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HomeMy WebLinkAboutBuilding Permit #813-12 - 52 MOLLY TOWNE ROAD 5/11/2012BUILDING PERMIT TOWN OF NORTH ANDOVER p APPLICATION FOR PLAN EXAMINATION Permit NO: 0 l3 Date Received D,gtp NORTy\ LED '9 3r - 6T6�i TYPE OF I E Alteration Repair, replacement Demolition PROPOSED USE Residential t.?_n ramuy Two or more.family No. of units: Assessory Bldg — Other Non- Residential DESCRIPTIONRF WORK TO BE PREFORMED: 'S I its 1Q i ly 4t...)e(( ,M L� J v oneug- . -TO j4 OWNER: Name: N 141n Arirlracc- Type or Print Clearly) Industrial Commercial Others: ARCHITECT/ENGINEER- L ti%Airen(tx. C)Q80-r,, Phone: `i18 .50a a 9'a1 Address: Iv m itl n ST , Geo rSTo wrt , M,A Reg. No. "2 -7 ^7 6 S FEE SCHEDULE: BULD/NG PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 5(oa , ':mo FEE: $ Check No.: 116 Receipt No.:,Z o ,�' NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund r� Plans Submitted Plans Waived Certified Plot :Plan < tamped 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 COMMENTSjj* e � � 491104AV CONSERVATION Reviewed on 6— Ao HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: r -L Conservation Decision: Water & Sewer Connection/sic DPW Town Engineer: Signature: Comments Comments '5- Dat 8� e � - t Z c r Driveway Permit Located 384 Osqood Street Dimension Number of Stories: Z i Total square feet of floor area, based on Exterior dimensions. 4/3700 Total land area, sq. ft.: 220115-. ELECTRICAL: Movement of Meter location, mast or service drop req u' s approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine 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 ❑ 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 NOTE: ❑ 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) ❑ IVI "'ass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products 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 RI a, ❑ 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: Building Permit Revised 2008 X/I Location -ra No. X1 – / -'– Date 9/—/ i a - Check # // 25294 TOWN OF NORTH ANDOVER Certificate of Occupancy $ /v Building/Frame Permit Fee $ e, 7,O Foundation Permit Fee $---Z—P-, Other Permit Fee $ TOTAL f � �j � Buildi46 Inspector 1SSACHUSE4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 813-12 on 5/11/2012 Date: March 25, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 52 Molly Towne Road — Lot 11 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: North Andover Realty Corporation 66 Spring Hill Road North Andover, MA 01845 Build' g Inspector Fee: PrePaid $100.00 Receipt: 25294 Check: 116 7.1 z . Vl E CL Z CA VJ :O O CA C cc O CD m C" c m O cm C 'c N m Z r.+ O Z O CD 5 fil U 4 v P4 is co O E co i O O C) Z a3 CL O CO) � C O O! ca CD CO ,� LA O O 'E m m ow 3� O � � CD 0 0 O O Q �Q O env .v Cc ..J •D d O .CO C Z � V y C•— • G 0. N! s. a P 4 �CL W w �- ��.. c at A.wW a id � 0 03w ww" w ,. v ° Q cn cn U, E CL Z CA VJ :O O CA C cc O CD m C" c m O cm C 'c N m Z r.+ O Z O CD 5 fil U 4 v P4 is co O E co i O O C) Z a3 CL O CO) � C O O! ca CD CO ,� LA O O 'E m m ow 3� O � � CD 0 0 O O Q �Q O env .v Cc ..J •D d O .CO C Z � V y C•— • G 0. N! s. a P 4 APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION BUILDING PERMIT it �5 13 ADDRESS/LOCATION OF PROPERTY: �� '11(1p L IY Tri Map S Parcel �l Lot Number SUBDIVISION: DATE REQUESTED FILEDIREADY FOR INSPECTION: N CLOSING DATE ON PROPERTY: LIVE (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\ r — Permit Issued to: ROUTING TOWN ENGINEER; SITE PL — DQ`�E- A� V W %f8 CONSERVATION PLANNING 3 DPW -WATER METER IJ 34 l� SEWER CONNECTION DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYANSPECTION REQUEST DPW SIGNATURE File: Application for OC form revised Jan 2007/2011 jY y �i: 3 r F �, sACIN5Et49 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 813-12 on 5/11/2012 Date: March 25, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 52 Molly Towne Road — Lot 11 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: North Andover Realty Corporation 66 Spring Hill Road North Andover, MA 01845 Fee: PrePaid $100.00 Receipt: 25294 Check: 116 N Build' g Inspector Ri. 1p po 1 E a M z N O N C cc 0 cm O cc cm m O 0) c 'c N m Z O Z O J cm I 42 .A O L O O CD Z y 0 v � cm ca Q . �E m m CD 0 CD O � CD CD 0 Q cc o d �Q cc *-0 C ccc v J .fl c Z C3 V y � C C d E 1. 