HomeMy WebLinkAboutBuilding Permit #637-2017 - 52 WELLINGTON WAY 12/13/2016�lian�5 `fiat SeAwwF,
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: (037- 3n-)
Date Issued: 0-/1Z /1Z 1"iU
Date Received
NORTy
O��t IED 'b q'irC
►32
Z
IMPORTANT: Applicant must complete all items on this page
LOCATION e-�� _
`Print
s PROPERTY OWNER We WA
K6.
Print 100 Year. Structure yes no
MAP L�C_PARCEL:46- ZONING DISTRICT: R t Historic District yes. a
Machine Shop Village yes,lip
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
a'New Building
Noo0ne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement -
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
D Septic ❑ UVell, ' s
❑AtFloodplain. 0 Wetlantls
UVateshed, Di tract'
Q Water/Sewed°
-
— - -
DESCRIPTION OF WORK TO BE PERFORMED:
Identification - Please Type or Print Clearly
OWNER: Name: r �f' � ,,; < Phone: 978' - G63- Ceo6
Address: 7�- 17e,�"f a r 01
Contractor Name:- L T C ® rh Phone: /�? 8' !C3 -moo az
Email ieod.�.'t—Ta AOL
Address: t4 73 Ro-s�Fe T&I
Supervisor's Construction License: C S 05R0,?!J Exp: • Date;
Home Improvement License: Exp. Date:
r,
ARCHITECT/ENGINEER -T!_ Phone: S 0 8 TC/- l a Co
Address: 7D /4&,%,q 6T Way lo-hj Ma Reg. No.
FEE SCHEDULE: BULDING PERMIT. • $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $_ 2 - 4 0 -0 FEE: $ 13,4 o o 60-
Check
eCheck No.: 1 b \ Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
-
.-.+,..... ..f`;/�:....r;17rl�e.r..irs. t -T-7" ..Giivr�re�..�f n�ntrn�+terYwnwwi f
Plans Submitted QV Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools ❑
Well ❑
Tobacco Sales ❑
Food Packaging/Sales ❑
Private (septic tank, etc.
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING DEVELOPMENT Reviewed On ILC�I�ignature_
C MMENTS�� I Civ41-
CONSERVATION
COMMENTS A
Reviewed on
HEALTH Reviewed on ( 1'I (3
COMMENTS
2 �2
Zoning .Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision:
8 Water & Sewer Connectio
DPW Town Engineer: Signa
Com
Dimension
Number of Stories: 2 Ya, Total square feet of floor area, based on Exterior dimensions. ®o s¢
Total land area, sq. ft.: y 91y3 sem,
ELECTRICAL.: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doe.Building Permit Revised 2014
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
OTE: 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
TOTE: 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
2012 IECC Energy code
Engineering Affidavits for Engineered products
OTE: 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
Location /,-,)
No. —(o�z 7 - -;, a t 7
Check#
All
Date /-�-AEA�
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee $
Foundation Permit Fee $- I I
Other Permit Fee $
TOTAL $
Building Inspector
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212.1' 100'
r WETLAND
SETBACK
LOT 2 � oma— — —
/
/
32.0' ` EXISTING FND.
N TCF= 146.3
0
20.6'---9'
LOT 1
io'
ON LOT 3
t ♦ -q �
EASEMENT
� 1
i
t
FOUNDATION LOCATION
CLIENT: ROBERT INNIS
THIS CERTIFICATION IS MADE AND LIMITED TO THE ABOVE CLIENT
LOCATION: NORTH ANDOVER,MA.
DATE: 1/2/17 SCALE: 1"=50'
i1
I CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS TO
THE HORIZONTAL SETBACK REQUIREMENTS 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
ABOVE,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
DRAWING OR ANY INFORMATION CONTAINED HEREON.
PROFESSIONAL ENGINEERS & LAND SURVEYORS
CHRIST/�4NSEN 8 .SERGI INC.
160 SUMMER STREET, HAVERHILL, MASSACHUSETTS 01830
WWW.CSI-ENGR.COM TEL.978-373-0310 FAX.978-372-3960
D W G. N 0.:14036.001.017
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AL04 GraenwoodAve 52 Wellington Circle
N.Andover, MA01845
**Ikr"=�
5 Stars Plus
Projected Rating: Based on Plans, Field Confirmation Required
Uniform Energy Rating System Energy Efflelent
1 Star 1 Star Plus 2 Stars 2 Stars Plus 3 Stars 3 Stars Pius 4 Stars 4 Stars Plus 5 Stars 5 Stars Plus
500,401 400301 300.251 250.201 200.151 150101 100 91 90.86 85.71 70 or Less
HERS Index: SS
<3eneral in rmation
Conditioned Area: 3167 ft o Houser f�
sq. ype: Single-family detached
Conditioned Volume: 26075 cubic ft Foundation: More than one type
Bedrooms: 4
MechanicalSystems Features
Heating: Fuel fired air distribution, Natural gas, 95.5 AFUE.
