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HomeMy WebLinkAboutBuilding Permit #891-11 - 85 OGUNQUIT ROAD 6/22/2011Permit NO: V/ // TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received v Print PROPERTY OWNER PeT-e�i-- r'�'e--✓v --m fi lae—+- Print MAP NO: PARCEL: ZONING DISTRICT: Historic District , yes no ?S�_ Machine Shop Village yes- no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building XO family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - aFlood"lain, : (] kWefIan s f i � Vatersl ed -.. r. ater e er`° _ Jli n .�CRIPTION OF WORK TO BEI.'ERFORMED: I/ /_7 OWNER: Name: Address:2 -20_1 CONTRACTOR Name: 1—%vv v 6 &/0 �wse, Please Type or Print Clearly) Lei 2 V /% eP r-Pn/ Phone �.eQ0 57-1- `ec? Lo1_) ,1 4-21� C�,✓.s%t r� L.r�Phone: 6F ? 1/2 Address: /�a J Supervisor's Construction License: 9 Exp. Date: 3 j© Home Improvement License: Exp. Date: ARCH ITECT/ENGI NEERL1211fJ.P 2 (A /�G� Phone:_ Address: MIR 7 FEE SCHEDULE. BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. 1 Total Project Cosi: $ % .0 S/O FEE: $ 7� Check No . `�` • Receipt No •r•,, NOTE: Persons contracting with unregistered contract o not have a� cuss to the guaranty fund �Sianature.of:Aaent/Owner,:-° ::' ::::: ~ .. Signature of contractor-:.: S;�, Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. [(� Tanning/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales El Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMEN k CONSERVATION Reviewed o DATE REJECTED DATE APPROVED ❑ p COMMENTS k HEALTH Reviewed on Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Penning Board Decision: ' 4 Conse�,,iation Decision: Waf-�r & Sewer Connectio ]DPW Town Engineer: FIRE DEPART MEN - Temp Located at 124 Main treet Fire Department signature/d4 L CONE\4ENTS Comments a 4 -If l.aca 384 Osgood Street p on site es no 3Lf Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals zat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location No. Date Check # 2 4 6 L, S TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ Building Inspector TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION J d /i Date Received pu (�PFRTY OWNER P�— R A ('�'e' 1� Z -13'L J0/ -0e"- Print , vNO: PARCEL: ZONING DISTRICT: Historic District yes no MAP Machine Shop Village yesno TYPE OF IMPROVEMENT PROPOSED USE Residential ' One family New Building [I Addition l Two or more family ❑ [I Alteration No. of units: air, replacement cement ❑ Re p p ❑ Assessory Bldg _ ❑ [i OtherDemolition _::--_- - _-- D NQXT a On ' D - u1ur OF WORK TO BE` .LI0N C�' G; CONTRACTOR Name: Address .51 Non- Residential 0 Industrial ❑ Commercial ❑ Others: etla ds f ''.mw- gtersb .t . 'r - PERFORMED: /'0 ification Please Type or Print Clearly) 10 4;"o 1c` � p,-1 /�I .,WP f- ?_ A/ Phond: 9: / .5 ,I i� �a ✓� .S /�:���, Coh/,� v ✓��, Phone: -9 r P ' 6�?� 17 Supervisor's Construction License: 9�Exp. Date: [-Iome improvement License: Exp. Date: ARCHITECT/ENGINEERS Z �' / `J/� /��=r Phone: Address:J� ��' /���� �!� Reg. No. � FEE SCHEDULE: BULDING PERMIT: $12.00 PER $11000.00 OF THE TOTAL ESTIMATED COSTSASED ON $125.00 PER S.F. 6/S 00 FEE:$ - o#^f Project Cosi: $ 7 � .`' Receipt No. � -heck No.: �TOTE: .Persons contracting with unregistered tonttactaY�s, do not heave access to the guaranty fund Si'natire ofcottracto:r _ +��ro°rQnPrif/[owner.._....... r _...