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HomeMy WebLinkAboutBuilding Permit #509 - 84 PEMBROOK ROAD 5/1/2018 NORTH .. ,ti ° n TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �9SSwCHO`'E� '. Permit NO: Date Received: Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 2,eAf g Print PROPERTY OWNER tl/11,4Ti C ze"667/7/ 714 05y ��— Print MAP NO.: 3 9\ PARCEL:` ,Sf- ZONING DISTRICT: FS TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential mew Building rOne family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving(relocation) ❑Other CI Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Alek. Gkv,A­ t. Sv/on/ L Identification Please Tyne or Print Clearly) OWNER: Name: Phone: 7—? Signature Address: CONTRACTOR Name: ,�9^ ©vrn 0-� Yh Phone: 9, Address: Supervisor's Construction License: 00 Exp. Date: g ` z e,_ Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BAD ON $125.00 PER S.F. 01 J Total Project Cost :$ y x10.00=FEE:$ Check No.: Receipt No.: n TYPE OF SEWARGE DISPOSAL Tanning/Massage/Body Art Swimming Pools ❑ Public Sewer Wellf OF Tobacco Sales Food Packaging/Sales CI Permanent Dumpster on Site Private(septic tank,etc. , NOTE: Persons contracting with unregistered contractors do not have access to the guaranty and Signature of Agent/Owner Signature of Contractor Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit i ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ � � COMMENTS ' DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes = Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection signature&date / Temp Dumpster on site yes/o Fire Departn t signature/date i Building Permit Approved and Issued by: ;� I � Building Setback ( Front Yard Side Yard Rear Yard Required. Provided Required Provides Required Provided / D -3013 � o DIMENSION Number of Stories: /� Total square feet of floor area,based on Exterior dimensions. 19 e14e1) Total land area, sq. ft.: /a 5; NOTES and DATA—(Por department use) i f r Doc:INSPECTIONAL SERVICES DEPARTMI NI'APPORM05 Created 1690.Jan.^_006 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 ❑ Debris Removal Form ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Form U ❑ Surveyed Plot Plan ❑ Debris Removal Form ❑ 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) New Construction (Single and Two Family) ❑ Building Pen-nit Application ❑ Form U ' ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of BuildingPlans One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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 II of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:131'FORM05 .r"D _ Location Yy No. U Date NORTH TOWN OF NORTH ANDOVER a y � Certificate of Occupancy $ • °, .-___. ' + Iry ' Building/Frame/Frame Permit Fee $ G f; suMU 9 •' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspe 6r March 2006 84-90 Pembrook Rd Credit Permit Address' Square Footage Amount Pd Amount Due Two family project stopped 263 A&B 90 Pembrook Rd $ 5,580.00 New Project 492 90 Pembrook Rd 3000 $ 3,750.00 $ 1,830.00 $' 1,830.00 Gerald Brown,Inspector of Buildings Permit Fee Amount Permit for 84 Pembrook 509 84 Pembrook Rd $ 3,488.00 $ 1,830.00 Due $ 1,658.00 "Paul St ilaire '� NOKTH Town of 4Andover 0 No. a 9 - m LA O 4 dover, M1SS.J •0 0 COCMIC EWICK V "?ATE '9S BOARD OF HEALTH PERMIT T. D Food/Kitchen Septic System JA BUILDING INSPECTOR THIS CERTIFIES THAT....... . ... ..... Foundation has permission to erec buildings on .. ......y... Rough t0 b8 occupied a , ti I Chimney r........ *......... .. . . provided that the per n accepting this permit sha in every respec nform t e terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating o the.Insp ction, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU N START Rough ...... ...... . .. Service /iLGLOING��PECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in. a Conspicuous"Place on the Premises — Do Not Remove Find No Lathing or Dry Wall To Be Done Until Inspected and. Approved by the Building Inspector. Butner. DEPARTMENT Street No. 3� y88 SEE REVERSE SIDE Smoke Det. fie Vr o��vrrcarzcriea,��i a�'��aoaar�u�e� I BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 009802 Birthdate:-08/24/1939 Expires; 08/24/2007 Tr.no: 