Heating: Fuel4ired air distribution, Natural gas, 95.5AFUE.
Cooling: Air conditioner, Electric, 13.0 SEER.
Duct Leakage to Outside: 126.00 CFM25.
Ventilation System: Exhaust Only: 69 dm, 112 watts.
Programmable Thermostat: Heating: Yes Cooling: Yes
Bullding StreB Features -` �` " �"�'
Ceiling Flat R-40.0 Slab: None
Sealed Attic: NA Exposed Floor. R-40.5
Vaulted Ceiling: R-07.8 Window Type: U -Value: 0.280, SHGC:0250
Above Grade Walls: R-23.0 infiltration Rate: Htg: 3.00 Cig: 3.00 ACH60
Foundation Walls: R-0.0 Mathod: Blowerdoortest
ELlift and Appliance Features
Percent Interior Lighting: 90.00 Range/Oven Fuel: Natural gas
Percent Garage Lighting: 100.00 Clothes Dryer Fuel: Natural gas
Refrigerator (kWh/yr): 691.00 Clothes Dryer EF: 2.67
Dishwasher Energy Factor. 0.60 Ceiling Fan (dn-dWatt): 70A0
The Hone Energy Rating Standard Disclosure for this home is available from the rating provider.
REMIRate - Residential Energy Analysis and Rating Software v14.6A
This information does not constitute any warranty of energy cost or savings.
01985.2016 Noresco, Boulder, Colorado. g1
Registry ID:
Rating Number. ABAS362
Certified Energy Rater. Dan Clark
Rating Date: 11/17/2016
Rating Ordered For. RLI Corp
Estimated Annual Energy Cost
Projected Rating
Use MMBtu Cost Percent
Heating 69.5 $1261 40%
Cooling 3.3 $173 5%
Hot Water 21.1 $373 12%
Ughts/Appliances 29.9 $1299 41%
Photovoltaics -0.0 $-0 -0%
Service Charges $59 2%
Total 123.8 $3164 100%
This home meets or exceeds the minimum
criteria for all of the following:
2012 International Energy Conservation Code
20121ECC Dud Leakage Requirement*
20121ECC Requirement -hrtiitrabon <3ACH50'
20121ECC Whole House Ventilation Requiremenr
MA Base Code HERS Rating Performance requirement*
Compliance with atteria for this program is
determined by the rater.
HERS Rater - _-
Advanced Building Analysis, He
2 Woodlawn St
Amesbury, MA 01913
Phone #- 978-2703911
Fax # - 978-587-0359
1
Certified Energy Rater
The Commonwealth of Massachusetts
DeparfiEnent of Indusiial Accidents
r 1 Congress Feet, ,5`AUi 100
Boston, HA 02114-2017
Y www.mass gov/dia
5 Wavkers' CoMpensationXnsoiaucd Affidavit: Brdlders/Coni�racto:rs/Elegddansl�'Imnbexs.
TO BEFff"WiTHTER M MVGTialo Y-
BleasePz�at
Name (Business/0igariization/Individuai)r nQL J
Address-=
City/Siatelzip
Phone ##:
Areyou aemPloyer? ecktfie appropriafeb
n qjox:
1 am a employerwi6i�_�19,P,s (f3n and/orpart idmo).*
2.0 1 am. asole proprietor orpartam bip andbaveno emPlayees Working forme in
any capacity. jNoworkers' comp- Renee required]
3.Q I am. ahomwwmr doing allworkmyse]£ END workers' comp. insnrancerequired]
4.n lam ahomeownerandv0behiringconfzecforsfocondmtallworkonmypropMt3r- IwiU
Mmze-fl a all contracfbis eifherhavew�' p� on' fimrawc or are sole
proprietors wiHinq 4ea�pJ.a3'ee5
s.QI am a genial. ealtmctUi , ,Agm �•61e sub -contractors Iisted on Hie attached sheet
These sub-omtm, ors haA 6hployees endhave workers' comp. insi ----
and its, officers bane emcisedtheirrigbt of-exemptionper MGL c.
6.C1weamacorpor?tio�._ s oworkers'comp. required-]
4 and' a have no esrployee . (N �^�+'*AT'r� d
Type of project (�egaired)',
7. VdNew'd6nst.dd ion
8. [� R�mode*
9. ❑ Demolition
10 [] Building addition
11.[] Electrical repairs
or additigns
1 G(:plumbing repairs or additions
13%Rbofrepaid
14.rl Other.