4 moi' � ca O O / � Q" t' {• ZW 4 . o ca W= O In �w te2 ccd= C!. C N .O co V O CD !E co C a' V3 O 'O O m _ W = h O a a�.m PQco adi co —cl < w` ° ° U ° u; ° E a M z N O N C cc 0 cm O cc cm m O 0) c 'c N m Z O Z O J cm I 42 .A O L O O CD Z y 0 v � cm ca Q . �E m m CD 0 CD O � CD CD 0 Q cc o d �Q cc *-0 C ccc v J .fl c Z C3 V y � C C d E 1. 4 ca O O = C D. Q" o mz 3 _ . o ca W= O 6*02,0 O = t •ca te2 ccd= C!. C N .O co V O CD !E co C a' V3 O 'O O m _ W = h O a a�.m E a M z N O N C cc 0 cm O cc cm m O 0) c 'c N m Z O Z O J cm I 42 .A O L O O CD Z y 0 v � cm ca Q . �E m m CD 0 CD O � CD CD 0 Q cc o d �Q cc *-0 C ccc v J .fl c Z C3 V y � C C d E 1. 4 O1. /SLED /6 .N AyfF ,ICATION FOR CERTIFICATE OF 00CU 'ANCY/INSPECTION, y9Ss ATED ��� BUILDING PERMIT # 13 ADDRESS/LOCATION OF PROPERTY: _ 'iYtp (-{ T V3A PA Map_'C 5 Parcel Qqtl Lot Number A r SUBDIVISION: DATE REQUESTED FILED/READY FOR INSPECTION: t 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\ f ., - Permit Issued to: ROUTING TOWN ENGINEER; SITEPL — DI�VE- A UVJW CONSERVATION PLANNING 3 DPW -WATER METER l"1 3b �'t5 SEWER CONNECTION 43— . DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYANSPECTION REQUEST DPW ,�A-- File: Application for OC form revised Jan 2007/2011 SIGNATURE V., f4 LAWRENCE H. OGDEN, P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978 352-2858 cell: 978-502-5921 November 9, 2012 Mr. James V. Carroll North Andover Realty Trust 66 Spring Hill Road North Andover, Ma. 01845 RE: Residence Lot 11 Molly Towne Road, North Andover, Ma. Dear Mr. Carroll As you requested I visited the site 11/9/12 and met with Mr.Dan Chad to review the installation of the Engineered Materials utilized in the framing of the above project. These are shown on plans A-1. to A-7, prepared by G.3.Bruno Associates, with sheets A-4, A-5, A-6, A-7 certified by me May 2, 2012, with A-5 revised May 30, 2012. Based on the above site visit and based on what I could visibly see I can certify that to the best of my knowledge the LVL Beams utilized in the framing as shown on the drawings are installed properly and meet the loading conditions of the a Edition of the Massachusetts State Building Code for 1&2 Family Residences. All other framing requirements of the drawings and code, including but not limited to materials, nailing schedules, blocking, connections, manufacturers installation requirements and other details are the responsibility of the licensed construction supervisor responsible for the project. It was a pleasure working with you, Dan and your framer on this project as you took the effort to review and follow the drawings with your subs, and brought any questions or requested revisions to my attention prior to proceeding. Should you have any questions please do not hesitate to call. Youm. truly, Va nce H. Ogden P.E. Structural 27765 E ti� tt jg/t a- VAL a LAWRENCE H. OGDEN, P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978 352-2858 cell: 978-502-5921 November 9, 2012 Mr. James V. Carroll North Andover Realty Trust 66 Spring Hill Road North Andover, Ma. 01845 RE: Residence Lot 11 Molly Towne Road, North Andover, Ma. Dear Mr. Carroll As you requested I visited the site 11/9/12 and met with Mr.Dan Chad to review the installation of the Engineered Materials utilized in the framing of the above project. These are shown on. plans A-1 to A-7, prepared by G.J.Bruno Associates, with sheets A4, A-5, A-6, A-7 certified by me May 2, 2012, with A-5 revised May 30, 2012. Based on the above site visit and based on what I could