2024.0 Restricted: 00..:. PAUL J ST HILAIRE 51 THISTLE RD G— N ANDOVER, MA 01845 Commissioner AR WCIP Liberty .; Workers Compensation and ISSUING OFFICE 354 - MUtua1,. INFORMATION PAGE Employers Liability Policy T NO. SUB ACCT NO. Liberty Mutual Insurance Group/Boston ACCOUNT 0000 LIBERTY MUTUAL FIRE INSURANCE CO. 16586 1-347619 POLICY NO. TD/CD SALES OFFICE CODE SALES CODE N/R IST WC2-31S-347619-015 XX X WESTON 102 REPRESENTATIVE 3000 2 YEAR ASSIGNED 2003 Item 1.Name of ANDOVER CONSTRUCTION& DEVELOPMENT CORP FEIN 04-2582435 Insured Address 51 THISTLE RD RISK ID 000071644 N ANDOVER,MA 01845 Status 03 CORPORATION Other workplaces not shown above: SEE ITEM 4 Mo.Day Year Mo.Day Year Item 2.Policy Period: From 09-01-05 to 09-01-06 12:01 AM standard time at the address of the insured as stated herein. Item 3.Coverage e policy applies to the Workers Compensation Law of the A. Workers Compensation Insurance: Part One of th states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A.The limits of our liability under Part Two are: Bodily Injury by Accident 500,000 each accident Bodily Injury by Disease 500,000 policy limit Bodily Injury by Disease 500,000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any,listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans. All information required below is sub'ect to verification and than lbDaudditt. LINE 110 m Basis Ratesated Per$100 Estimated Code nnual of RE- Annual Cl2SSIfiCatiO11S No. ums muneration Premiums SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 500 MA Total Estimated Annual Premium $ 7,092 Interim adjustment of premium shall be made: ANNUAL This policy,including all endorsements issued therewith,is hereby countersigned by SEE ATTACHED FORM 1710 Authorized Re resentative Date 09-07-05 Loc.Code Term. Oper. Audit Basis Periodic Payment Rating Basis Pol.H.G. Home State Dividend RENEWAL OF: 09-07-05 NR MA WC2-31S-347619-014 GPO 4030 R1 Copyright 1987 National Council on Compensation Insurance WC 00 00 01 A INSURED COPY The Commonwealth of 1Vlassaehusetts Department of industrial Accidents Office of Investigations 600 Washington Street , ;.. E Boston, ,NA 02111 ►vivw.mass.govldia f A Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ;applicant information Please Print Legibly vaflle I I�usincss/l)r�zaniration/Indi�idunl): �ii-0`Gy�/j (_Q 11��$'�` �—�� b�� �'U� � Address:_3 �` jS7"�1� Ad: City/State/Zip: /Vi ..�ov b , Phone #: ore you an employer?Check the appropriate box: Type of project(required): I.L`7 lam a employer with r 4. ❑ I am a general contractor and l 6. [New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- Iisted on the attached sheet. * 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for the in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ i atm a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. C. 152, §1(4),and we have no 12.EJ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] '.any applicant that checks box#I must also till out the section below showing their workers compensation policy information. y Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box nntst attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy .4 or Self-ins. Lic. It: Expiration Date: Job Site Address: 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 line 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 tine Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ppaipnss andpenalties of perjuryf iat the inf wination provider/above is true and correct. Signature: _/�G i�d '` �D�2' � 7� nate: Official use only. Do not write in this area, to be completed by city or town#/ficin/. City or Town: Permit/License# Issuing.authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cILS150A. Also, note Permits are required under Fire Prevention laws:Chapter 148 Section 1 OA. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date Permit Number REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code REScheck So$ware Version 3.6 Release la Data filename: C:\Prograrn - en e. C.\ og am Files\Check\REScheck\CL 363.rck PROJECT TITLE: Plan #CL-363 /25-151 CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other(Non-Electric Resistance) WINDOW /WALL RATIO: 0.14 DATE: 01/23/06 DATE OF PLANS: January 13, 2006 PROJECT DESCRIPTION: 28 x 38 Colonial 2,790 sq. $. DES IGNER/CONTRACTOR: Andover Constr. 