Mass, T 0� IANE A- A, .A s � BOARD OF HEALTH Food/Kitchen PERMIT TJ (f LD Septic System THIS CERTIFIES THAT 5;7 .eLd..r..�........I +� ��— ,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR ............... ...................................................... has permission to erect buildings on ....... Foundation Rough tobe occupied as .......... ,( I.1 v.............................................................................................. 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 CONSTRUCTION STARTS Rough Service ................................................................................ Final 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. Location �6nr- No. _ ` Date — e - TOWN OF NORTH ANDOVER >` a4 Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ' ' Other Permit Fee $ �. TOTAL $ Check# 28074 Building Inspector Location No. r Date . • TOWN OF NORTH ANDOVER , Wtittibate of Occupancy $ s �13 ii ing/Frame Permit Fee $ _ , Foundation Permit Fee Other Permit Fee �$ �,. TOTAL`'- $ Check# ' 28074 Building Inspector Location No.`3�q r Date . . - TOWN OF NORTH ANDOVER • 5' • • Certificate of Occupancy $ N B[iilding/Frame Permit Fee $ ,Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# �' Building Inspector 1J/ L'U11/iviull UI . JJ t11V1 M(XL fU'lYLDA 1110UE'VikdL "A Av. JIODU`tGLUJ C, UU1/UU1 0 13MOOR"° ATE CERTIFICATE OF LIABILITY INSURANCEF9/15/2014D IDDIY- 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: A & K Fowler Insurance PHONE (978)664-0366 FAX (978)664-2209 AIC,No Ext: AIC No): 200 Park St E-MAIL INSURER(S)AFFORDING COVERAGE NAIC# North Reading MA 01864 INSURERA:Preferred Mutual Insurance INSURED INSURER B,Arbel la Protection Ins. Co. DiVecchia Brothers Construction Co. Inc. INSURERC:Travelers Insurance Company 6 School Hill Lane INSURERD: INSURER E North Reading MA 01864 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1491506949 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISESS( RENTED 100 000 Ea occurrence) $ i A CLAIMS-MADE ❑X OCCUR CPP0110566728 /14/2014 /14/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PE LOC $ AUTOMOBILE LIABILITY Ee eBINEDISINGLE LIMIT 500,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 1020015432 /12/2019 /12/2015 BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS X NON-OVMVED PROPERTY DAMAGE $ AUTOS Per acadent PIP-Basic $ UMBRELLA LAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION VIC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100 000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 7PJUB0277N71014 /22/2019 /22/2015 UE.L.DISEASE-EA EMPLOYE $ 100,000 es,describe under SCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance Verification CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 120 Main St. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Nicole Orlanzo/NMO ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD North Andover Board of Assessors Public Access Page 1 of 1 NORThNorth Andover Board of Assessors 9SSACHuSEt "` roperty Record Card Click Seal To Return Parcel ID :210/022.0-0068-0000.0 FY:2014 Community :North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge �yL}X"• Search for Parcels Search for Salesr " '� � r._.."ate•_ - �w Summary Residence Detached Structure