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HomeMy WebLinkAboutBuilding Permit #517-12 - 517 REA STREET 1/3/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: s/z—/ � Date Received Date Issued: / -1-11 /rx IMPORTANT: Applicant must complete all items on this page LOCATION 5� ... � atL c�G V"CrZ ... Pint PROPERTY OWNER' �j Paint MAP NQ ,20 PARCEL: `�` ZONLNG DISTRICT Historic District yes no Machine -Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Phone: 5G5,,-- 3257 -6- y V/ Residential Non- Residential j_New Building VOne family ❑ Addition 11 Two or more family El Industrial 0 Alteration No. of units: ❑ Assessory Bldg ❑ Commercial ❑ Repair, replacement ❑ Others: ❑ Demolition 0 Other I] Septic o We11 ❑ Floodplain d.Wetlands (a VVatershedtp strict ICAlater/Sewer. . JPTION OF WORK TO BE PREFORMED: i-mc4 he -;we - Identification Please Type or Print Clearly) OWNER: Name:_('; njuA)ie. o4o Phone: g7X-(��%' Address: CONTRACTOR Name.: ' . teE e A -vs 0 Phone: 5G5,,-- 3257 -6- y V/ Address: 1-te��ie�- -: Supervisor'sConstruction 'License Exp: `Date:. / 7h 7 /2Ga.Z .. _:... Horime lm ARCHITECT/ENGINEER CC'I ws- Phone: q18 1/61- &V34, Address: 5-719A /V6,tlGl bet Ski Reg. No. 33 (?gg FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: FEE: Check No.: / Receipt No.'�15- NOTE: Persons contractink ith anregiste%ed contractoYs,do not have access to the guaranty fund Signature of Agent/Owner __ Signafiu of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Tobacco Sales ❑ Permanent Dumpster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed Reviewed on Signature y Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Water & Sewer Connection/Sig DPW Town Engineer: Signature: FIRE'DEPARTMENT -Temp: Located at 124 Mainistreet Fire Department. signature%d,. COMMENTS_ Comments Comments re Drivewa Perm V____i yam. 07� _2" " /—I�/ — Located 384 Osgood Street §ter -onsite yes. 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 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/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 MOTE: 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 ICOMMENTS_ Location 5-/ 7 wr S?— No. % 7 —/Z�! z Date MORTh TOWN OF NORTH ANDOVER 3 O F w 9 Certificate of Occupancy $ s+cMus•`� Building/Frame Permit Fee $ 70 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _ Check # 2 4 9 6 /Building Inspector CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 517-12 on 1/3/2012 Date: September 20, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 517 Rea Street, North Andover, MA 01845 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: Connie Doto 517 Rea Street North Andover, MA; 01845 Budding Inspector Fee: Pre Paid Receipt: 24926 Check: 1149 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 517-12 on 1/3/2012 Date: September 20, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 517 Rea Street, North Andover, MA 01845 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: Connie Doto 517 Rea Street North Andover, MA; 01845 4 Budding Inspector Fee: Pre Paid Receipt: 24926 Check: 1149 E Ea � Y 0 zed = v/ CO2 O Zri�z r �iO�O ti cm t OAF CO E a:9 m 7 C V�`y y VJ cc Z 'D y y = C O W ^ X ev �cm ` v`oc 0 c' .3 m oa'c y CD c �- C, _ ccP, O o cl IS,._ O cm Q i y c. m= O N F" ,o y o o o co s LiJ O _ Wcc tq .Sdt C Z ♦ LU v CD � O W cj CS y �_ F— t 4- CL=.. m ., 0 Me T co 0 C i o o s Z °o o. 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C cc CO2 i uj ul W W rg W C4 Ac �+ 2a .