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HomeMy WebLinkAboutBuilding Permit #566-15 - 79 HEWITT AVENUE 12/18/2014 c t%ORTH BUILDING PERMIT o� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ozo40 �s9s R47ED SPP�4 SACHU`�� Date Issued: mi 14 I P RTANT:Applicant must complete all items on this page LOCATION 71 5, Print PROPERTY OWNER I IP Yrk(J'- 0 evr 1 e4V4rVJ �G-G Print 100 Year Structure yesfno MAP 1 PARCEL: ZONING DISTRICT:®R3 Historic District yeso 600iK Icy P�.yc 7 Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ew Building VOne 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 DESCRIPTION OF WORK TO BE PERFORMED: iu yJ ?yfo© S F� 1'wel 1 rn Identification- Please Type or Print Clearly OWNER: Name: Phone: g784179IZ6Z 1 Address: �l F � . R�d� M q Contractor Name:(',k,nsV�cry L(-t Phone: US CM I 1 Z,4 Z< Address: I q r,rant✓Ls �,�' ILV ;, Supervisor's Construction License: LS - 0%0a? 7 Exp. Date: -7 _ Z0t 5 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: q 7 q - 375 ZS cl0 Address: 114NiLJ 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: $ �a o FEE: $ O �d l� Check No.: Receipt No.: �� L 1 NOTE: Persons contracting with unregistered ontractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor .r Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Q� TYPE'OF SEWERAGE DISPOSAL Public Sewer "1 Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ZPLANNING & PMENT Reviewed On ( �' Signature_ rs � .� CONSERVATION Reviewed on Si nature6e - -.,-Ct COMMENTS 01eX\10,,,l U V\ \'M" CLj /HEALT Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date C nL'i ��- e n 'Piths COMMENTS Dimension Number of Stories: '3 Total square feet of floor area, based on Exterior dimensions. 2400 %9 0 Total land area, sq. ft.: (306A 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) ok JA '�z � ILN �j dv ❑ Notified for pickup Call Email Date Time Contact Name 1 Doc.Building Pen-nit Revised 2014 i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing g, 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 o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) � ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 I Location ?/ y� No. Date, //� j/ . - TOWN OF NORTH ANDOVER • ��. �n rte' � Certificate of Occupancy $ ° Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector HERRICK DEVELOPMENT LLC i QUALITY. EXCELLENCE. RELIABILITY CHRIS HERRICK CHRIS HERRICK@Q MSN.COM 19 FRANCIS ST. [978] 979-1262 NO.READING, MA 01864 of NORTH�M 3?d•_e D'+'•got 378�CRUSE4 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 566-15 on 10/7/2014 Date: September 23, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED at 79 Hewitt Avenue 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: Herrick Development LLC 79 Hewitt Avenue North Andover,MA 01845 Bui ding Ins ector Fee: PrePaid $100.00 Receipt: 28372 Cheek : 545 a. NRT O M F - Town oAndover �. No. ' � _ ..mow'• .'t•. " h over, Mass,0 4 1,".6.1. l a ' [O[Nlc"t—CK 1• r S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ..........YOAIJ��........ ............. .. '.'L ..... ...................................... i i BUILDING INSPE TOR . . ,� � has permission to erect .......................... buildings on .... ........ ............. ..... ...... ................ Roug to be occupied as ....�.!.... ........... � ........... d.l.`.!5.....`.