r Condo 407 WOOD LANE Commercial Location: 407 WOOD LANE Owner Name: PULVERENTI,ANTHONY J ANTONETTE PULVERENTI Owner Address: 407 WOOD LANE City: NORTH ANDOVER State: MA Zip: 01845 Neighborhood:5-5 Land Area: 0.41 acres Use Code: 101-SNGL-FAM-RES Total Finished Area: 1300 sqft ASSESSMENTS CURRENT YEAR PREVIOUS YEAR Total Value: 288,200 288,200 Building Value: 113,600 1.13,600 Land Value: 174,600 174,600 Market Land Value: 1.74,600 Chapter Land Value: LATEST SALE Sale Price: 0 Sale Date: 12/31/1955 Arms Length Sale Code: N-NO-OTHER Grantor: Cert Doc: Book: 00840 Page: 0110 http://csc-ma.us/PROPAPP/display.do?linkld=2432492&town=NandoverPubAcc 9/22/2014 Massachusetts -Department of Public Safety Board of Building Regulations and Standards 1 Construction Supen-isor +' License: CS-087143 ` JOHN DIVECCW 6 SCHOOL HH U AIN NORTH READING NaQ1$ J ) lox 1I, Expiration 05/18/2015 commissioner uoa�vnu�uuea�t o�Co�ac�u.�eGCa Office oirs&Business Regulation f Consumer AffaLicense or registration valid for individul use only before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR egistration: <1:35313 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration -3/221201_6_; Individual Boston,MA 02116 JOHN DIVECCHIA kt x JOHN DIVECCHIA 6 SCHOOL HILL LANE NORTH READING, MA 01864 Undersecretary Not valid withou�signature V:T�HIS'C / zuIi/IVIUly UI . UU AM mm0 ru44Lm1 moumiiur. PHA iuu, U/0004LLUd r, UU1/UU1 o° CERTIFICATE OF LIABILITY INSURANCE DATE 2014 Y) ii ERTIFICATE 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. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: A & K Fowler Insurance PHONE Ext: (978)664-0366 FA No: (978)669-2209 200 Park St E-MAIL INSURER(S)AFFORDING COVERAGE NAIC# North Reading MA 01864 INSURERA:Preferred Mutual Insurance INSURED INSURER ISArbella Protection Ins. Co. DiVecchia Brothers Construction Co. Inc. INSURERC:Travelers Insurance Cam an 6 School Hill Lane INSURERD: INSURER E: North Reading MA 01864 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1491506949 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. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDIYYYY MM DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR CPP0110566728 /14/2019 /14/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 21000,000 X POLICY QCT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 500,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED X SCHEDULED 1020015432 /12/2014 /12/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS X X NOWOVMIED PROPERTY DAMAGE $ HIRED AUTOS AUTOS ,.,accident PIP-Basic $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I J RETENTION$ $ C WORKERS COMPENSATION VAC STATU- 0TH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PRO PRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 7PJUB0277N71014 /22/2019 /22/2015 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance Verification CERTIFICATE HOLDER CANCELLATION (978)688-9542 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Nicole Orlanzo/NMO "; Y. ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD �I PR OPO SED ADDITION /F FI TZGERALD LOCATION: 407 WOOD LANE NORTH ANDOVER ,MA. DATE: SEPTEMBER 11, 2014 SCALE: 1"=20' ZONING DISTRICT: R 4 MINIMUM SETBACKS: FRONT YARD = 30' SIDE YARD = 15' REAR YARD =30' Q�/ v I CERTIFY THAT THE DWELLING IS LOCATED ON THE • V� GROUND AS SHOWN, AND THAT THIS PLAN IS THE RESULT OF AN INSTUMENT SURVEY. h N/F KRES / jH of Mgss cy q 4,600, o� N � STEPHEN P. O \ U DESROCHE ai N0.27699 ¢ O p /STE¢� 1y6 PROFESSIOIXL LAND SURVEYOR DATE: //13; fl O 00' PREPARED BY 36-38) 8,05 7 S.F. ENGINEERING & SURVEYING SERVICES 70 BAILEY COURT HAVERHILL, MASSACHUSETTS 01832 TELEPHONE: (978)-556-0284 IN CONJUNCTION WITH NEPONSET VALLEY SURVEY REFERENCES: DEED BOOK 840 PAGE 110 PLAN NO. 507 .-4p FNo. N 9?8O, ' C,q<C 1 9S� I i FFG h V 99, i o �� l TO 38 5 / N I o 79 1 to O 1'90 1 AprQc � ti LOTS o Lo AREA=1 155.60' DEED 155.60' CALL. GRAPHIC SCALE W 0 0 D L A N E 0 20 40 (IN FEET) 1 Inch - 20 ft. The Cammonwearth of.Il aso,'Ouse'us Pe primint ofXndwjWgI'.AeddatS d •0 waft on street Nostow,,.tom 02111 Worckex0'Coinpemalxoitbsurancefxc-avit: erp •A� �i�a�.� o�a�.�o�. . PX�ase�'xzn.��� '�i� r7111eusiness(Oxga Natiox�Jvdz`t�'c7uaZ}: l� • ( ��< �� ' Address: [ /t " e n an employer?C�.eck the appropx!ate"oXr Typo of project(req*ed} 1, lama emplopex wztb_� 4• h S am.a general contractor and <,. ew constnzction employees(�andloxpaz�tine}T 7iaveliiredt�.e sub-contxactoxc rlis ted on the attached sheet°T 7. EJ Ream adoft 2.Q 1 am a salepropxiotox orpaxtnex OMP and`haveno.employees These Mb-contxaetorshave S. �Demolztzon workers'com i smance. Building addition waldug faxme in ani'capacity. • `. PTO worZ�exs'Camp.z I=ance 5. ❑�e axe a corporation audits 10•r]ElectricalTop airs ox additions reclt�ired. officers have morcised.their light o f exem tion exSVSGB 11..�(1'lumbingxepairs or addwons I El Z am a homeowner doing all work g � p soyseL.�loworlcers'comp. c.152}§1�4},andweliaveno 12,QRoofxePais ixanc�xe ed. employees.EToworkexs'� 13.[]OtTiex comp.7nstixancaxecloixed.] . .Auyapplicar 'hat cbecksho ZmusEatSo Ito ithese�tionbel6wshowingtheiri�orkers'compensatioupolioyinfomration. I omeov,narswho submittbi�affldaYitmdreaiingihey2redoing al worVandthenhiraouisidoconfraotorsmussubnutamewaffldagtindica5ngsuc&. TCm--hactmathe,chdkfliisbox stattachedanadditionalsheetsho�tingtheuameo thesuT�-coAEraeforsandtheiFworkers'comp.rolicyinfozmatzon. I t ur2 ex�tp �aicycrtra�Site `ployiev&I1SvrovIdIng wolkelS,conn0 Or am byeYBeoa7e L`�s mea,CornpanyName:. �olZcy or felt Ins. ic.#: L�� 11 SS G 7 E ix�tionDate: fobSite t ddxess: �D o Af Eaeh,a copy of tie workers'compensatiORT olicy cieclaxatiou page(s'xaws ing'tAe policy mmnhex aMd gpkatzou date). tae to sec�ar�coverage as xec�ixedmtdex�ectifln 25.A.ofN.�'G�c.x52 can leadto the imposition of cximinalpenaTtzes of a e T to$x,500.OD andlox one-Fear imprisonment,.as well.as civilpen:alties in the fom of`a STOP WORT ORDER.axed a fma ofupto$250A0'aday agaiusttheviolator. Beadvised t&tacopy ofthbsfatementmayhefoxwaxdedtothe Of9ce-of hyastigadoaag oftheDSA.fox in=ancecoveragevexiffoation. X&fiezeby ce cXe t e itirt� c pevalties rerfta v trial Ate in a �nntiox�p�ovic ec r�t7ove i ue a�tc co zee, afar°• Date: —�`O Q�ciaZ�,sc��try, dJo r2oi w.rzte in trti�a�ett,tQ rie cox�retert riy e�z�a.��ot�o�ezai: City or Town: BerxaitlLicezise� f8sulagAntlaoffly(ckcle une}. 1.Board offealth?.BuildiUPOParim.ent 3.CifylT'owA Cle& 4.DlectAcal l':uspector 5.TfAmbingfaspector f.Other i Information and Instructions Massachusetts Gene . . xal Laws eha e t 5 p x 1 2 xec�ires all em to exs to xovide o e � y .