�-- 4 3•� he ,Y °• 'a O O ".. M APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION 7 A�RArgo nPa 5 BUILDING PERMIT # 6 11 - �SSACHU`�E� ADDRESS/LOCATION OF PROPERTY: 61'Z ega- AP-4get,,t_ Map__3B Parcel 1/0 Lot Number SUBDIVISION: /VA DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE Permit Issued to: Address a ROUTING TOWN ENGINEER, SITE PLAN — DRIVE -WAY REVIEW CONSERVATION PLANNING DPW -WATER METER D o J 1l SEWER CONNECTION TTV DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYAINSPECTION REQUEST DPW SIGNATURE File: Application for OC form revised Jan 2007/2011 _1/- /z V-�tLED /6 N �6 0 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION '�SsgCH„sE<BUILDING PERMIT # 15 I '7 - 17- A.DDRESS/LOCATION OF PROPERTY:! Map, 38 Parcel IVO Lot Number SUBDIVISION:_ %V DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE. CHARGED IF THE -STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: Address: APPLICANT SIGNATURE ROUTING TOWN ENGINEER, SITE PLAN — DRIVE -WAY REVIEW C CONSERVATION PLANNING DPW -WATER METER J 1� SEWER CONNECTION 0 0k- Td �✓ DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW SIGNATURE File: Application for OC form revised Jan 2007/2011 _ 2/�/z z m Cos t y O N C O 0 cm cm c 0 cp C �C N m 0 Z 0 O ^) rr F"r v US oz T U Q • n.s LLI uj U) W W 19 W cc c c A c'S a 0 U • 0 a 0 W C ' w.+ O O W CL C ev ev O w° a cn w° w°' U G tz o a4 G i�. • L m � cw cii w C w u. O = w cn o cq m Cos t y O N C O 0 cm cm c 0 cp C �C N m 0 Z 0 O ^) rr F"r v US oz T U Q • n.s LLI uj U) W W 19 W cc c c m c c'S • 0 L C N O C ' w.+ O 00i V CL C ev ev Z O i GCA Q • L m � m :+ C O = i 0 cm CD c \ o.;... �. m m L L pn O y CO) C.D. 3 cm CD � C C a C to . V : Zy atop y � ci G .�>Z =L CD CL Q CD y m C C ~ •N 0 C °C dt �E c, � v I- ®mac o� Vi a mO� = = ca 0 N= C) 4-�4-m m Cos t y O N C O 0 cm cm c 0 cp C �C N m 0 Z 0 O ^) rr F"r v US oz T U Q • n.s LLI uj U) W W 19 W cc ,Loc us s tr/3,t J " G ,Lor A ,$ HOydN ON "OR7-'/4 ,E.5 S tX AR -G /ST fly OF .Aro ps p/,pN Jt /03/8 �N /A/o R T hi %V N iD o v ,E R, l `fA S S. S uRv I--y0p FO14 CoN57'AN C� DoTo S7-OWZRS J:?SSvaiarAs .rNc RTC, 1. Alvo 'S UAV aya mS %JJ3C�EM�P1C 26)1 LArN, P7p55. R F A a,1" Ij� IN ti fR a Pas�Q DFcK 3,9 �PROPos,EA FIRE l��.gcE � Cl 'Y a 00 (f� PRO posED STC1°s PR o posE p Imo' PORCM if'X6' �v ExF r�N G 32.8 J� fR a Pas�Q DFcK 3,9 �PROPos,EA FIRE l��.gcE � Cl 'Y a 00 (f� V JCevelopment Corp. 87 Lafayette Road Unit #4 Hampton Falls, NH 03844 Phone: 603-926-1200 December 29, 2011 Connie Doto 517 Rea Street North Andover, MA. Oil 845 Re: Cost Plus ercentage Contract to Build New Home at 517 Rea Street North Andover MA. This agreement is made this 29th day of December 2011 between Connie Doto, the owner, and MJC Development Corp., the contractor. The owner and the contractor agree as set forth below: 1. The contractor accepts the relationship of trust and confidence established between his company and the owner by this agreement. He covenants with the owner to furnish his best skill and judgment in furthering the interest of the owner. He agrees to furnish effective business administration and supervision and to use his best efforts to furnish at all times an adequate supply of workers and materials, and to perform the work in a most expeditious, economical and workmanlike manner. 2. The work to be performed under this contract started November 15"' 2011. The contractor shall use his best efforts to complete said work of improvements on or before June 30, 2012 3. The owner agrees to reimburse the contractor for the direct "cost of work" as defined in paragraph 6 below. Such reimbursement shall be in addition to fee stipulated in paragraph 4. 