�G'b��.T�t .......... Chimney provided that the person ac pting this permit all in every respect conform to the terms of the application in 4� on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING NSP U R Rough �7/4_7 �t t V VIOLATION of the Zoningor un Regulations os this Permit. Building RliVidhi g Finale PERMIT EXPIRES IN 6 MONTHS ELECTRICAL IN ECTOR UNLESS CONSTRUCTION A S r �. �� �-% ,ser-P - BUILDING INSPECTOR Fina GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPART ENT Until Inspected and Approved by the Building Inspector. ger Street No. Smoke Det. 4 i � . ��� � � . i �, Y �� � I ,w N/F N/F RYAN S. ZANNINI ROBERT LEITCH KATHLEEN A. RECKENDORF LT 41 CARTY CIRCLE 40 CARTY CIRCLE MAP 47 PARCEL 35 MAP 47 PARCEL 34 125.4' sial WALL _:. LOT AREA z 11,347.± S.F. Z PAVER PATIO 7-1 �Z ZONING SETBACK LINE1117-1 I N/F � - 7777-7/j , 25.0' JOHN & ROBERTA SCALI I 83 HEWITT AVENUE N/F EXISTING I MAP 47 PARCEL 9 I I, iA� o DONALD & KAREN ROKES DWELLING A 67 HEWITT AVENUE MAP 47 PARCEL 5 30.5'_ _ // ZONING SETBACKS: R3 PORCHy /� FRONT YARD 30 C / SIDE YARD 20' REAR YARD 30' PA),ER WALK t I__ BIT aR,E YdA / �% RECORD OWNER: .— HERRICK DEVELOPMENT, LLC (FND.) 42 j BOOK 14017 PAGE 165 79.8' PLAN REFERENCE: LOTS 250-255 ON PLAN NO. o� �f 360 OF 1906 orf B1 T. SIDEWALK DIT. CURD �P�SN OF Mess HEWITT AVENUE SCOTT M Gm (PUBLIC — 40' WIDE) E CERRATO NGINEERING, INC. .,,No. 500 o. 50049PLAN Civil Engineers & Land Surveyors lyHo SOf NE"AloP GRAPHI ALE 234 Park Street . North Reading, MA 01864 0 978-664-8141 20 0 10 20 40 AS-BUILT FLAN I HEREBY CERTIFY THAT THIS PLAN IS BASED ON AN ACTUAL INSTRUMENT SURVEY MADE ON THE GROUND IN AUGUST 2015 AND THAT THE STRUCTURE DEPICTED HEREON IS LOCATED AS SHOWN. 1" - 20' 79 H EWITT AVEN U E NORTH ANDOVER, MASSACHUSETTS - y- MAP 47 PARCEL S DATE SIGNATURE SEPTEMBER 4, 2015 O, 10RTH 1ti ti a i r M i '� °4n.✓"19 �sSACHU`+pi I CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 566-15 on 10/7/2014 Date: September 23, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED at 79 Hewitt Avenue 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: Herrick Development LLC 79 Hewitt Avenue North Andover,MA 01845 Budding Ins ector Fee: Prepaid $100.00 Receipt: 28372 Check : 545 F NORTo� . Town of 0 •.,'• y'' to No. * t h over, Mass, I a - .�.� 'S1 COC NIC Nl MACK �� � V A�R�tEO /•P�` 5 i U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System aZ�— BUILDING INSPE OR YO&kTHIS CERTIFIES THAT .......... .r....... ..............'. ..... . .................................................... '� f -�has permission to erect .......................... buildings on .... .. ......... .............................. Roug C I to be occupied as s� ��'� ...........��.. ... ....�C!4�1.�...���' ...�................... Chimney provided that the person ac pting this permit all in every respect conform to the terms of the application in on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBINGlNSP Cog R Rough r' VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL IN ECTOR UNLESS CONSTRUCTION A S .................... ......... ..........- ........................ oc-A,wI�_ - .-� S'- Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPART ENT Until Inspected and Approved by the Building Inspector. Byer Street No. Smoke Det. 4. �_ i � _ .. i r, ' _ .7 �-► i I I 1 HOME CERTIFIED TO MEET THE PROVISIONS OF THE 2009 INTERNATIONAL ENERGY CONSERVATION CODE This home built at j 79 Hewitt Ave, North Andover, MA by Chris Herrick exceeds the minimum requirements for the 2009 International Energy Conservation Code Building Features Ceiling Flat R-32.8 Duct R-6.0 Sealed Attic: NA Duct Leakage to Outside: 93.00 CFM CS)25 Pascals Vaulted Ceiling NA Total Duct Leakage: 189.00 CFM @ 25 Pascals Above Grade Walls R-21.0 Infiltration: Htg: 884 Clg: 884 CFM50 Foundation Walls R-0.0 Window U-Value: 0.300, SHGC: 0.260 Exposed Floor R-30.0 Heating Fuel-fired air distribution, Natural gas, 96.5 AFUE. Slab None