� w xlz xs compensationf'oxthe�employees. Pursuant fo tSiis statr�te,an e�� loyee is defMed as",-evex,�pexson M—lb service of amthex under any contract o aa,, express orim0ed,oral o,-Vdtten." Alt erqroyee:is defined as"an individual,partnership,association,corporation ox otherlegal entity,q anytwo oxmoxe' . ofthe oxegoxn engagediaxajoiuzenterprise,and ncluding- a legal receiverr oa tisfee ot'aa 3ndzstidual, raztuersl p, xepxesenfafzvesofadeceaseden le asscationor berlegal MAY, e ployees, x1 11 .ovxerhh owxtero�.a dwellin liouseha ` g vrngnotxrtoxetha7zfbxeea e fs d paxtm n andwhoxesidesexeirt,orthe occupantoffhe w0l& bause o,,a o. e g n th r who employs persons to domaintenance,constnxctzon oxrepaix wog ori such.dwelling house or onfhegxoums oxbuildingappuxienaaffhexefo shallnotbecause of such em to e t se n be deemedt p y�. o be an.eanployex MGL chaptex 152,§25C(6)also states that"every state or local fle-ensiug agency shall withltold the issuance or renewal of a license or permit to operate a business or to comixuet buildings in the:commonwealth for:any �pplicauf who has xtot pxoduced•acceptabla evidence of:co.*m-0Fan.ee wh the insuraHce coverage required." .A.ddiflonally,MaL chapter 152,§25C(7)states"Weitherthe eommonwealthnox an o ' y fits polif1Gal subdiv.Mzons sha11 enfexx-oto�nycontractfor�tepexforman,ceof ublzewor�unf ecce zl table e " e .� vzd nGe of co p rn. Bance wit he" p ht xnsrlaance xecluirementsozfbischapterh.avebeen resenfedtatheco ix c �� p .0 a tin aufhorz , Appllcart g Pleasp m out the workers'compensation affidavit-completely c leteb p y, heclang the boxes that apply to your situatXon and,if 9iecessary,supply sub-confractox(s)name(s),addresses)a114110nenumber(s)alongwitb.their cetacate(s)of :ffiOx'ance, I,irn%tedLzabMYCompanies(LLC)oxLimitedLiabilifyPartnerships(LLI.')wifhno employees othexthattthe members oxpartners,arenotregaredto caxryworkers'compensatianiusurance. 1fanL-C oxLll?�doesbave employees,aPolicy is xogyu red. Be advisedtliaf this afdavitmay be submittedto the,Depart ment of Industrial Accidents fox confirmation ofiusurance covexage. .dlsa b a sure to sign,and crate the aMdavz. !fie affidavit should be xetamddto the city ar town that the application fox theperovt ox license is being xe�ue ted,xto f7�e D attment of IndusfrialAcoidenis. Shouldyouhaveany questionsregardagthe law oxifyouaxexeguixedtoobtakaa*orlt(-,xs" eompensaonpolicy,pleasecalliheDepa?Ementattl� munbexlistedbelow: Selfinsuxeticompanzess7�ouldenteriltesr self-insurance license number on the appropriate lute. Clfy or Tom Officials �'Zeasebesuxefbattbea�izdavifiscomplefeaudpxinfedlegibly. T$eDepaxtmenfhasprovidedaspaceatthebofiom of t O a£ft-Vif foxyou to ill out la the event the Office of XV0sf19aV0nsAas to contactyou regarding the apjRcant. Please be-sure fo z"rll,intho permit/Iicense numbex whieh'WM be used as a reference,number, k addition,an app9cant that must submitrnultiple permit/Iiconso applications:•aay givenyear,need only submit one,affidavit iudicating oway, policyanfoxrrtatfon(h,necessary)andunder rob,Site.Address"the applicanfsbouldwdte`°alllocationsin (city ox tawir)"A copy otlie affidavit fhathas been ofciallysriainped oxmaxltedbytlte city ox