4. In consideration of the performance of the contract, the owner agrees to pay the contractor as compensation for his services a contractor fee of 11 % (eleven) of all costs incurred over total project length paid as per paragraph 9. The following materials shall be supplied by the owner and shall be excluded from the 11% Contractors fee: Kitchen & Bathroom Cabinets, Appliances, & Lighting and Plumbing fixtures. The labor to install these materials shall be subject to the Contractors fee. The landscaping contract, except for the spreading of the loam & the driveway, shall also be excluded from the contractor's fee. -M 7JC evelopment Corp. 87 Lafayette Road Unit #4 Hampton Falls, NH 03844 Phone: 603-926-1200 5. The scope of work shall consist of the project cost analysis worksheet that was submitted to the bank. This analysis is solely for the purpose of describing the categories of work and are for budget purposes only, final cost of work will be determined after all selections are made and all work performed. 6. The term "cost of work" shall mean cost necessarily and reasonably incurred in the performance of the work and actually paid by the contractor, including all costs incurred due to changes and extras not listed on the cost analysis. 7. The contractor shall procure the necessary permits for the work of improvement. Owner shall pay for all fees associated with said permits. 8. Subcontractors shall perform all the work performed. The owner shall have the right to request that the contractor entertain bids from her subcontractors. In the event that the owner prefers that the contractor use a subcontractor that he is not comfortable with, he must bring this to the attention of the owner. If the owner insists the subcontractor be used, the contractor has the option to exclude this work from his limited warranty. 9. The contractor shall, every two weeks during the course of work, deliver to the owner a statement showing in complete detail all costs incurred by his company in the execution of this contract for the preceding two-week period. Accompanying said statement should be a copy of all back-up documentation including material and labor invoices and all receipted bills for which payment is due. The owner shall review the statement and shall remit such amount within seven days of the owner's receipt of the statement. 10. The contractor hereby agrees to hold the owner harmless and to indemnify the owner against any and all claims, which may arise during the course of the work as a consequence of the negligent acts or deliberate omissions of the contractor, its agents or employees. This agreement is executed the day and year first written above. Owner Contractor's OwnerLicense Number CS Date /a /�) y/,?, / / Date 11;11d VZ o !! 2 ASI File # Date Rec'd RESIDENTIAL: PROJECT COST ANALYSIS Customer: o -N Project: 7 Address: ge y9Sr - Phone: 11A Hampton Road Exeter, NH 03833-4807 Builder: W��C Address: yl La�_'�Qk(e_ L -L rhofuri Its ,q Ph. -603-772-1180 Fax: 603-772-1181 Phone: (o03,q26- 17,00 5-0e- ? q5-- (9 DESCRIPTION 1 SITE PREPARATION clear_- grub -blasting 2 ___ EXCAVATION rough driveway septic / sewer 19 fill -._fin1SjLqra_qt 3 LANDSCAPE 20 loam - seed other 4 5 PAVEMENT other FOUNDATION 22ACCESSORIES walls slabs entry insulate __-coating 6 FRAME materials 7 labor DECKS - STEPS 8 9 HOOFING SIDING 10 11 EXTERIOR TRIM 911-111411FIE - FIREPLACE 04W FRC/i. .... .. Sit - 12 INSULATION 13 14 SHEETROCK - PLASTER FLOORING 26 carpet - inlaid 27 the wood other 15 STAIRS main 29 cellar 16 WINDOWS - DOORS EXT 31 ext package other Fromm P E 17INTERIORTRIM trim - mop doors special 18 PAINT INTERIOR other 19 PAINT EXTERIOR other 20 CABINETS -VANIT!E§ �p other 21 ---- SPECIAL SYSTEMS alarm central vac 22ACCESSORIES door lidwre _she1_ving_ZC_tq-54;t:�x NX bath - other ELECTRICAL —24 rough finish -- ALLOWANCE-- L—LOWAN&E 25PLUMBING finish fixtures 26 HEAT - HVAC 27 rough finish WATER city hook-up 28 APPLIANCES other 29 SOFT COSTS 30 MISCELLANEOUS 31 LAND 32 REAL ESTATE FEES �CT COSTS k(�PF (,C _�J -I The Commonwealth ofMassachusetts Department oflndustrialAcddents Ofjtce of Investigations 600 Washington Street av Boston, MA 02-1-11 www.naass.gov1 d'ia i licant Intformatinn Workers' Compensation InsurAnce Affidavit: Builders/Contractors/Electricians/Plumbers Name City/State/Zip: Phone #:.6401 r 9-*;�6 % L,00 Are you an employer? Check the appropriate box: u' 1. ❑ I am a employer with 4. ❑ I am a. general contractor and I employees (full and/or part-time).* 2. I am a sole proprietor or have hired the sub -contractors listed partner- ship and have no employees on the attached sheget. t These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. We are a corporation and its 3. Erequired.] ]I am a homeowner doing all worn officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] i' employees. [No workers' comp, insurance re d ' Type of project (required): 6. K New construction 7. ❑ Remodeling 8. 0 Demblition 9. [] Building addition 10. ❑ Electrical repairs or additions I1.❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ Other applicant ire .] I Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy mformahon. Homeowners who check this bothiaffidavit indicatingtheyare 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. Iam an employer thatisprovfding workers' compensation insurancefoY information. my employees Below is tltepolicy andjob site Insurance Company Name: Policy # or Self -ins. Lic. #: Job Site Address: Expiration Date: — 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 Investigations of the DIA, for insurance coverage verification. statement may be forwarded to the Office of t do IZeteky ce//�•/ley ztnde^r e pai/ns�andpenalties ofperjury tliat the information provided above is true anti correct. —JJ4c:1ac use only .Uo not write an this area, to be completed bycity or tow City or Town: Permit/Li 11suingAuthority (circle one): cense tr L Board of Health 2. Building Department 3. City/ToVvn Cleric 4. Electrical inspector 5. Plumbing Ins ector 6. Other g p ,lam. tl- ��:f® �-/Lt�f► A� Contact Person: Phone #: I III.nUU nuc/IWLlvnal INCW Cnglana 10:AI IN: maurice (16039261200) Client#: 67560 16:12 1 212111 1 GMT -05 Pg 03-03 MAURICEJCA ACORD,. CERTIFICATE OF LIABILITY INSURANCE r DATE(MMIDDIYYYY) TYPE OF INSURANCE 12/21/2011 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: HUB International New England PHONE 978 657-5100 9789880038 A/C. No. Ezt : A1C, No 200 International Drive, Suite 290 EMAIL Portsmouth, NH 03801 ADDRESS: 603 436-7069 INSURER(S) AFFORDING COVERAGE NAIC b INSURER A: Peerless Insurance Co INSURED Maurice J Caruso Development INSURER B PERSONAL & ADV INJURY $1,000,000 Corp DBA MJC Development Corp INSURER C: 87 Lafayette Road -Unit 4 INSURER D: INSURER E: Hampton Falls, NH 03844 INSURER F: GENERAL AGGREGATE 52,000,000 a.%JVr_M nurQ CERTIFICATE NUMBER: RGlnclnu NUMBER• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED `NAMED ABOVE1 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. INS LTRR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF WDDIYYY POLICY EXP MM/DDNYY LIMITS A GENERAL LIABILITY CBP8189711 8/19/2011 08/19/201 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 51 OCCUR PREMSIES ER occurrence) $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE 52,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PE� LOC PRODUCTS - COMP/OP AGG s2,000,000 $ A AUTOMOBILE LIABILITY BAS185012 8/1912011 0811912012EataaideDISINGLELIMT $1,000,000 BODILY