visibly see I can certify that to the best of my knowledge the LVL Beams utilized in the framing as shown on the drawings are installed properly and meet the loading conditions of the 8P Edition of the Massachusetts State Building Code for 1&2 Family Residences. All other framing requirements of the drawings and code, including but not limited to materials, nailing schedules, blocking, connections, manufacturers installation requirements and other details are the responsibility of the licensed construction supervisor responsible for the project. It was a pleasure working with you, Dan and your framer on this project as you took the effort to review and follow the drawings with your subs, and brought any questions or requested revisions to my attention prior to proceeding. Should you have any questions please do not hesitate to call. 7wrence truly, SH Of H. Ogden P.E. Structural 27765 o &AWIMM `boy HAROW '//9/1 lA Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 5623500.00 m $ - $ 6,750.00 Plumbing Fee $ 843.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 843.75 Total fees collected $ 8,537.50 52 Molly Towne Road 813-12 on 5/11/2012 New Single Family Lii �0., k r .LOQ' I I EXISTING FOUNDATION ELEV. =212.3' i �0 fib. FOUNDATION LOCATION PLAN CLIENT: NORTH ANDOVER REALTY THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION: MOLLY TOWN RD, NORTH ANDOVER, MA. SCALE: 1" =.60' DATE: 5122112 ZONING DISTRICT R-2 MIN. AREA = 21,780 S_ F. MIN, LOT WIDTH = 100' MIN. FRONTAGE = 100' MIN. FRONT SETBACK = 20' MIN. SIDE SETBACK* = 20' MIN. REAR SETBACK = 20' (* - THE STRUCTURE MAY BE PLACED UPON A SIDE LOT LINE WITHOUT A SIDE SETBACK, PROVIDED THAT THE ADJACENT LOT TO WHICH THE ZERO SETBACK IS LOCATED HAS THE REQUIRED SIDE YARD SETBACK.) I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REOUIREMENTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED, (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS, WETLANDS,EASEMENTS, ORDERS OF CONDITIONS,ETC.) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ASOVE,EXCEPT WITH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED. CHRISTIANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAINING OR ANY INFOR- MATION CONTAINED HEREON. CHRISTIANSENrXy SERGI PROFESSIONAL EYORS NGINEERS LAD160 SUMMER Sr. NAVERHILL,MA. ` 01830 TEL, 978-373-0310 @2008 BY CHRISTIANSEN & SERGI INC. DRAWING NO. 97066010 24- P(A,,j 1'© FOUNDATION LOCATION PLA N CLIENT: NORTH ANDOVER REALTY THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION: MOLLY TOWN RD, NORTH ANDOVER, MA. SCALE: 1 " = .60' DATE: 5122/12 ZONING DISTRICT-, R72. MIN. AREA = 21,780 S.F. MIN, LOT WIDTH = 100' MIN. FRONTAGE = 100' MIN. FRONT SETBACK = 20' MIN. SIDE SETBACK* = 20' M1N. REAR SETBACK = 20' (* - THE STRUCTURE MAY BE PLACED UPON A SIDE LOT LINE WITHOUT A SIDE SETBACK, PROVIDED THAT THE ADJACENT LOT TO WHICH THE ZERO SETBACK IS LOCATED HAS THE REOUIRED SIDE YARD SETBACK.) I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK R£OUIREM£NTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENA NTS, WETLANDS, EASEMENTS, ORDERS OF CONDITIONS,ETC.) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXCEPT 1111TH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED. CHRISTIANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- MATION CONTAINED HEREON. CHRISTIANSEN;Xh,SERGI PROFESSIONAL SURVEYORS ENGINEERS 160 SUMMER Sr. HAVERHILL,MA. ` 01830 TEL, 978-373-0310 @2008 BY CHRISTIANSEN & SERGI INC, DRAWING N0. 