town.may bepxovided to the applicant as prflo that a valid affidavit.is an iile ox hep exmiis orRoenses. A n ew aifYdavitmust be filled ouz each Year.WheroalLomaownerorcitizenisobtaiuingalicenseaaybusiaessoxcommercialvenfttre (z,e.adoglicense X iermittoburnleaveseta,)saidperson.isXDTroquhadtocompletethisamdavit. The Office ofInvestigations would Ma to thank you in advance for your coop exatka and should yore have any questions, " please do Rothesitde to give us a call. The.Depattmenfs address,telephone ahclfaxnurnber. 'h C -t?: Ox3l�_�X�ior�•� sac,liv P •q ( Qe Off1wQNRgaV0..A,% 600 aS1:3, QJa, '� Tel 617'H72,t-4.,00 Qd 40,6 ax 1-$77':1 _ revised 5 2 /5 ���K T-76� FR 74. REScheck Software Version 4.5.0 Compliance Certificate Project JOHN DIVECCHIA Energy Code: 2012 IECC Location: North Andover, Massachusetts Construction Type: Single-family Project Type: Addition Climate Zone: 5 (6322 HDD) Permit Date: Permit Number: onstruction e: Owner/Agent: Designer/Contractor: 407 WOOD LANE NO ANDOVER, MA • •: Cornpliance: 0.0%Better Than Code Maximum UA: 94 Your UA: 94 The%Better or Worse Than Code Index reflects how close 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. Envelope Assemblies Ceiling 1: Cathedral Ceiling 521 �' 0.0 0.034 18 Wall 1: Wood Frame, 16" D.C. 629 21.0 0.0 0.057 30 Window 1: Wood Frame:Double Pane with Low-E 61 0.290 18 Door 1: Glass 18 0.320 6 Door 2: Solid 22 0.220 5 Floor 1: All-Wood joist/Truss:Over Unconditioned Space 505 30.0 0.0 0.033 17 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 2012 IECC requirements in REScheck Version 4.5.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Notes: ALL INFORMATION SUPPLIED BY BUILDER Project Title: JOHN DIVECCHIA Report date: 09/23/14 Data fllenam \Users RB96 e: C: Documents\REScheck\DIVECCHIA 407 WOOD LANE NO ANDOVER MA.rck Page 1 of 8 \ \ NotREScheck Software Version 4.5.0 Inspection Checklist Energy Code: 2012 IECC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. Secti,on P a Plans Verified ; ;Eeeld Verified # ,Pre-Ins `ection/;Plan Review torn" lies? CommentstAssumptians . &`Req.117 Value _.Value ❑Com lies 103.1, ;Construction drawings and �k �� � �d� �; p' x 103.2 x ❑Does Not documentation demonstrate [PR111 energy code compliance for the building envelope. N x )❑Not Observable n z'El Not Applicable 103.1, :Construction drawings and x fir`' ❑Complies 103.2, documentation demonstrate •••. ., .,..'[-]Does N t No Xz 3 403.7 energy code compliance for [PR3]1 'lighting and mechanical systems. a, ❑Not Observable !. Systems serving multiple Applicable Applicable w x < :dwelling units must demonstrate � �h compliance with the IECC `Commercial Provisions. 302.1, =Heating and cooling,equipment is; Heating: Heating: ;❑Complies 40.6 sized per ACCA Manual S based 3 Btu/hr Btu/hr ;❑Does Not [PR2]2 on loads calculated per ACCA Cooling: Cooling: t Manual J or other methods ❑Not Observable approved by the code official. ; Btu/hr Btu/hr E❑Not Applicable F t f 3 Additional Comments/Assumptions: 11 High Impact(Tier 1) 12 Medium Impact (Tier 2) 13 Low Impact(Tier 3) Project Title:JOHN DIVECCHIA Report date: 09/23/14 Data filename: C:\Users\RB96\Documents\REScheck\DIVECCHIA 407 WOOD LANE NO ANDOVER MA.rck Page 2 of 8 a X012 IECC. Foundation Inspection Complies? Comments/Assumpfiions 303.2.1 A protective covering is installed to ;❑Complies [F01i]2 }protect exposed exterior insulation '❑Does Not F and extends a minimum of 6 in. below f ' ❑Not Observable' grade. ❑Not Applicable 403,.8 =Snow-and ice-melting system controls:'❑Complies ; [FO12]2 •I installed. ❑Does Not .