Cooling Air conditioner, Electric, 13.0 SEER. Water Heating Conventional, Natural gas, 0.66 EF, 75.0 Gal. The organization below certifies that the proposed building design described herein 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 compliance with Chapter 4 based on Climate Zone 5A and with all mandatory requirements. Name Inette Rex Signature Inette Rex ;- = � { Organization The Energy Hound Date September 15, 2015 The 2009 International Energy Conservation Code is a registered trademark of the International Code Council, Inc. ( "ICC"). No version of this software has been reviewed or approved by ICC or its affiliates. REM/Rate- Residential Energy Analysis and Rating Software v14.5.1 i RESHET Home [energy Rating Standard Disclosure The' For home located at: 79 Hewitt Ave Flie ,, 1, City: North Andover State: MA H ®� 1. ❑ The Rater or Raters employer is receiving a fee for providing the rating on this home. 2. ❑ In addition to the rating, the Rater or Raters employer has also provided the following consulting services for this home. A. Mechanical system design B. Moisture control or indoor air quality consulting C. Performance testing and/or commissioning other than required for the rating itself D. Training for sales or construction personnel E. Other(specify below) 3. F1 The Rater or Raters employer is: A. The seller of this home or their agent B. The mortgagor for some portion of the financial payments on this home C. An employee, contractor or consultant of the electric and/or natural gas utility serving this home I 4. The Rater or Rater's employer is a supplier or installer of products,which may include: Installed in this home by: OR is in the business of: HVAC Systems Rater Employer Rater Employer Thermal Insulation Systems Rater Employer Rater Employer Air sealing of envelope or duct systems Rater Employer Rater Employer Windows or window shading systems Rater Employer Rater Employer Energy efficient appliances Rater Employer Rater Employer Construction(builder, developer,construction contractor, etc.) Rater Employer Rater Employer Other(specify below): Rater Employer Rater Employer I attest that the above information is true and correct to the best of my knowledge. As a Rater or Rating Provider I abide by the rating quality control provisions of the Mortgage Industry National Home Energy Rating Standard as set forth by the Residential Ener Services Network RESNET . Energy ( ) The national rating quality control provisions of the rating standard are contained in Chapter One 4.C.8. of the standard and are posted at http://resnet.us/standards/RESNET_Mortgage_Industry_National_HERS_Standards.pdf. The Home Energy Rating Standard Disclosure for this homeis available from the rating provider. Inette Rex 1180746 Raters Printed Name Certification# Inette Rex -:,,,,"„., September 15,2015 Raters Signature Date RESNET Form 0300-2 REWRate-Residential Energy Analysis and Rating Software v14.5.1 This information does not constitute any warranty of energy cost or savings. 0 1985-2014 Architectural Energy Corporation, Boulder, Colorado. 9705 Home Energy Rating Certi cite Registry Ir 140441 Rating Number EH044 NAND HewittAv 79 Certified Energy Rater Inette Rex 79 Hewitt Ave Rating Date 9/9/2015 North Andover, MA 01845 Rating Ordered For -The ' Estimated Annual Energy Cost Use MMBtu Cost Percent 5 Stars Plus Heating 54.3 $1064 35% Confirmed HERS Index: 60 Cooling 2.3 $119 4% Hot Water 22.4 $421 14% Lights/Appliances 25.3 $1221 41% General information Photovoltaics -0.0 $.0 -0% Conditioned Area 2379 sq. ft. House Type Single-family detached Service Charges $190 6% Conditioned Volume 19018 cubic