97066010 N O FOUNDATION LOCATION PLA N CLIENT: NORTH ANDOVER REALTY THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT. LOCATION: MOLLY TOWN RD, NORTH ANDOVER, MA. SCALE: 1 " = ,60' DATE: 5122112 ZONING DISTRICT R-2 MIN. AREA = 21,780 .S. F. MIN. LOT WIDTH = 100' MIN. FRONTAGE = 100' MIN. FRONT SETBACK = 20' MIN. SIDE SETBACK* = 20' MIN. REAR SETBACK = 20' (* - THE STRUCTURE MAY BE PLACED UPON A SIDE LOT LINE WITHOUT A SIDE SETBACK, PROVIDED THAT THE ADJACENT LOT TO WHICH THE ZERO SETBACK 1S LOCATED HAS THE REOUIR£D SIDE YARD SETBACK.) I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO THE HORIZONTAL SETBACK REOUIREMENTS OF THE LOCAL APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED. (THIS CERTIFICATION DOES NOT CONSIDER ANY OTHER RESTRICTIONS SUCH AS COVENANTS, WETLANDS, CASEMENTS, ORDERS OF CONDITIONS,ETC.) THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY PURPOSE OTHER THAN THAT OUTLINED ABOVE,EXCEPT 1111TH THE WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC. FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE IS PROHIBITED.CHRISTIANSEN & SERGI TAKES NO RESPONSIBILITY FOR THE UNAUTHORIZED USE OF THIS DRAWING OR ANY INFOR- MATION CONTAINED HEREON. CHR/STlAN5EN11) 5(„„ RG1 PROLAND ONAL ENGIN S RVEYORSEERS 180 SUMMER ST. HAVERHILL,MA. 01830 TEL. 978-373-0310 @2008 BY CHRISTIANSEN & SERGI INC. DRAWING NO. 97066010 A REScheck Software Version 4.4.0 Compliance Certificate Project Title: COLONIAL HOUSE Energy Code: Location: Construction Type: Glazing Area Percentage: Heating Degree Days: Climate Zone: Construction Site: LOT 11 MOLLY TOWN 0184 2009 IECC North Andover, Massachusetts Single Family 18% 6322 5 N. ANDOVER Owner/Agent: Compliance: 29.3% Better Than Code Maximum UA: 570 Your UA: 403 The % Better or Worse Than Code Index reflects how dose to compliance the house is based on code tradeoff rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum -code home. Designer/Contractor: Ceiling 1: Flat Ceiling or Scissor Truss 2288 38.0 0.0 69 Wall 1: Wood Frame, 16" o.c. 3298 21.0 0.0 153 Window 1: Vinyl Frame:Double Pane with Low -E 525 0.030 16 Door 1: Glass 84 0.030 3 Basement Wall 1: Solid Concrete or Masonry 2288 30.0 0.0 162 Wall height: 8.0' Depth below grade: 7.0' Insulation depth: 4.0' 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 2009 IECC requirements in REScheck Version 4.4.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name - Title Signature Uate Project Title: COLONIAL HOUSE Report date: 05/07/12 Data filename: C:\Users\JERRY\Documents\REScheck\jim carroll.rck Page 1 of 4 REScheck Software Version 4.4.0 Inspection Checklist Ceilings: ❑ Ceiling 1: Flat Ceiling or Scissor Truss, R-38.0 cavity insulation Comments: Above -Grade Walls: ❑ Wall 1: Wood Frame, 16" o.c., R-21.0 cavity insulation Comments: Basement Walls: ❑ Basement Wall 1: Solid Concrete or Masonry, 8.0' ht / 7.0' bg / 4.0' insul, R-30.0 cavity insulation Comments: Windows: ❑ Window 1: Vinyl Frame:Double Pane with Low -E, U -factor: 0.030 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1: Glass, U -factor: 0.030 Comments: Air Leakage: ❑ Joints (including rim joist junctions), attic access openings, penetrations, and all other such openings in the building envelope that are sources of air leakage are sealed with caulk, gasketed, weatherstripped or otherwise sealed with an air barrier material, suitable film or solid material. ❑ Air barrier and sealing exists on common walls between dwelling units, on exterior walls behind tubs/showers, and in openings between window/door jambs and framing. ❑ Recessed lights in the building thermal envelope are 1) type IC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. ❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated (without insulation compression or damage) to at least the level of insulation on the surrounding surfaces. Where loose fill insulation exists, a baffle or retainer is installed to maintain insulation application. ❑ Wood-buming fireplaces have gasketed doors and outdoor combustion air. Air Sealing and Insulation: ❑ Building envelope air tightness and insulation installation complies by either 1) a post rough -in blower door test result of less than 7 ACH at 33.5 psf OR 2) the following items have been satisfied: (a) Air barriers and thermal barrier: Installed on outside of air -permeable insulation and breaks or joints in the air