[-]Not Observable s i❑Not Applicable Additional Comments/Assumptions: 11 High Impact (Tier 1) 2 1 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title:JOHN DIVECCHIA Report date: 09/23/14 Data filename: C:\Users\RB96\Documents\REScheck\DIVECCHIA 407 WOOD LANE NO ANDOVER MA.rck Page 3 of 8 Section Plans Verified Field Verified v # Framing 1 Rough-in Inspection Value Value Complies. Comments/Assumptions: & Req. 1R.1 .............._. _ __ _._ w_._�._..: _..._.:_ _ i.... _.. _L _ _....... .. ......._ _.....�._ 402.1.1, Door U-factor. U U- ;❑Complies See the Envelope Assemblies 402.3.4 ❑Does Not table for values. [FRl]1 ; ;[]Not Observable z❑Not Applicable 402.1.1, `Glazing U-factor(area-weighted U- U ❑Complies See the Envelope Assemblies 402.3.1, average). ❑Does Not ;table for values. 402.3.3, 402.3.6, : ❑Not Observable 402.5 : ❑Not Applicable [FR2]1 { 303.1.3 U-factors of fenestration products ❑Complies [FR4]1 are determined in accordance a❑Does Not :with the NFRC test procedure or f •'` FBF ❑Not Observable taken from the default table. ❑Not Applicable 402.4.1.1 ;Air barrier and thermal barrier ❑Complies [FR23]1 E installed per manufacturer's t v .' ❑Does Not instructions. ❑Not Observable 1❑Not Applicable h k&n 402.4.3 Fenestration that is not site built ❑Complies w• , [FR20]1 �is listed and labeled as meeting -X ❑Does Not FAAMA/WDMA/CSA 101/I.S.2/A440 ' ❑Not Observable 'or has infiltration rates per NFRCw ❑Not Applicable ;400 that do not exceed code h :limits. 402;4.4 IC rated recessed lighting fixtures ""❑Complies [FR136]2 sealed at housing/interior finish ❑Does Not :and labeled to indicate <_2.0 cfm � 5 leakage at 75 Pa. ❑Not Observable ❑Not Applicable 403.2.1 Supply ducts in attics are R- R- ;❑Complies [FR12]1 insulated to >_R-8.All other ducts E R R ;❑Does Not \ ti in unconditioned spaces or ❑Not Observable ;outside the building envelope are "insulated to >_R-6. ❑Not Applicable 403.2.2 All joints and seams of air ducts, ❑Complies [FR13]1 'air handlers, and filter boxes are El Does Not sealed. ' ❑Not Observable ' . «k i❑Not A licable t p p 403.2.3 -;Building cavities are not used as b `�❑Complies [FR15]3 :ducts or plenums. ❑ Does Not • ?❑Not Observable ;,T❑Not Applicable _ ------ __. __ --_----- 403.3 i HVAC piping conveying fluids R R- ❑Complies [FR1:7]2 'above 105 °F or chilled fluids : :❑Does Not !below 55 °F are insulated to >—R- : 3 ;❑Not Observable ❑Not Applicable 403.3.1 Protection of insulation on HVAC K ❑Complies [FR24]2 ,piping. T '❑Does Not ' "Nw,'I❑Not Observable y x� ❑Not Applicable 403.4.2 Hot water pipes are insulated to R- R- i❑Complies [FR18]2• '=>_R-3. : {❑Does Not F `{ ? ,❑Not Observable : ;❑Not Applicable 1 High Impact (Tier 1) 2" Medium Impact (Tier 2) 3 Low Impact(Tier 3) Project Title:JOHN DIVECCHIA Report date: 09/23/14 Data filename: C:\Users\RB96\Documents\REScheck\DIVECCHIA 407 WOOD LANE NO ANDOVER MA.rck Page 4 of 8 y Section Plans Verified 'Field Vei�fied , # Framing 1.Rough-lnInspection Complies? LComments/Assumptions & Req.lD� �. -Value Valus W. __...._..... 