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Building Permit #635-13 - 45 HEPATICA DRIVE 4/1/2013
TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 63-5"-1-3 Date Received Date Issued: RTANT: Applicant must complete all items on this LOCATION `Y.5"�7`Cj°/¢ rr c r� i Vii . ,t a 'f� g 7 Print PROPERTY OWNER 17"e Print 100 Year Old Structure MAP NO: ���PARCEL; ZONING DISTRICT: Historic District Machine Shop Villa yes no yes TYPE OF IMPROVEMENT PROPOSED USE Resid ntial Non- Residential ew Building ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District Water/Sewer cv-ys DESCRIPTION OF WORK TO BE PERFOR ED: 'O'l '04'r s. N G-zIf F-le ew;z,� S 6"S7,40,01 �er2 J # -'p8� -,3 isSap0 161149113 Identification Please Type or Print Clearly) OWNER: Name: l e �l '2:;4 e- • Phone: Address: 10 CONTRACTOR Name: Phone: 508-a--)-8-4(0;0 Address: Vic, of A 9184e Supervisor's Construction License: 0�75�0Z Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER ©Sy��Bd Y�QcG�� ��iS Phone: 78/ --7'1/6 - .1800 Address: 614t't f �. es 4J o &, A - Reg. No. &rV /O FEE SCHEDULE. BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �5z /���,0� FEE: Check No.: S'72 � K Receipt No.: 2e",1'-' NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund 1 Signature of Agent/O�w� L__6g ture of contracto rl_ Plans Submitted PI s Waived ❑ Certified Plot Plan ❑ Sta ped Plans C� e8K Plans Submitted 11' Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans H TYPE OF SEWERAGE DISPOSAL Public Sewer F"*' Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS Reviewed on Signature HEALTH Reviewed on Signature COMMENTS , Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments t Conservation Decision: Comments Water & Sewer Connection/signature at� D�'-� Drivewa P DPW Town Engineer: Signature: �4 Located 384 Os o FIRE DEPARTMENT = Temp Dumpster on site yes no Locate_ d at'124,Main'Street - Fire Department�signature/date COMMENTS Street 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 El Notified for pickup - Date Doc.Building Permit Revised 2010 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2012 Location k 4 / No.— Date Check # 26242 TOWN OF NORTH ANDOVER Certificate of Occupancy $ /zr 0 Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $- TOTAL $ 'Building Inspector CE MO °7N 1H 3? .`..c. •• "•.'• dot SSACW CERTIFICATE OF USE & OCCUPANCY Building Permit Number 635-13 4/1/13 Date: September 4, 2013 THIS CERTIFIES THAT THE BUILDING LOCATED ON 45 Hepatica Drive Lot #27 MAY BE OCCUPIED AS 3 bedroom single family residence IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: $100.00 Receipt: 26242 Check :5794 Key Lime Inc. 10 Hepatica Drive North Andover MA 01845 Building Inspector of poeTM iqM 3? ea1D • �. �� SS�cNuse CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 635-13 4/1/13 Date: September 4, 2013 THIS CERTIFIES THAT THE BUILDING LOCATED ON 45 Hepatica Drive Lot #27 MAY BE OCCUPIED AS 3 bedroom bedroom single family residence family residence IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Fee: $100.00 Receipt: 26242 Check :5794 Key Lime Inc. 10 Hepatica Drive North Andover MA 01845 Building Inspector N O ,Z n O O • O :FJ O � O t ^ v w+ y CL (D �a CDa y- o S✓ E r a. • L :/i Y � E cm PQ 10 In a Z Cf) CD LU o c ami > L�N0acnX Eoo a, > o c W c F-_ 0- w� I Q 0 0 m ® 0 = o m J., c o 0 o Q L L O� O wV m d W = -0— o O U- N FL N N O N v 0 0 LU •E v�_� F= • V 0 0-0 d � F-4 N 0. 