barrier are filled or repaired. (b) Ceiling/attic: Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed. (c) Above -grade walls: Insulation is installed in substantial contact and continuous alignment with the building envelope air barrier. (d) Floors: Air barrier is installed at any exposed edge of insulation. (e) Plumbing and wiring: Insulation is placed between outside and pipes. Batt insulation is cut to fit around wiring and plumbing, or sprayed/blown insulation extends behind piping and wiring. (f) Corners, headers, narrow framing cavities, and rim joists are insulated. (9) Shower/tub on exterior wall: Insulation exists between showers/tubs and exterior wall. Sunrooms: Project Title: COLONIAL HOUSE Report date: 05/07/12 Data filename: C:\Users\JERRY\Documents\REScheck\jim carroll,rck Page 2 of 4 Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum L ❑ skylight U-factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Materials Identification and Installation: C] Materials and equipment are installed in accordance with the manufacturer's installation instructions. Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value. Materials and equipment are identified so that compliance can be determined. 0 Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. F-) Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. Duct Insulation: 0 Supply ducts in attics are insulated to a minimum of R-8. All other ducts in unconditioned spaces or outside the building envelope are insulated to at least R-6. Duct Construction and Testing: rl Building framing cavities are not used as supply ducts. Ll All joints and seams of air ducts, air handlers, filter boxes, and building cavities used as return ducts are substantially airtight by means of tapes, mastics, liquid sealants, gasketing or other approved closure systems. Tapes, mastics, and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction. Metal duct connections with equipment and/or fittings are mechanically fastened. Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three equally spaced sheet-metal screws. Exceptions: Joint and seams covered with spray polyurethane foam. Where a partially inaccessible duct connection exists, mechanical fasteners can be equally spaced on the exposed portion of the joint so as to prevent a hinge effect. Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in. w.g. (500 Pa). O Duct tightness test has been performed and meets one of the following test criteria: (1) Postconstruction leakage to outdoors test: Less than or equal to 8 cfm per 100 ft2 of conditioned floor area. (2) Postconstruction total leakage test (including air handler enclosure): Less than or equal to 12 cfm per 100 ft2 pressure differential of 0.1 inches w.g. (3) Rough-in total leakage test with air handler installed: Less than or equal to 6 cfm per 100 ft2 of conditioned floor area when tested at a pressure differential of 0.1 inches w.g. (4) Rough-in total leakage test without air handler installed: Less than or equal to 4 cfm per 100 ft2 of conditioned floor area. Heating and Cooling Equipment Sizing: Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanical and/or Service Water Heating (Sections 503 and 504). Circulating Service Hot Water Systems: Circulating service hot water pipes are insulated to R-2. Ll Circulating service hot water systems include an automatic or accessible manual switch to tum off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: Ll HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Swimming Pools: F1 Heated swimming pools have an on/off heater switch. Pool heaters operating on natural gas or LPG have an electronic pilot light. Timer switches on pool heaters and pumps are present. Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar- and/or waste-heat-recovery systems. n Heated swimming pools have a cover on or at the water surface. For pools heated over 90 degrees F (32 degrees C) the cover has a minimum insulation value of R-12. Exceptions: Covers are not required when 60% of the heating energy is from site-recovered energy or solar energy source. Lighting Requirements: Project Title: COLONIAL HOUSE Report date: 05/07/12 Data filename: C:\Users\JERRY\Documents\REScheck\jim carroll.rck Page 3 of 4 A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following: (a) Compact fluorescent (b) T-8 or smaller diameter linear fluorescent (c) 40 lumens per watt for lamp wattage <= 15 (d) 50 lumens per watt for lamp wattage > 15 and <= 40 (e) 60 lumens per watt for lamp wattage > 40 Other Requirements: ❑ Snow- and ice -melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a) the pavement temperature is above 50 degrees F, b) no precipitation is falling, and c) the outdoor temperature is above 40 degrees F (a manual shutoff control is also permitted to satisfy requirement's'). Certificate: Lj A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R -values; window U -factors; type and efficiency of space -conditioning and water heating equipment. The certificate does not cover or obstruct the visibility of the circuit directory label, service disconnect label or other required labels. NOTES TO FIELD: (Building Department Use Only) Project Title: COLONIAL HOUSE Report date: 05/07/12 Data filename: C:\Users\JERRY\Documents\REScheck\jim carroll.rck Page 4 of 4 C2009 IECC Energy J(111 Efficiency Certificate Ceiling / Roof 38.00 Wall 21.00 Floor/ Foundation 30.00 Ductwork (unconditioned spaces): Glass,8 Door Rating s y a�� z�� �� �U Factor '•�SHGCS `.�c�r:,�t.� •Mzs;�,:�4rz�._,..,; �x�s.�rszi:,.,�4f �r �:'.�'.�;:_,a,�s��. Window 0.03 Door 0.03 NA Heating System: Cooling System: Water Heater: .4 y Name: Date: Comments: tilxssachusctts - Department of Public Safety ` Board of Building Regulations ant! Stand<u•ds Construction Supervisor License License: CS 63503 i JAMES V CARROLL 21 JOHNSON CIRCLE j NO ANDOVER, MA 01845 ('onnnissioncr Expiration: 7/19/2013 Tr#: 687 05/08/2012 13:52 9786833147 PAGE 01/01 or-%%-%F-'r CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOffyyy) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORIQATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS/8f 2012 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 INSURERS}, AUTHORIZED REPRESENTATIVE' OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the csrtfficati? hold9r ie an ADDITIONAL INSURED, the policy(Ies) must he andorsetl. tf SU9ROGgTION IS WAIVED, subject to the terms and coniiftions of the Policy, certain Policies may require an endorsernent. A Statement On this C -15ROG Clogs not AIVEr rights m the Csrtlftcate holder A► lieu of such endorsematrt(B)_ PRODUCER M P ROBERTS INS AGCY INC NAME: 1060 Osgood street 'AS E (978)683-8073 North Andover, MA 01845 Arc . com 8) 683-3141 Ao°rsa:sal�di@mprobertsinsuranae. eom INSURFDINSURER A : TPA _ XNSURANCE NAICa NORTH OVER REALITY CORP, INSURF,R 5: 66 SPRING BILL ROAD INSURER C NORTH ANBOVER, MA 01845 INSLIRERD: 978-556—.9834 INSURER E ,'iOVEFAGES �` INSURER P CERTIFICATE NUMBER: THIS IS TO CERTIFI' THAT THE POLICIES OF INSURANCE LISTED BELOW HAV $ BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD REVISION NUMBER: INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY i3E ISSUED OR MAY PERTAIN, THE SHOWNM AHAORDEp BY THE PDLICfES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, WRFEXCLUSIONS AND CI)NDITIONS OF SUCH POLICIES. LIM(TS SHOWN MAY HAV$ BEEN REDUCED BY PAID CLAIMS, TR TYPE 017 INSURANCE F--1 ERAL, LIA911-ITY N O POLICY NUMBER MMIDD MMD1YY LIMITS Mt:v IAL GENERAL LIABILITY CLAIMS-MA.QE E OCCUR LIMIT APPLIES PER: DMOBILE LIABILn-Y ANYAUTO ALI, OWNED 3CNEDULEp AUTOS AUTQS NN HIRBO AUTOS `AUTO WNED UMBRr LLA LIAR OCCUR EXCESS LIAR CLAIMS-MAOE DEA R :TEVTION $ WORMERS CCMPENSAnpN AND EMPLOYERS LIACILI7Y ANY PROFRIETOMPARTNtWEXECUTIVF- Y/N A OFFMMMINIBER EXCLUiED7 I�biMVetOry In NM � �NIA EACH Ea oCIXNIbnCe $ rn ana person) � & ADV INJURY S 4WREGATE $ COMPIOP AGO 3 BODILY INJURY (Per Orson) $ BODILY INJURY (Per exlClent) S Per eCCidat $ S EACH OCCNe4z I WCC5010734012012 03/13/12 103/13/13 T�yaLIhC E.L. EAC LI CuEK• DENT E.L. DISEASE - EA EMPLOYE ; E.L. DISEASE _ onl Iry , u.,r ., DESCRIPTION QF OPERATION31 LOCATIONS J VL•HICLES (AIIWrh ACOgQ 101, AtlUiticnBl Ralnark9 Schedule, ii norg space is rpgWrcd) 'T'OM OI!' NORTH ,ANDOVER 1600 043GOOD STREET NORTH IMOVER, MA 01845 FAX: 978-655-4760 ,COR025(2010105) 21-1000 500,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TWE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED QtT,35ot0 The ACORD name and logo are registered marks of ACORD All rights reserved, The Commonwealth of Massachusetts Department oflndustria(Accidents Office of Investigations 600 Washington Sheet 5� Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers wlicant Information 01PA QP prim• T ., Name (Businesslorganization&c' vidual): Address: City/State/Zip:[1�.IL�ry�,,,ti,�o a1 Cor Phone #:_ Q7 8 -Z56n p *S'7 Are y an employer? Check the appropriate box: 1 • I am a employer with _ L 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- on the attached sheget ship and have no employees These sub -contractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing .officers have exercised their all work right of exemption per MGL Myself [No workers' comp. insurance required.]r c. 152, §1(4), and we have no employees. [No workers' comp, insurance required j '4pe ofproject (required): 6. ew construction 7. ❑ Remodeling 8. ❑ Demblition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑11lumbingrepairs or:3dditions 12.❑ Roofrepairs 13.❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I 11 Homeowners who submit this affidavit indiFating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Confractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for information. my employees Below is the policy and job site Insurance Company Name: -T l n Si j l/`a,,,LC,_ Policy ## or Self -ins. Lie. #: W ,C C SQ l 0 ? '46 k Expiration Date: Q ! 3 1 3 Job Site Address:_ !)4 rnc. t i,t T -O y n P , City/State/Zip: 111 � Q � L. V ��O l 8 u �T Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required winder Section 25A of MGL c. 152 can lead to the imposition of c fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP riminal penalties of a ViiORK ORDER and a fine Of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the informafton provided above is true and correct. (\ Official use only. City or Town: Do not Write in this area, to be completed by city or town offcial Permit/i.;�p„�e issuing Authority (circle one): , X. Board of Health 2. Building Department 3. City/TOWn Clerk 4. Electrical Inspector 5. PIumbing 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, l or written." express or implied, ora 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 employer." MGL chapter 152, §25C(6) also states that "everystate or local licensing agency shallwithhold 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 ofpublic 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 -contractors) 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 affidavitshould be retained 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. PIease 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 (ifnecessary) 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 bum leaves etc.) said person is NOTrequired 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: `i'he Co owc—all'a of Massadilalisetts Department of Industrial Accidents Office- of Investigatious 600 Washington street Boston;MAA 02111 Tel. # 617-727-4900 ext 406 ox Z,a77,mASS.A~FB Revised 5-26-'05 Fax #,617-727-7749 Www.mass.>;ovaa W W Cd w Q °�x c p v W z A c° u u. W U C2 cd r. w U u U a ' cn w Gd O ER :J a ' w H Z w A cn Q o cn c y- o as c V : Cy O C OCc c A �. 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