403.5 ,Automatic or gravity dampers are �y ❑Complies [F1119]2 iinstalled on all outdoor air I ❑Does Not pnm intakes and exhausts. P .,-"[]Not Observable ! r x ❑Not Applicable Additional Comments/Assumptions: 11 High Impact (Tier 1) 2 !Medium Impact(Tier 2) 3 Low Impact (Tier 3) Project Title:JOHN DIVECCHIA Report date: 09/23/14 Data filename: C:\Users\RB96\Documents\REScheck\DIVECCHIA 407 WOOD LANE NO ANDOVER MA.rck Page 5 of 8 r Section Plans Verified . Field Verified # Insulation Inspection Value ValueComplies? Comments/Assumptions & Req.ID ._._._ _ ..- ......_....:. ...._...... _..._� 303.1 "Al installed insulation is labeled b � ❑Complies [IN13]2 !or the installed R values i IT3❑Does Not provided. 3 -� a s ) � ❑Not Observable .T]Not Applicable 402.1.1, Floor insulation R-value. R- R- ;❑Complies See the Envelope Assemblies 402.2.6Wood Wood ;❑Does Not table for values. [IN1]1 ❑ Steel ❑ Steel ❑Not Observable ❑Not Applicable f 3 303.2, ;Floor insulation installed per fr � ;❑Complies 402.2.7 manufacturer's instructions, and ❑Does Not [IN2]1 in substantial contact with the -44 ❑Not Observable underside of the subfloor. f ) ❑Not Applicable _....._........__....._.......... ----..................------.__..._........_ ......_.......__. _ .. _:_ :_._.... 402.1.1, :Wall insulation R value. If this is a; R- R- ❑Complies See the Envelope Assemblies 402.2.5, mass wall with at least 1/Z of the Wood ❑ Wood ;❑Does Not table for values. 402.2.6 wall insulation on the wall E] Mass ❑ Mass ![-]Not Observable [IN3]1 exterior,the exterior insulation requirement applies (FR10). ❑ Steel Steel i❑Not Applicable 303.2 Wall insulation is installed per `, Amy! Complies [IN4]1 manufacturer's instructions. =❑Does Not g xa wx ❑Not Observable v 'S --N ❑Not Applicable Additional Comments/Assumptions: 11 High Impact(Tier 1) 2 iMedium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title:JOHN DIVECCHIA Report date: 09/23/14 Data filename: C:\Users\RB96\Documents\REScheck\DIVECCHIA 407 WOOD LANE NO ANDOVER MA.rck Page 6 of 8 .l 6econ P1anS Ver�fi d Feld Verified # - Sinai Inspection Rr`ovi ions, Complies? Comments/Assumptions & Req.ID °Value Valu m . ,.. 402.1.1, Ceiling insulation R-value. R- R- ;❑Complies See the Envelope Assemblies 402.2.1, ;❑ Wood ❑ Wood ❑Does Not table for values. 402.2.2, 402.2.6 ;E] Steel ❑ Steel ;❑Not Observable [FI1]1 ;❑Not Applicable 44 303.1.1.1, :Ceiling insulation installed per ❑Complies 303.2 manufacturer's instructions. >p❑Does Not [F12]1 Blown insulation marked every [ Gi,4�4 300 ftz. ) ❑Not Observable W r ?❑Not Applicable 402.2.3 ',Vented attics with air permeable ���-I❑Complies [FI22]2 'insulation include baffle adjacent { ❑Does Not to soffit and eave vents that extends over insulation, x ' . k=❑Not Observable ❑Not Applicable 402.2.4 :Attic access hatch and door R- R- ❑Complies [FI3]1 insulation >_R-value of the ;❑Does Not "adjacent assembly. ;❑Not Observable ❑Not Applicable 402.4.1.2 ;Blower door test @ 50 Pa. <=5 ACH 50 = ACH 50 = ;❑Complies [FI17]1 ach in Climate Zones 1-2, and r ;❑Does Not <=3 ach in Climate Zones 3-8. ;❑Not Observable ❑Not Applicable 402.4.2 Wood-burning fireplaces haves '❑Complies [FI8]2 ;tight fitting flue dampers and [ ❑Does Not ;outdoor air for combustion. ❑Not Observable k ❑Not Applicable 403.2.2 Duct tightness test result of<=4 ; cfm/100 cfm/100 ;❑Complies [F14]1 cfm/100 ft2 across the system or { ftz ftz ❑Does Not <=3 cfm/100 ft2 without air rough-in ;❑Not Observable ':handler @ 25 Pa. For oug tests, verification may need to t ;❑Not Applicable occur during Framing Inspection. 