152, §l( ), . ,-
aft oTicy3nf0=aaiion:
�,°,nY�pucanzrnazcagvn� �„a�=�
T Homeowners who sabmi -this . .. -
tCo,1raotvrsY9C,d cb Jcibi�s B�b{��m. I-tqa
orrlTirmnn.C_ ifthe sub•confractors �e
llouithe sectionbelowshowmg-ftesworkers aompens enp bmft anawaffidaviiindicaiingsneh
�gtheyy are doing all VoIk and-ff mbire outside coniractom n whether w a idEgit entities have
ka additional sbeetshowingthename ofthe snb-aontraafioss and
T1,rvmIIstprasid0&eir W0rI=ecomp.Policynumbtm
X ain an employer azat is providing-W0'*Vs'
compensation insurancefor my employees $elow inv tliepoPrey andYob site
informadon. �Y
Insurance Company Name:
�o _ _ Expirafion.DAo,
Policy # or Self -ins. Lic. #: _ -
.� � city/state/Zip:
Job Site Address')
_ ation policy declaration page (showh_Ig the policy number and expiration
Attach a copy of the evoxkexs' Compdate}.
152, §25A is a cfi�ainal violation punishable by a fine up to $1,500-00
Failure to secU�re coverage as required Under MGL c.
and/or one-year imprisonment as well as civil penalties in the form o£ a STOP WORK ORDFZ and a fine o£up to $250.00 a
day against the violator. A copy
oftbis statement may be forwarded to e Office of htvestigaiionss of the DIA for insm uGe
coverage verification
X do Iiere/iy ce�fy ��' tliepains andperzaldes ofperjury that the informationg�'ovided move is fie at?d correct
Phone #:
Official use only. Do not -write in tizis area, to be corr�pleted by city or town official
permiiUMeense #
Citi or Town"
Iss=g A-alho nty (circle one):ector 5.21 umbinglnspecior
1. Board of Health 2. Building Department 3. CitylTo evn Clerk 4. Rleet-deal )Gasp
6. Other
Phone
Contact person-
12/07/2016 09:01 9786810773 DEANGELIS INS PAGE 01/01
4 oRti' ATE
CERTIFICATE OF LIABILITY INSURANCE D12/7IDDIYYYY)
12/7/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the poBCy(i0s) 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 certlfictllte does not confer rights to the
rs
certificate holder in lieu of such endomemen s .
PRODUCER coME C Tracy Loeechen
DeAngelis insurancePHONE (978)682.3397 NML; 170)rIIL-0771
283 Merrimack Street B -MAIL
..,-.-�e.e, ♦een�n,un nnueeen■ I NAIL A
Matuuen ask 01844
INSURED
R L 2 Corp
475 Boston Road
Billerica Xh 01821 1INSURER F -I --I
COVERAGES CERTIFICATE NUMBER:2016 Term REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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.
NY9R I LTRTYPE Of INSURANCE P Y NUM ER POLICY EFF PO Y 6 P UMRS
COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE f
CLAIMS -MADE El OCCUR PREM15!>:�1— 5
MED EXP (AnY one Ptmeon S
PERSONAL & AoV INJURY S
GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE Z
N
S
RPOLICY ��--``�� PRCTO• LOC
PRODUCTS - COMP/OP AGO
L_I JE
S
THER:
AUTOMOBILE LIABILITY C MaOeoW D SIN E LIME
S
AL—
BODILY INJURY (Par Pemmn) f
ANY AUTO
ALL
QED SCHEOUL50 AUTOS
BODILYINJURY (Peroceldenq S
NON -OWNED PROPRE—R—TYFAMAGE S
HIRED AUTOS AUTOS P eM
S
UMBRELLA LIAR OCCUR EACH OCCURRENOE S _
EXCESS LIAB CLANS -MADE AG4REOATE S
DED I I RETENTION S E
WORKERS COMPENSATION p E OTH-
AND EMPLOYERS LIABIUTY Y r N E.L. EACH ACCIDENT f
ANY PROPRIETORIPARTNERIEXECUTWE N I A
OFFCERIMEMBEREXCLUDS07 66614845624913 5/6/2016 5/6/2017 E. L. DISEASE - EA EMPLOYE 6 100.000
A IMandarory in NH)
IIyae deacrlbauneer E.L DISEASE - POUCYLIMIT 500.000
DES�RIPTI F PPJ7AT10 ew
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addittmat Remeft SehedWe, may Oa nlfaeh IS If Moro ePeee U MQUIMd)
Certificate in issued in the interest of the named insured and holder listed below. Subject to company
conditions and exclusion@.
CERTIFICATE HOLDER CANCELLATION
(978)557-5490
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town O£ North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1600 Osgood street
North Andover, MA 01845 AUTHORIZED REPRESENTATIVE p
David Segal/TEL�'"rr
rpt 1888-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 (201401)
z Massachusetts Department of Public Safety
P Board of Building Regulations
and Standards
License: CS -058839
Construction Supervisor
ROBERT L INNIS
3 LORRAINE TERR
'.w
BILLERICA MA 01827 - x
v
" `--
Commissioner
Expiration:.
06/25/2018