ft. Foundation Unconditioned basement Total 104.3 $3015 100% Bedrooms 4 Criteria Mechanical Systems Features This home meets or exceeds the minimum criteria for the following: Heating: Fuel-fired air distribution, Natural gas, 96.5 AFUE. Cooling: Air conditioner, Electric, 13.0 SEER. Water Heating: Conventional, Natural gas, 0.66 EF, 75.0 Gal. Duct Leakage to Outside 93.00 CFM25. Ventilation System Exhaust Only: 76 cfm, 9.5 watts. Programmable Thermostat Heat=Yes; Cool=Yes Building Shell Features Ceiling Flat R-32.8 Slab None Sealed Attic NA Exposed Floor R-30.0 Vaulted Ceiling NA Window Type U-Value: 0.300, SHGC: 0.260 Inette Rex, RTIN: 1180746 Above Grade Walls R-21.0 Infiltration Rate Htg: 884 Clg: 884 CFM50 The Energy Hound Foundation Walls R-0.0 Method Blower door test 11 Broadway, Suite 3 Lights and Appliance Features Beverly, MA 01915 978-578-1782 Percent Interior Lighting 96.00 Range/Oven Fuel Natural gas Percent Exterior Lighting 8.00 Clothes Dryer Fuel Electric Refrigerator(kWh/yr) 709.00 Clothes Dryer EF 3.01 Inette RexX °��k.° � w, Dishwasher Energy Factor 0.46 Ceiling Fan (cfm/Watt) 0.00 Certified Energy Rater: REM/Rate-Residential Energy Analysis and Rating Software v14.5.1 This information does not constitute any warranty of energy cost or savings. O 1985-2014 Architectural Energy Corporation, Boulder, Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. NORT11 Town of E : 1� ¢ Andover p y' 0 No. 666 --0'105 * - Cohover, Mass, I allk A- COCNICMI WICK �1. 7�p�R�{TfD S V BOARD OF HEALTH Food/Kitchen PERMIT . LD Septic System L � THIS CERTIFIES THAT .......... .....�/..�...(.k i ....... BUILDING INSPECTOR has permission to erect .......................... buildings on ....tl��....... .......... .. ./..�. .................... Foundation L!. ' ,1 �� .. Rough to be occupied as .....5, !.. ...........��..;Y. :.t ........... ar-flrdlre..i �.'..".... ............. Chimney provided that the person ac pting this permit all in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR � UNLESS CONSTRUCTION A .. S.. Rough Service .................... .... ......................................... Final BUILDING_ INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. � NORTH q O SLEO f6 APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION eya �9S R�TEo BUILDING PERMIT # ��•G-�u� SACHus ADDRESS/LOCATION OF PROPERTY: wt it q Map` 14 , 0 areel g Lot Number 8 SUBDIVISION: �A DATE REQUESTED FILED/READY FOR INSPECTION: Z3 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 ($20.00)WILL BE CHARGED IF THE-STRUCTURE DOES NOT MEET ALL AP PLIC LE C S. APPLICANT SIGNATURE Permit Issued to: Gkri 5 )jeX kGJL Address: ROUTING TOWN ENGINEER, SITE PLAN—DRIVE-WAY REVIEW CONSERVATION Nl PLANNINGs �''�$ � DPW-WATER METER L�' `)1'2 31 CS SEWER CONNECTION L►I' DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW �C '► (�.i ice- ���3 It SIGNATURE File:Application for OC form revised Jan 2007/2011 i i I' Massachusetts -Department of Public Safety + Board of.Buiiding Regulations and Standards Construction Supen isor r i License: CS-080377 CHRIS A HERRICLK 19 FRANCIS ST NO READING Na 086 ;, Expiration 08/07/2015 Commissioner I I i stry ID Home Energy Gating Certificate Regiumber Rating Number EHO441 ANDD 79 Hewitt Certified Energy Rater Ian Rex 79 Hewitt St Rating Date 09/23/2014 Rating Ordered de ed For Andover, MA 01845 Rat g 0 Estimated Annual Energy Cost Use MMBtu Cost Percent 5 Stars Plus Heating 45.6 $916 34% Projected Rating HERS Index: 57 Cooling 3.2 $168 6% Hot Water 18.8 $357 13% Projected Rating: Based on Plans - Field Confirmation Required. Lights/Appliances 23.0 $1100 40% General Information Photovoltaics -0.0 $-0 -0% Conditioned Area 2379 sq. ft. House Type Single-family detached Service Charges $190 7% Conditioned Volume 19018 cubic ft. Foundation Unconditioned basement Total 90.5 $2731 1006 Bedrooms 4 Criteria Mechanical Systems Features This home meets or exceeds the minimum criteria for the following: Heating: Fuel-fired air distribution, Natural gas, 92.0 AFUE. Heating: Fuel-fired air distribution, Natural gas, 92.0 AFUE. Cooling: Air conditioner, Electric, 13.0 SEER. Duct Leakage to Outside 110.00 CFM25. Ventilation System Exhaust Only: 61 cfm, 8.6 watts. Programmable Thermostat Heat=Yes; Cool=Yes Building Shell Features Ceiling Flat R-47.2 Slab None Sealed Attic NA Exposed Floor R-30.0 Vaulted Ceiling NA Window Type U-Value: 0.300, SHGC: 0.300 Ian Rex Above Grade Walls R-21.0 Infiltration Rate Htg: 3.00 Clg: 3.00 ACH50 The Energy Hound Foundation Walls R-0.0 Method Blower door test 11 Broadway, Suite 3 i Lights and Appliance Features Beverly, MA 01915 978-233-1433 Percent Interior Lighting 94.00 Range/Oven Fuel Natural gas www.TheEnergyHound.com Percent Exterior Lighting 8.00 Clothes Dryer Fuel Electric Digitally signed by Ian Rex Refrigerator(kWh/yr) 500.00 Clothes Dryer EF 3.01 DN:cn=lan Rex,I=US,o=The Energy �/ d Dishwasher Energy Factor 0.00 Ceiling Fan (cfm/Watt) 0.00 Certified Energy Rater: Rex ema-Ian@TheEne gyHaund<om, c—UHouiln ted States,givenName=Ian Rex ' ate:za .ogzs a aoo REM/Rate-Residential Energy Analysis and Rating Software v14.5.1 This information does not constitute any warranty of energy cost or savings. ©1985-2014 Architectural Energy Corporation, Boulder, Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. s Informaflon and Instructions .* lassachuseffs General saws chapter 152 xerpiixes all employers to pxovidewoxkexs'compensation£oxthei employees. Pursaaxi�to this stafate,an employee is defined as`°..,evexypOrson in-tbe sexvice of anoihex under any cEoir t ployo; express orzmplied,oxal oxwxitt e A�er ro e is de�sn ed as"an individual,paxtnexship,association,corpoxadon o�ofher legal eafity,or any two oxxaoxe' . Off oxegoingengagedina�ointentexpxise,andzncludingthe,legalxepresentativesofadeceasedeXlg ex,.oxthe xeceivex o isfee oi'an individual partaership,association or other legal Mtify,employing aniployees. oOwevex tha owxzex of�dwe7lingh,ousehaviugnatmoxetiza�tfhtee apar�menfs aadvrllaxesxdes ihexehc,axi�,e occupaaaf offYte dwelling hoose of another wlxo employs persons fo do zaainfenance,constnzctioxt ox repair woxl�on such dwelling house or on the.grounds orbuilding appurtenant the shallnot because of such employ mentbe deemedto be an employe:" 1V G1,chapter 152,§25C(6)also states that"every state or Ideal Yuensing agenep,shall withhold the issuance ox renewal of a lz'eeme or pexmzt to operate,a business or to eonstxttet buildin gxu the s common e alf w h for - an. . applicant who leas xtot produced.accepfable evidence o�co�npliaxtee with,the insurance cavexage re�:aired Additionally,I+�GIi chatex 152,§25C(7)states"l�Teither the commonwealth nor any of ifs PON subdivisions shall enter intoanpcox�tracffor tl�epex£oxmauceofpublicwoxl until acceptableuvidenoeofcomp-iauceyvztbthexns�xanee xecluixeraenfs of this cltaptexlzavebeenpresenfedfathecgztixactingautbority." rA.pplfcantg Please X11 out the workers'compensation affidavit completely,by checking the boxes that a l fo our situation anl,if iiecessaxy,supply,�,b-conixactor(s)name(s),addresses)and hoxtertumbex(s)along wkh their ex`f"zcafe(s)of in=ance. limited Liability Companies(LLC)OrMn fedLhbftrPartnexsliips(I ),kWthno employees othextb.Wtbe members mpartuexs,arenotrequixedto canyworkers'compensation 1ilAT7Yance, L