403.2.2.1 .Air handler leakage designated i w�. ❑Complies [F124]1 by manufacturer at <=2%of $ ❑Does Not design air flow. ' ❑Not Observable ❑Not Applicable 403.1.1 'Programmable thermostats ; '" .'❑Complies [FI9]2 installed on forced air furnaces. ❑Does Not ,❑Not Observable 1 F ?❑Not Applicable 403.1.2 Heat pump thermostat installed - ❑Complies [Fll0]2 on heat pumps. j❑Does Not []Not Observable ❑Not Applicable 403.4.1 ,Circulating service hot wateri .a❑Complies [FI11]2 systems have automatic or a ❑Does Not ,accessible manual controls. ]Not Observable <« ❑Not Applicable 403.5.1 All mechanical ventilation system h xir ❑Complies [F125]2 Mans not part of tested and listed ❑Does Not HVAC equipment meet efficacy `, ❑Not Observable ,and airflow limits.N g 3 , �;]❑Not Applicable 1 I High Impact(Tier 1) 2 Medium Impact (Tier 2) 3 1 Low Impact(Tier 3) Project Title: JOHN DIVECCHIA Report date: 09/23/14 Data filename: C:\Users\RB96\Documents\REScheck\DIVECCHIA 407 WOOD LANE NO ANDOVER MA.rck Page 7 of 8 Section u Plans Verified 'Field Verified - Final.inspection Provisions .�. Value Complies? Comments/Assumptions. ; & Req.ID -Value _W—._ 403.9.1 ;Readily accessible switch on -• •- ❑Complies [FI12]3 :heaters for swimming pools or - El Does Not ;permanent in-ground spas. ❑Not Observable El Not Applicable ___ —___ ___ _._ —_.._..._. _ -...._........_..__....._._....... 403.9.2 ;Timer switches on heaters and ❑Complies [FI19]3 r pumps serving pools and `' ❑Does Not ;permanent spas. ,; k ❑Not Observable ❑Not Applicable 403.9.3 'Heated pools and permanent ❑Complies [F120]3 =spas have a vapor retardant :': �"❑Does Not cover. �fins �4❑Not Observable ❑Not Applicable 404.1 75%of lamps in permanent n ❑Complies — [F16]1 fixtures or 75%of permanent r , ;❑Does Not ,fixtures have high efficacy lamps. ` " `Does nota I to low-voltage ❑Not Observable apply '-`101\lof Applicable lighting. . _ - PP 404.1.1 3 Fuel gas lighting systems have4❑Complies ;no continuous pilot light. x i ❑Does Not [F123]3 ❑Not Observable 0"d � .. �,. ❑Not Applicable _____._......_ ---_.._._.__..__.__.._.__........_..._.� _._.�.__._.__........____..._.._ __ 401.3 `Compliance certificate posted. a° ❑Complies (9712 ,[]Does Not ❑Not Observable ❑Not Applicable __. _._.__......__ _......__ ............ 303.3 ;Manufacturer manuals for ❑Complies [FI18]3 mechanical and water heating ❑Does Not ;systems have been provided. i ` �F- ❑Not Observable a ?❑Not Applicable Additional Comments/Assumptions: 1 I High Impact (Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title:JOHN DIVECCHIA Report date: 09/23/14 Data filename: C:\Users\RB96\Documents\REScheck\DIVECCHIA 407 WOOD LANE NO ANDOVER MA.rck Page 8 of 8 .t` w 2012 IECC Energy Effidency Certificate • o � Wall 21.00 Floor 30.00 Ceiling / Roof 30.00 Ductwork (unconditioned spaces): Window 0.29 Door 0.22 M Ell Heating System: Cooling System: Water Heater: M-141"�-MTVAM-11"YIN a. Name: Date: Comments e s