INJURY (Per person) S ANY AUTO Ix ALL OWNEDSCHEDULED AUTOS X AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS X NON-OWNEDAUTOS $ Per accident A X UMBRELLA LIAROCCUR CUS189212 8/1912011 08/19/2012 EACH OCCURRENCE $1,000,000 EXCESS LIAB --...HCLAIMS-MADE AGGREGATE s2,000,000 DEO I X RETENTION 510000 s WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFiCERWEMBEREXCLUDED? NIA WC STATU- OTH- TORY IMT R E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE S Mandatory in NMI If (t yes, describe aunder E.L. DISEASE - POLICY LlhRli g DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Job for: Connie Doto Job site: 517 Rae St. North Andover, MA Salem Co-operative Bank ISAOA ATiMA 3 South Broadway Salem, NH 03079 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 REPRESENTATIVE ftr.4rt IV 1040,011- IV IU&I-AU1U ACURU CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S630424iM630423 LF001 /\ CN T§ 3 .. e �\ - ) \ § \ 0 f� N w\\© \ \ % . . L \� > ®� «><<< -_ 0 ' yz «y« $\.2 I \ f ; = c G 3 e G 2 / - LU o _• = g § E 4 } I .� \\/\W� to = o / % ; { w w UJ >- \ \ EE f ƒ / ° _ � ® D i ) \ / k % 7 / /\ !K . T§ 3 .. e �\ - ) \ 0 f� N w\\© \ . E 23 . �� ■G R.. 2. }ƒ< \� > ®� «><<< -_ 0 ' yz «y« $\.2 I \ Lu 2 ± °a = E0 L 3 e G 2 / - LU o \ 2 \ I .� = REScheck Software Version 4.4.2 Compliance Certificate Project Title: 517 Rea St North Andover MA Energy Code: Location: Construction Type: Glazing Area Percentage: Heating Degree Days: Construction Site: 517 Rea St North Andover. MA 01845 2003 IECC North Andover, Massachusetts Single Family 13% 6322 Owner/Agent: Connie Doto Compliance: 35.6% Better Than Code Maximum UA: 926 Your UA: 596 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. Designer/Contractor: Maurice Caruso MJC Development Corp 87 Lafayette Rd #4 Hampton Falls, NH 03874 508-395-6441 Ceiling 1: Flat Ceiling or Scissor Truss 2621 0.0 38.0 66 Ceiling 2: Flat Ceiling or Scissor Truss 427 30.0 0.0 15 Wall 1: Wood Frame, 16" o.c. 4342 21.0 0.0 213 Window 1: Vinyl Frame:Double Pane with Low -E 524 0.350 183 Door 1: Solid 42 0.076 3 Door 2: Glass 42 0.350 15 Floor 1: All -Wood Joist/Truss:Over Unconditioned Space 3048 30.0 0.0 101 Furnace 1: Forced Hot Air 94 AFUE Air Conditioner 1: Electric Central Air 13 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 2003 IECC requirements in REScheck Version/4.4.2 and to comply with the mandatory requirements 'sted inth Scheck Inspection Checklist. (1121(E t rriso Tn�tC>7�r 2.. Name - Title Signature Date REScheck Software Version 4.4.2 Compliance Certificate Project Title: 517 Rea St North Andover MA Energy Code: Location: Construction Type: Glazing Area Percentage Heating Degree Days: Construction Site: 517 Rea St North Andover, MA 01845 2003 IECC North Andover, Massachusetts Single Family 13% 6322 Owner/Agent: Connie Doto Compliance: 20.7% Better Than Code Maximum UA: 752 Your UA: 596 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. Designer/Contractor: Maurice Caruso MJC Development Corp 87 Lafayette Rd #4 Hampton Falls, NH 03874 508-395-6441 Ceiling 1: Flat Ceiling or Scissor Truss 2621 0.0 38.0 66 Ceiling 2: Flat Ceiling or Scissor Truss 427 30.0 0.0 15 Wall 1: Wood Frame, 16" o.c. 4342 21.0 0.0 213 Window 1: Vinyl Frame:Double Pane with Low -E 524 0.350 183 Door 1: Solid 42 0.076 3 Door 2: Glass 42 0.350 15 Floor 1: All -Wood Joist/rruss:Over Unconditioned Space 3048 30.0 0.0 101 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 2003 IECC requirements in REScheck Version 4.4.2 and to comply with the mandatory requirements listgdjn the REScheck Inspection Checklist. 44?&r/Cert X0,9 &Arew(a'112112- Name C 1 /Z Name - Title Signature Dat