- I U CL Z 0 x LU r 2J 0- :3 tL ILO t co 0 u 69 z LLJ 0 LU = co 5! w U Z (Y- 0 LLI ul U z > > LLI LLI 0 T- F - U) a_ Z uj U-) qt (1) (Y) z I r REScheck Software Version 4.4.1 Compliance Certificate Energy Code: 20091ECC Location: ,Andover, Massachusetts Construction Type: Single Family Glazing Area Percentage: 18% Heating Degree Days: 6322 Climate Zone: 5 Construction Site: Owner/Agent: Designer/Contractor: ot 6 - Ogunquit Rd. Andover, MA • •asseslusing Compliance: 7.3% Better Than Code Maximum UA: 492 Your UA: 456 The % Better or Worse Than Code index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum -code home. Ceiling 1: Flat Ceiling or Scissor Truss 1750 38.0 0.0 53 Wall 1: Wood Frame, 16" o.c. 3392 21.0 0.0 157 Window 1: Vinyl Frame:Double Pane with Low -E 542 0.300 163 Door 1: Solid 38 0.190 7 Door 2: Glass 60 0.300 18 Floor 1: All -Wood Joist/Truss:Over Unconditioned Space 1750 30.0 0.0 58 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 4.4.1 and to comply with the mandatory requirements listed ' the REScheck Inspe tion Checklist. Name - Title Ignature Date Project Title: Data filename: Untitled.rck Report date: 06/01/11 Page 1 of 4 REScheck Software Version 4.4.1 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: Windows: ❑ Window 1: Vinyl Frame:Double Pane with Low -E, U -factor: 0.300 For windows without labeled U -factors, describe features: #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1: Solid, U -factor: 0.190 Comments: ❑ Door 2: Glass, U -factor: 0.300 Comments: Floors: ❑ Floor 1: All -Wood Joist/Truss:Over Unconditioned Space, R-30.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. 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. (3 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 -burning 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. M Comers, headers, narrow framing cavities, and rim joists are insulated. Project Title: Report date: 06/01/11 Data filename: Untitled.rck Page 2 of 4 (9) Shower/tub on exterior wall: Insulation exists between showers/tubs and exterior wall. Sunrooms: ❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U -factor of 0.50 and the maximum 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: F1 Materials and equipment are installed in accordance with the manufacturer's installation instructions. F-1 Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R -value. F1 Materials and equipment are identified so that compliance can be determined. n Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. o Insulation R -values and glazing U -factors are clearly marked on the building plans or specifications. Duct Insulation: ❑ 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: Lj Building framing cavities are not used as supply ducts. Lj 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 181 A 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). Duct tightness test has been performed and meets one of the following test criteria: 0 ) Postconstruction leakage to outdoors test: Less than or equal to 268.9 cfm (8 cfm per 100 ft2 of conditioned floor area). (2) Postconstruction total leakage test (including air handler enclosure): Less than or equal to 403.3 cfm (12 cfm per 100 ft2 of conditioned floor area) pressure differential of 0.1 inches w.g. (3) Rough -in total leakage test with air handler installed: Less than or equal to 201.7 cfm (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 134.4 cfm (4 cfm per 100 ft2 of conditioned floor area). Heating and Cooling Equipment Sizing: F -I Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. F1 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: Lj Circulating service hot water pipes are insulated to R-2. Cj Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: C] 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. F-1 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. 