7 devel. 51 Thistle Road North Andover, MA 01845 978-258-9173 PROJECT NOTES: Paradigm window units COMPLIANCE: Passes Maximum UA= 546 Your Home UA= 514 5.9%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA i Ceiling 1: Flat Ceiling or Scissor Truss 1723 30.0 0.0 60 Ceiling 2: Other 9 0.200 2 Wall 1: Wood Frame, 16" o.c. 2789 13.0 0.0 192 Window l: Vinyl Frame:Double Pane with Low-E 369 0.400 148 Window 2: Vinyl Frame:Double Pane with Low-E 14 0.400 6 Window 3: Other 13 0.560 7 Door 1: Solid 56 0.350 20 Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 1670 19.0 0.0 . 78 Floor 2: All-Wood Joist/Truss:Over Outside Air 26 19.0 0.0 1 Furnace 1: Forced Hot Air, 90 AFUE 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 Massachusetts Energy Code requirements in REScheck Version 3.6 Release la(formerly MECcheck) and to comply with the mandatory requirements listed in the REScheek Inspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as pecified in Sec . ns 780CMR 1310 and J4.4. Builder/Designer Date 11�1� Awkoo REScheck Inspection Checklist Massachusetts Energy Code REScheck Software Version 3.6 Release la DATE: 01/23/06 PROJECT TITLE: Plan# CL-363 /25-151 Bldg. Dept. Use Ceilings: [ ] ( 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation Comments: [ ] 2. Ceiling 2: Other, U-factor: 0.200 Documentation must be submitted verifying the overall assembly U-factor. The U-factor must be developed in accordance with accepted engineering practice. Comments: 447'r/C Above-Grade Walls: [ ] 1. Wall 1: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: Windows: [ ] 1. Window 1: Vinyl Frame:Double Pane with Low-E, U-factor: 0:400 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? [ ] Yes [ ]No Comments: �V=,64J-E7 ;/ (AAS [ ] 2. Window 2: Vinyl Frame:Double Pane with Low-E, U-factor:0.400 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? [ ]Yes [ ]No Comments: cAsa5t�t� T' [ ] 3. Window 3: Other, U-factor: 0.560 For windows without labeled U-factors, describe features: #Panes Frame Type Thermal Break? [ ] Yes [ ]No Comments: Doors: [ ] 1. Door 1: Solid, U-factor: 0.350 Comments: Floors: [ ] 1. Floor 1: All-Wood Joist/Truss:Over Unconditioned Space, R-19.0 cavity insulation Comments: [ ] 2. Floor 2: All-Wood Joist/Truss'Over Outside Air, R-19.0 cavity insulation Comments: Heating and Cooling Equipment: [ ] 1. Furnace 1: Forced Hot Air, 90 AFUE or higher Make and Model Number Air Leakage: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope, recessed lighting fixtures shall meet one of the fallowing requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfin (0.944 Us)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/$2 pressure difference and shall be labeled. Vapor Retarder: [ J Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. Materials Identification: [ ] Materials and equipment must be identified so that compliance can be determined. [ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R-values, glazing U-ffictors, and heating equipment efficiency must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut of the heating and/or cooling input to each zone or boor shall be provided. Heating and Cooling Equipment Siang: [ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/offheater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120°F or chilled fluids below 55 T must be insulated to the levels in Table 2. i Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Insulation Thickness in Inches by Pipe Sizes Heated Water Non-Circulating Runouts Circulating_Mains and Runouts Temperature U12 to 1" Un to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2" Runouts 1" and Less 1.25 to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from complianc9 With any applicable or requirements. APPLICANT FILLS OUT THIS SECTIO APPLICANT ���vc� l�l�-s7`� a ,amu PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) STREET �! �,,,5�� ST. NUMBER OFFICIAL USE ONL RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVE D DATE REJECTED COMMENTS ------------ FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR ----DATE RevhW OW jm