0 0 Z P V,ry� N J W2 O d 4. \' W r go W N ~ W (� LL p m oC ol ui Naim 0 4 J LJJ �, tJ LL >• N v_ ^CL '' v -O s c _ '-co s _ to s jt i to ' _ j ro O v v Y O O LL N C LOl- d' _ C K LL 9 N C d' LL N n O O • O :FJ O � O t ^ v w+ y CL (D �a CDa y- o S✓ E r a. • L :/i Y � E cm PQ 10 In a Z Cf) CD LU o c ami > L�N0acnX Eoo a, > o c W c F-_ 0- w� I Q 0 0 m ® 0 = o m J., c o 0 o Q L L O� O wV m d W = -0— o O U- N FL N N O N v 0 0 LU •E v�_� F= • V 0 0-0 d � F-4 N 0. 0 0 Z APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit # 60 cr,J" 12 ADDRESS/LOCATION OF PROPERTY: Parcel SUBDIVISION 491W S Lot Number oP 7 DATE REQUESTED FILED/READY FOR INSPECTION 9.j�3 CLOSING DATE ON PROPERN:---9—/,:0��,3 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGFr) IF TUF cToi irlri 10c DOES NOT MEET ALL APPLICABLE CODES. ^6rx::E r a... i cua ISSUe"d tv. Address SIGNED CONSERVATION PLANNING DPW, WATER METER SEWERMATER CONNECTION NOTE RO TING O 7`Q3MA.-"T DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUP CYANSPECTION REQUEST DPW ; / - '? —/-3 File: Application for OC form revised Jan 2007 rN 0.19 f :�l _An D J O LLJ am O O Q x d (n )4S W OR Z N OZ Z V Z W w O 00 c E T O ` T ca +- w '� uiC 9J L6 �j J a+ o a) 0 N a O mi LL N o O LL C L as -OD o c K LL L U O v fA o = w LL u E Ln D J O LLJ am O W :a coZ 0 r Q Z r : .� � O N Z U n W 'O C X Z LU V W �a LL Z_ m L O _ N d t O Z O Q J O LLI vI U) 19W W ce W CA O O O O 'Q CL (D ca +- �Q •� c oo '++ J. • y V E d y • d yr � t O 1' G O' J Vim, m . O= �, `t• y o o y Q w Eo zo. =w y o 0 L CL d ) w �+ _ v = _ Q L L :C 2 ~ d ' Q d � m Ca y .v LL •2 N y = O Z WL- 0 N ` V co Q O -a H y s M 0 O o v w C. 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V N C LL U uj a Z Q -C to 7 d' LL z W Q W W LL G1 m O ZY v (% N o O N n CIS 0 M � O v y o. ca +-� c 00 s �• H m `rte \ • E c. s' w N N .Y Y= Cl O �+ r VQ h c -v P Oa O CL 6 u) `m A ��•mc U)�� o •a > � � ) Q c =a N �. CL a� N C p :s. 0 3 a' c2H e. 4 t a) ( c L c 0y 0 1 o� c = C VONQ a) c CO) U) m � LLJ Lu_ _ -o---oo LL N � N C O .Q s �_ o Z 4Z49y = ""� "'' '� O W •E v _ • V .- CD 0-0 a) + Q �-, vN -•o4- 0 H t $ c. o t> > 2 Z m CDZ W w CL W H W d O W :a c� o im Lf U f� Z 0 CO LUJ E O Z O D � I ,A c CD Q •EQ CD m CLQ- = CD _ >+ O �, d v D O o a-a,� Q O cc M D _ Z Z O �.± tCCL D '4./ 'P 7 i he s,*wo- �� u : 993037333 Rating NNumberber: ABA1299-5•3 /1) , Certified Energy Rater Sara K. Forristall F,rK Rating Date: 11!2112012 Lot 28, 39 Hepatica Drive Rating Ordered For- North or North Andover. MA 01 B45 5 Stars Plus Confirmed Rating Uniform Energy Rating System MMBtu Energy Efficient 1 Star 1 Star Plus 2 Stars 2 Stars Plus 3 Stars 3 Stars Plus 4 Stars L ,---- 4 Stars Plus 5 Stars 5 Stars Plus t 500-401 400-301 . 300.251. 