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. Project Title: Report date: 06/01/11 Data filename: Untitled.rck Page 3 of 4 Exceptions: Covers are not required when 60% of the heating energy is from site -recovered energy or solar energy source. Lighting Requirements: F -I 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: ri 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 V). Certificate: 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: Report date: 06/01/11 Data filename: Untitled.rck Page 4 of 4 2009 IECC Energy Efficiency Certificate Psui.atioh.Ra ing Ceiling / Roof 38.00 Wall 21.00 Floor I Foundation 30.00 Ductwork (unconditioned spaces): Window 0.30 0.70 Door 0.30 0.70 Heating System: Cooling System: Water Heater: Name: Date: Comments: LAWRENCE H. OGDEN, P.E. 198 EAST MAIN STREET GEORGETOWN, MA 01833 978-352-8318 fax 978 —352-2858 cell: 978-502-5921 August 18, 2011 Mr. Stephen Breen Travis & Tim Construction 770 Boxford Street North Andover, Ma 01845 RE: Lot 6 Ogunquit Road, North Andover, Ma. 01845 Dear Mr. Breen As you requested I visited the site August 17, 2011 to review the installation of the Engineered Materials consisting of LVLs utilized in the framing of the above project. These are shown on plans 1 to 11 prepared by Martha Macinnis, dated June 1, 2011 with the framing plans sheets 1.1 and 8 thru 1 I certified by me 6/15/11. As we discussed there are two minor items that need additional work. Ensure that all LVL Members are connected together as shown on sheet 11 and add the Simpson LSTA 24 straps on the interior face of the garage door frames as shown on sheet 1.1. Based on the above site visits and based on what I could visibly see I can certify that to the best of my knowledge the LVLs members utilized in the framing as shown on the drawings are installed properly and meet the loading conditions of the Massachusetts 7t' 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 and other details are the responsibility of the licensed construction supervisor responsible for the project. I wish to thank you for the care and professional manner in which you insured the construction of this project was in accordance with the plans. Should you have any questions please do not hesitate to call. Yours truly, vl�'/ awrence H. Ogden RE Structural 27765 VN OF * kWRENCE ��yc HAROLD v� Q �o Ma c� O ` t O h C _ w 'ate iy C O O ' m C m p 0 O. Q E c O m l' G° C-1 O ts cm di:. caW CD - 4D C o : Z' 3 y CD A: O cw �• C m ca C=Q caIn mo Ce m m C Z V y'Z R .� O O O O. m C = m CIL ~ .0. ;COD mom ~ uiOW C Ow�t y.r •� d.00 W C 7 +-' •N LU E V •E v� V 10 cm C** d Go F- s .- CL m E h Z VJ O` CA C cm m cm c m O CD 6 �C N m Z O Z O 0 a V �,- O O L co z 0. O y ® C CD I C cm y ® -0 O— y O O �E C CL CD CD O O O CL iii.. C cX ca s c ccc .a j �v Q O C CD U y c C C ■s C _c _ �. 0 0 a a ° � � U a z W W O or- o a a � a 0' Z � W 2 v o a U w w w w a°' co u. cn cn �o Ma c� O ` t O h C _ w 'ate iy C O O ' m C m p 0 O. Q E c O m l' G° C-1 O ts cm di:. caW CD - 4D C o : Z' 3 y CD A: O cw �• C m ca C=Q caIn mo Ce m m C Z V y'Z R .� O O O O. m C = m CIL ~ .0. ;COD mom ~ uiOW C Ow�t y.r •� d.00 W C 7 +-' •N LU E V •E v� V 10 cm C** d Go F- s .- CL m E h Z VJ O` CA C cm m cm c m O CD 6 �C N m Z O Z O 0 a V �,- O O L co z 0. O y ® C CD I C cm y ® -0 O— y O O �E C CL CD CD O O O CL iii.. C cX ca s c ccc .a j �v Q O C CD U y c C C ■s C _c _ �. 0 0 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 �,,, SY` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print LeQibl Name (Business/Organization/Individual): Address: / / 7 J,, 5 f..t �] �o d - City/State/Zip: �� ,P f� ,C/ r�1X o i LI Q Phone 1'7 J Ar ou an employer? Check the appropriate box: 1.01 am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. [,'New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T 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 must 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' co m enation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: �axj-A/eCity/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 06/02/2011 12:46 9786833147 PAGE 01/01 CERTIFICATE OF LIABILITY INSURANCE ` 6/2D-YYYY) TMS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE D(X3 NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERMICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. ..