anLLC orLLP daeshave exnplopees,aPolicyigxecluited. Be advisedthatthisafdavitmaytoaubmittedtotheDe azfirtento Dep f industrial Accidents for coniirtnatzon ofiusuxance coverage .A.lso be suxe to sign,and date the afdavi: Sze affidavit should bexetuxitedtn the city or town Eat Mb applieat`tvnzox tb.epermit Or license is being xegested,?zotflte_Dq�axim.ent Of 11dustral.A-ccidents. Shouldyou have;any yuesffonsxegardingtlielawoxuyou ato:rcq*edtaoTitainawoxkexs' rDxll]erlsatlOIlpollGy,pleasecallthe�7epaentattlt�numbaxJisfed7�elow gelxnsuxerem aniessho • self xnsWauce H-cense numb er on t7ze appropriate line. p d enter their City or Tom officials Pleasebesuxethattheazddavitiscompleieandpxintedlegibly. TlLoDopartmenthaspxovidedaspace atthelottoin oz the afdavit fox you to M out in the event the Office of kvestlgatlons has to contactyouregarding the applxcanf Please be-sure to till intthepe�mxf/license rtumher tvhiclzvfj be used as a xezexencenutxtberF In addition, tlZatnzustsu�miixnultiplepezmif/11ce eapplzoa ons in an artapplicant olic inx"oxrna"o ,� y givenyeax,need only submit one affidavit ladicatin current p ti n i tece " l� g y ( ssaty)and under lob�ite.A.ddress the applicant shouldwxite"all lotions in,_____;(cify or towzt}:'A copyo thea davitthathasbeonOca fciallysiainpedormarke'dbythecityoxtowumaybe pxovidedfothe applicautasprbofthat avalida£ davit-13,on:ffle�Co-r La xepexmifsorllcensec. ,A.newafidavitmustbe illedouteaclt Year.Where ahome owner oro fizenis obtabib g alicense oxpewitnotxelafedto anybminess ox commercial venture (i.e.adog 7lcenseorljerMittobtttxl.leaveseta)sazdpexsov.isX0Txecpk0dtocompletethisaf clavi The Office,offnvespgaffons would like to th"k you in advance for your cooperation and should you have any questions, please do zuot hesitate to give us a call. , TheDepaxttnenf'saddress,telephone aitdfaxxlumbex. . PQp xteGtt 4�'.�xtd-WaZAcolde TO, 617-7-2t,49-00 Q#40,6Ql A.gffl Rovisod5 26-05 www•lllav,g4-VcRa The Comvtonweaftk offfassarch.asefty .flee offivesfigafeoas 6`Q`(JF�ash�ng�rr��,S'i�ee� Rostov,HA 02111 -r mmasygovIdxa oXke:t,q'Comp emadonYmuxamoAffianit:J Yxi c e /�Co c c o • 1 � re c nsl'i% rex Apnzea� orc�a�-Ooz� PXaexzn �iXy Name(Bu-iaessI0rgMzation&&id-aalJ^__��P►M C.k- �f 1i��1�L11sNt1✓i. L'�' �I Address: lot C-v-k AS 54- UV/StatcM:►: Ara yoixanena,&Yer?Check theapPropxzateboxr Typo projeetcreg,*ecl): �, El lain a general contxactox andT �.E] S m a exnplayex v�ith. 6. �Tew 66nstruction. employees(TM and(oxpalttima).T have nodt oSub-confractors 2.[ S am.a sole proprietor or partner listed ont$e atiached sheet T 7. �B,emodelirzg MP and'havena•employees These Mb-contxactarslcave 8. Femolition woxldng forme Many capacity, workers'comp.Nu=ance. 9, Buffdh g additgon. PTO work-exs'eomp.plsU Mce 5. Q We are acorporation and fig 1�•�Blectricalxepairs ox add-Woes xecpaizerl.� o�xcers have exerczsed.their ht orM&I PxwnbEg repairs ox addztzons I am.a homeowxlex doing all rz o t exemption woxk g pon� myseL.Ulowoxlrers2 comp. o,1.52,§1(4)a mftahaven.o 12.E]Roofre�rairs it rancoxecpzixed.� employaes.ENOWorkexs' 13.[]flag comp.insurancerecluired•� . Anya�pTicantihac cf�eckshoxmusEalsol(onithcse�tionbeldwshowingtheirvabrkers'oompensationpolicinformafion. 7Homeowners W110submittbis aifidayitmdYcatingihey ate dping all�vor7 andtiren bite oufside contractors mustsn7�znit anent of dayif indicaffi such. xContracfors.3iat cheekthis boxmbstatfaehed art additionai sheetsT�o�vingtfieziame o£the suit-eouhaefors audtheirytorkers'comp.voRoyiebruaa6on. am an empfoy4v tAd z,1providingWo Aers,compe a r�tioninsr��anee fo �v, WT 0yeeY Be�aW is die a liefffirljob,�& ire,fo mation. hsnrauce CornpmyName% policy 0 ox 9eIMM.VG.