250-201 200-151 150.101 100.91: J ' 90.86 85-71 70 or Less ' HERS Index: 57 $141 4% General Information 18.5 $608 Conditioned Area: 2380 sq. it HouseType: Single-family detached Conditioned Volume: 23336 cubic ft Foundation: Unconditioned basement Bedrooms: 3 -0% Mechanical Systems Features $72 Heating: Fuel -fired air distribution, Propane, 96-1 AFUE. Cooling: Air conditioner, Electric, 14.0 SEER. Water Heating: Conventional, Propane, 0.67 EF.40.0 Gal. Duct Leakage to Outside. 49A0 CFM. Ventilation System: Exhaust Only: 54 cfm, 16.0 watts. Programmable Thermostat Heating: Yes Cooling:Yes Building Shell Features Ceiling Flat: R-38, R-30, R-20 Exposed Floor. R-30, R-35 Vaulted Ceiling. R-33, R-32 Window Type: U:0.30, SHGC:0-29 Above Grade Walls: R-24, R-21, R-20, R-15 Infiltration: Foundation Walls: R-0.0 Rate: Htg: 943 Clg: 943 CFM50 . Slab: None Method: Blower door test Lights andAppllance Features Estimated Annual Energy Cost Confirmed Rating Use MMBtu Cost Percent Heating 55.9 $1870 49% Cooling 2.7 $141 4% Hot Water 18.5 $608 16% Lights/Appliances 22.8 $1126 29% Photovoltaics -0.0 $-0 -0% Service Charges $72 2% Total $3817 100% This home meets or exceeds the minimum criteria for all of the following: 2009 International Energy Conservation Code Sara Forristall, HERS Rater Percent Interior Lighting: 100.00 Range/Oven Fuel: Propane Advanced Building Analysis, LLC Percent Garage Lighting: 100.00 Clothes Dryer Fuel: Electric 2 Woodiawn Street Refrigerator (kWhtyr): 709.00 Clothes Dryer EF: 3.01 Amesbury, Me. 01913 Dishwasher Energy Factor. 0.78 Ceiling Fan (chnlWatt): 0.00 (508) 648-0808 sara@advancedbuildinganalysis.com The Home Energy Rating Standard Disclosure for this home is available from the rating provider. REMIRate - Residential EnergyAnalysis and Rating Software v13.0 This information does not constitute any warranty of energy cost or savings. 7j� /Lt- �j 5 e� j 7j 01985-2012 Architectural Energy Corporation, Boulder, Colorado. `— Certified Energy Rater 2009 IECC Certificate Lot 28,39 Hepatica Drive, North Andover, MA01846 f3u�ilding: �inv�lape lns;uidtign Ceiling Flat: R-38, R-30, R-20 Vaulted Ceiling: R-33, R-32 Above Grade Walls: R-24, R-21, R-20, R-15 Foundation Walls: R-0.0 Exposed Floor: R-30, R-35 Slab: None Infiltration: Htg: 943 Clg: 943 CFM50 Duct: R-6.0 Duct Leakage to Outside: 49.00 CFM @ 25 Pascals Window •Datil U -factor SHGC Window: 0.300 0.290 ilAechdnicai:J quiprnertt . . HEAT: Fuel -fired air distribution, Propane, 96.1 AFUE. COOL: Air conditioner, Electric, 14.0 SEER. DHW: Conventional, Propane, 0.67 EF, 40.0 Gal. Builder or Design Profe.:sstonal Signature RFM/Rate • i ential Energy Analyst and Rating Software vf3.o or / , Q WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803 (800) 876-2765 NCCI NO 40959 ITEM 1. The insured Mail Address: Key Lime Inc 10 Hepatica Drive Street No. North Andover Town or City POLICY N0. I WCC 5007581012012 PRIOR NO. I WCC 5007581012011 MA 01845 County State Zip Code FEIN xxxxx1218 ❑Individual []Partnership ®Corporation ❑Jointventure- ❑Association []Other Other workplaces not shown above: 2. The policy period is from 09/15/2012 to 09/15/2013 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under PartTwo are: 13odily.lnjury by Accident $ 1.000.000 each accident Bodily Injury by Disease $ 1.000,000 policy limit Bodily Injury by Disease $ 1.000.000 each employee C. Other States Insurance: Coverage Replaced By Endorsement WC 20 03 06A 0. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates code Estimated Per $100 Estimated No. Total Annual Of Annual 14 Remuneration Remuneration Premium INTRA 285896 SEE E KTIENSION OF INFORMATIC N PAGE Minimum premium $ 500.00 As indicated interim adjustments of premium shall be made: ❑ Annually ❑ Semi Annually ® Quarterly ❑ Monthly This policy, including all endorsements, is hereby countersigned by Total Estimated Annual Premium $ 4,470.00 Deposit Premium $ 1,160.00 MA Assessment Chg. $4,026.02 x 4.2000% GOV STATE GOV CLASS KIND AUDIT PLACING OFFICE CLAIM OFFICE NAME CHECK SAFETY GROUP MA 5645 14 505 WC 00 00 01 A (7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. Authorized Signature M P Roberts Insurance Agency Inc . 1060 Osgood Street North Andover, MA 01845 $169.00 07/10/2012 Date Schedule of Endorsements Remarks: WC000000 B Policy Conditions WC000311 A Voluntary Comp & Employers Liability WC000404 Group Pending Rate Change Endorsement W0000406 Endorsement No. Premium Discount Endorsement WC000414 109/15/2013 109/15/2012 Notification of Change in Ownership WC000422 A Terrorism Reauthorization Disclose Endorse WC200301 Key Lime Inc rnnr r Appl Lim Liab WC200302 A MA Assess WC200303 D MA Notice WC200306 A MA Lim Other States WC200403 MA Const Class Prem Adj Endorsement WC200405 MA Premium Due Date Endorsement WC260601 A MA Canc WC200604 Massachusetts Policy Definition This endorsement is attached to the policy Indicated, below and Is effective on the date stated herein, at 12:01 A.M., standard time at the address of the insured es dArfAhad In tha ininrmatinn nano Policy No. Group Expiration Date of Policy Effective Date of Endorsement Endorsement No. WCC 5007581012012 109/15/2013 109/15/2012 Issued to Additional Premium Return Premium Key Lime Inc rnnr r r a:nv uvJlJ nfV VV¢ %,%JIVI r -MM i Countersigned G &Z Authorized Representative \ � O trJ CD � ►� '-C 00 r rn00>�� V 00 n tTj ooWo0d� � w 00 CO rn w�C 0 y yw> H y � CD O � 00 W oy�,�' oo00 G� 0 00 N O O O 6 Cl) m r oar ' c" < �zD oP Z U O T D z W-3' 10•-0" 17-6 ED) S fTl S m T 3 A W U2 N oao m O � 1 I (n• I � I `D'Fcni O 8,7 gym ® 8D wpm I �r m �n Sp NNNNN_NN iD. p' �nog N -+u 3'-6' O �8 O < ° O b 4 Oft ��� 4 m dor Y m o Igg � o� D 9 P O w N w v Om mP O; O; RP•PPPPP O � y N II I 1 z06 m I i pl i�� n p� -Ail � �RI v a� �� g cin$g mwwwS,aixtxsx�xw mm VMM: zD n Z j o ' m ��— NmA W-3' 10•-0" 17-6 ED) S fTl S 2.y T 3 A W U2 N oao m 0 � 1 I (n• I � I `D'Fcni O 8,7 gym ® 8D wpm I �r m �n Sp NNNNN_NN D O p' �nog N -+u 3'-6' O �8 O < ° O b 4 Oft ��� 4 m dor Y m o Igg � o� D 9 P O w N w v Om mP O; O; RP•PPPPP y N II I 1 z06 m I i pl i�� n p� -Ail � �RI v a� �� g cin$g mwwwS,aixtxsx�xw mm VMM: zD n Z j o ' m ��— G .. 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