- ---,. r ■0P1111GV1, , 3UUIC1, W the temps and condltlons of the policy, certain policies may require an endomement. A sb*rmrd on this certificate does not confer rights to the certificate holder In lieu of such endorsernun PRODUCER CONTACT— NAW: M.P. RobertE: Insurance Agency PMONS ri►x N 1060 Osgood Street Aoi 166: North Andover, MA 01645 I'MI)WERF.RInJs 2509 _ INSURBRIS) AFFORDING COVERAGE NAIC* INSURED INSURER A : _ PETER BREED? EXCAVATING INC INSURERS A/0 TRAVIS Si TIM CONSTRUCTION INSURER C :ACE USA 770 HOXFORD STMET INSURER 13, _ NORTH ANDOVER, MA 03,84:5 IhsuRmr, -' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A90VE FOR THE POLICY PFRIOD INDICATED. NOTVATHSTANDNG 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. NOR TR TYPECIFINSURMCE A� 9U6R pollcrEFF AIQA� YTxY I UMTS wvD POLICY NUMB a` GENERAL UABtur, EACH MtURRGNCk 3 _ COMMERCIAL GENE RAL LIABILITY DANA GE TO RENTEb CLAIMSAIADE F7 OCCUR NEO ExP (A vna ersen) $ — G. I VWRKERS COMPE143ATICMI YIN WC STAT T UiH_ AND EMPLOYERS' UAHRJTY ANY PROPRIEMWARfNE"XECUT7VE C46385937 1111s � i OFFICERIMEM3ER EXCLUDED? NIA E.L. EACH ACCIDENT $ 500 , 000 pNenddmcrpeUnd E.L. DISEASE - EAEWLOYE S T 500_1000 nyee tlaacrfae untler DESLLRIPTION OF OPERATIONSbolow EL DISEASE •POLICY LRAIT 3 5no _ nAA DESCRIPTION OFOPERA710MILOCATION$/V@ICLm IACachACORD101,AddigonelRaftyk,ScheeEAM,ItMOM s.PncalaregUrod) TOWN OF NORTH ANDOVER OSGO037 STREET NORTH ANDOVER, MA 01845 CORD 25 (2009/09) SHOULD ANY OF THE A00VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE wITH THE POLICY PROVISIONS, AUTIO b REPRESENTAVM 0 IM -2009 ACi The AC ORD name and 1090 are registers d ma rks of ACO RD All rights reserved. PERSO NAL A ADV I NJURY — GENERAL AGGREGATE g GEN'LAGGREGATE LPAATAPPLIES PER PRO PRObUCrS - CAMP/OP AGG S POLICY LOC $ AUTOMOMLE INABILITY C0101011VEDSINOI.ELUrr _ ANYAUTD S AI.L OwneD AUTOS BODILY INJURY (Per pemon) S _ BODILY INJURY (Per as k*M) S SCHEDULED A UrOS HIREDAUTOS PROPEMY DAMAGE - (Per atc idgnq NON -0W NE D A UTOS S UM6WLLA L1A6 OCCUR $ EXCESS LIAB EACH OCCURRENCE _ 8 CLAIMS -MADE DEDUCTIBLE I I AGGREGATE I $ G. I VWRKERS COMPE143ATICMI YIN WC STAT T UiH_ AND EMPLOYERS' UAHRJTY ANY PROPRIEMWARfNE"XECUT7VE C46385937 1111s � i OFFICERIMEM3ER EXCLUDED? NIA E.L. EACH ACCIDENT $ 500 , 000 pNenddmcrpeUnd E.L. DISEASE - EAEWLOYE S T 500_1000 nyee tlaacrfae untler DESLLRIPTION OF OPERATIONSbolow EL DISEASE •POLICY LRAIT 3 5no _ nAA DESCRIPTION OFOPERA710MILOCATION$/V@ICLm IACachACORD101,AddigonelRaftyk,ScheeEAM,ItMOM s.PncalaregUrod) TOWN OF NORTH ANDOVER OSGO037 STREET NORTH ANDOVER, MA 01845 CORD 25 (2009/09) SHOULD ANY OF THE A00VE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE wITH THE POLICY PROVISIONS, AUTIO b REPRESENTAVM 0 IM -2009 ACi The AC ORD name and 1090 are registers d ma rks of ACO RD All rights reserved. �' L O APPLICATION FOR CERTIFICATE OF OCCUPANCY/ANSPECTION ADDRESS/LOCATION OF PROPERTY BUILDING PERMIT # E9 � Map Parcel Lot Number G SUBDIVISION: .4`c; -'k _7 DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: Address: APPLICANT SIGNATURE 0 ROUTING TOWN ENGINEER, SITE PLAN — DRIVE -WAY REVIEW � CONSERVATION PLANNING DPW -WATER METER SEWER CONNECTION DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST SIGNA File: Application for OC form revised Jan 2007/2011 ri W cd o � rot x , IV lk� A v � . aa w° w cn cn n �o C2 C2 L h C2 C CJ V �d p, C : cc C O 'ID E � L '= V C2 C E c �,o m o O ..cm�s m o L o Z' 3 y cm _m y C A V &i my m _ aC.7 C,* m m c �Q 2 V y O y. C d O ¢ mL i m C = m :mt3 O dOH ,• y m ... W C coco 0 +=+T� .• � .vyJ mt�Oc v •� vVvsm _ CD Go d :.OE... m M V) l E (n �D N rn-y. (7 Cad 0 CD CD c w m P, Cl .cm C �C N m t w+ 0 Z O g O 5 0 O r-4 ._b 44. 6 0 a� O L O C s z CD CL O CO) ® c CD tm I O -0 CO3 O O .f CD CL 0� O O L !—C O CL ZLCL C CO) c ev � M o? 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