#: ExpirationDate: rob Bite.A.d*ess: CityfSfatefip: Attach,a copy compensavoxtpofcy RecfaxatZou page(slxowibgAe poNcy'Rmnhar and e�*a-Qoa date). yatme,to securer coverage as xegr6odu nder SoetioA25A ofMGL o.152 call lead-to the imposztioxt o£OTh alpmalties of a L• ofa,BTOp y the faxen_ 0 ORl7ERandafine inze up to$1,500A0 and/or one-dear xrapxisos�naenE�.as well.as czyllpenal�zes mW ofup to $250•0 U a day against the v.1olafoz: Be advised that a copy o£this statMentmay be foxwaxdedto the Me-of 1'nyestigation s oftlio MA fox insnran cG coverage vormoatzon. ttoXieeyeerfyuricXetTieiair�sanci nartieore (tarytXicettlieir� ax�rtati©x�proviciec�aioye% txueanrico�zeet. Sipiata Date: 17 Tbona4. (1,f�i`eial u se mly. .Do nol vice in this area,to be eoxazpl'ete by ei�or toren n�eiaf. City or Tow= BexmizULIcertse# s�zxng A�xtb oxztg(cixcla one : Z.Board of�ealtla �.BuzldingJmeaxtment 3.Cxtyf7Coa Clerkleetrzcal[Jfnspeetor .Blur�abiugJCaspector 6 Other J N/F N/F ROBERT LEITCH RYAN S. ZANNINI � 41 CARTY CIRCLE KATHLEEN A. RECKENDORF LT MAP 47 PARCEL 35 40 CARTY CIRCLE , MAP 47 PARCEL 34 125.4' sTONE WALL ' LOT AREA 11,347E S.F ZONING SETBACK LINE N/F — i — 27' JOHN & ROBERTA SCALI 40' 83 HEWITT AVENUE MAP 47 PARCEL 9 N PROPOSED U N/F I GTRer�c. oz DONALD67ITT EWREN ROKES FRONT YARD 30' AVENUE SIDE YARD 20' I 31, 24 MAP 47 PARCEL 5 REAR YARD 30' i OWN R• I CONNECT TO DONALD A. & KAREN L. ROKES PROPOSED J EXIST. WATER & BOOK 1799 PAGE 97 I / BIT. DRIVEWAY SEWER SERVICES IRON PIPE: _ 1 !S29 SEI RFN F• �,c., f M LOTS 250-255 ON PLAN N0. 42 3' tf y `'Y" r' ``� 360 OF 1906 GRAVEL t1 m 79.8' a ,� EDGE OF -- __ ASN OF M �& '� 8M SIDEWALK P Gv s _ Gv _ q _.. moo`' SCOTT No.50049 "' _. _ 1'4-' _ ._ SS%�N C SND SURVE0�P �' -- -- D __ _ -to_DRAIN D --- --- ENGINEERING I Civil Engineers & � NC' HEWITT A VENUELand Surveyors HEREBY CERT/FY THAT THIS PLAN /S BASED ON AN ACTUAL 234 Park Street . North Reading, MA 01864 . 978-6 - INSTRUMENT SURVEY MADE ON THE GROUND /N SEPTEMBER (PUBLIC — 40' WIDE) 64 8141 2014 AND THA T THE STRUCTURES DEP/CTED HEREON ARE LOCATED AS SHOWN. GRAPHIC SCALE PROPOSED FOUNDATION OUNDATION PLAN o 10 20 40 DATE ^ �- � 79 HEWITT AVENUE � JIGNATURE NORTH AN DOVER, MASSACHUSETTS 1» = 20' MAP 47 PARCEL 8 SEPTEMBER 19, 2014 ACCORIDCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/25/2014 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(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME: Commercial Lines A & K Fowler Insurance pHONE . (978)664-0366 FAx AIC No:(918)664-2209 200 Park St. E-MAIL .ADDRESS: INSURERS AFFORDING COVERAGE NAIC# North Reading MA 01864 INSURERA:Preferred Mutual Insurance INSURED INSURER B: Herrick Development, LLC INSURERC: 19 Francis St. INSURER D: INSURER E: North Reading MA 01864 INSURERF: COVERAGES CERTIFICATE NUMBERCL1311403459 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADL UB POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurr.".3 nce $ 100,000 A CLAIMS-MADE a OCCUR CPP0130602153 10/15/2013 0/15/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 T POLICY JFrT PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N I ER ANY PROPRIETOR/PARTNERIEXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance Verification CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE / K Boutin, CIC CRM CIS ikJl r l V� ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD I Enter construction cost for fee cal- North Andover Fee Calculation Construction Cost 3725,000.00 m $ - $ 4,464.00 Plumbing Fee $ 558.00 Gas Fee 100 comm. $ 100.00. Electrical Fee $ 558.00 Total fees collected $ 5,680.00 i 79 Hewitt Avenue 566-15 on 12/22/2014 Single Family Home