HomeMy WebLinkAboutBuilding Permit #339 - 9 AMELIA WAY 11/14/2008 NORT#f
BUILDING PERMIT oF�t�eD "ti
O.r �6 �t^
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION 7°
Permit NO: -� 7 Date Received �9gDg17ED IPPV`+
�SSgCHUS
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print
MAP NO: PARCEL: ZONING DISTRICT: *. - Historic Distnct yes (no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Buildi22 t
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 PREFORMED:1TT
a i
Identification Please T e or Print Clearly)
Y)
OWNER: Name: J3E7-TIYzr'.r eT4T,. Phone:47a 723 41 V
Address: SI T 4x—
CONTRACTOR
Name: Phone: fra
Address:
Supervisor's Construction License; c5 17 `14 IExp. Date: 0�� �"""2b it
Home Improvement License: Exp. Date
ARCHITECT NGINEER-t>EE�AIINL1 ` = 1''lil7 Phone: '57� '371 7 �
Address: Reg. No. D
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ,cl 2 / FEE: $ /�
�P
Check No.: � e Receipt No.: J
NOTE: Persons contracting with unregistered contractors do not have access to h gua n
signature of Agent/Owner�. ""- ,Signature of contractor
ALocation L
No. „�� Date
NORTH TOWN OF NORTH ANDOVER
C� .. e yah
� 9
. 4 Certificate of Occupancy $ /� d
�ssuHUst<� Building/Frame Permit Fee $ CI�GS
Foundation Permit Fee $ / Q
Other Permit Fee $ r
r' TOTAL $
Check 11 0
('27y
21 6y3
Builbing inspector
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
i
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT A /Lo�
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS AU OSP 7 CL
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Con nection/si nature&Da �4&0* Driveway Permit
IKLDPW Town Engineer: Signature: ��
Located 384 Osgood Street
"FIRE DEPARTMENT -Tempbumpster on site yesz e no
Located at 124 Main Street
Fire Department signatureldate gly��' A
COMMENTS
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
NOTES and DATA—(For department use
❑ Notified for pickup - Date
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
❑ 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)
❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
NpRT►y
Town of Andover
No. 3 ~ - -
o dover, Mass.,
COCHICHEwICK V�
RA7E0 P`PG,`��
4 BOARD OF HEALTH
Food/Kitchen
Septic System
PERMIT T D
BUILDING INSPECTOR
THIS CERTIFIES THAT........... .......................................I.......... Foundation
C
has permission to erect........................................ buildings on ......�'.,.�. `4- .Z' /.......�,(JP� . . ............................. Rough
COA/ x-`/✓'UC:� � � � 6 %j r `� �? tF� � Chimney
tobe occupied as......................................................�.. �................................................. ! .................... ....................
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PER.MI I' EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
............................ Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
Trident Project Advantage Group
155 N BROADWAY
PO BOX 68
SALEM,NEW HAMPSHIRE 03079
Telephone(603)898-6110
Facsimile(603)890-1070
CONTRACT PRICE AFFIDAVIT BY OWNER'S PROJECT MANAGER
This Affidavit is made this 13th day of November, 2008 by Trident Project
Advantage Group, a New Hampshire limited liability company ("OPM"), relating to
the construction of the Cottage at #9 Amelia Way, North Andover Massachusetts
(the "Project") by Windover Construction, Inc. of Manchester, Massachusetts (the
"Contractor"), at the direct request by the Town of North Andover, Massachusetts
for the contract price.
1. OPM states that the contract price of the Contractor for the
Project is set at Four Hundred Nine Thousand Nine Hundred
Seventy One Dollars ($409,971), not including soft costs for
bonding, insurance, contingency, general conditions or fee
items.
IN WITNESS WHEREOF this affidavit has been executed this 13th day of
November, 2008.
B
ur
Gino J. Baroni
Owner and Managing Principal
State of Massachusetts
ss
County of Essex
On this 13th day of November, 2008 before me, a notary public, appeared
Gino J. Baroni known to me to be the person who executed the above
instrument, and acknowledged that he/she executed the same.
RA
,
Won
to ._Public: Anita L. Morrill
•u Commission Expires: March 21, 2014
.91
rA
k pod
DEVELOPMENT IV TION PROJECT
MANAGEMENT MANAGEMENT MANAGEMENT
e- e
i
REScheck Software Version 4.1.4
Compliance Certificate
Project Title: Edgewood Retirement Community
Report Date:08/21108
Data filename: F:\DSA Project Files\Edgewood 0706\04.MA Energy Code Check\0706.00 Unit B.rck
Energy Code: Massachusetts Energy Code
Location: North Andover,Massachusetts
Construction Type: 1 or 2 Family,Detached
Heating Type: Other(Non-Electric Resistance)
Glazing Area Percentage: 23%
Heating Degree Days: 6322
Construction Site: Owner/Agent: Designer/Contractor:
575 Osgood Street Dewing&Schmid
North Andover,MA 01845 30 Monument Square Suite 200B
Concord,MA 01742
• • _
Compliance:1.9%Better Than Code Maximum UA:378 Your UA:371
Assembly Area or R-Value R-Value or D..
Perimeter U-Factor
Basement:Solid Concrete or Masonry 1846 0.0 10.0 103
Wall height:7.5'
Depth below grade:7.5'
Insulation depth:7.5'
First Floor:Wood Frame,16"o.c. 1854 21.0 0.0 79
Windows:Wood Frame:Double Pane with Low-E 361 0.300 108
Door:Solid 42 0.290 12
Door:Glass 58 0.290 17
Ceiling:Flat Ceiling or Scissor Truss 1725 38.0 0.0 52
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 4.1.4 and to comply with the mandatary requirements listed in the REScheck 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 specified in
Sections 780CMR 1310 and J4.4.
Name-Title Signature Date
Project Notes:
Unit B
Project Title: Edgewood Retirement Community Report date:08/21/08
Data filename:F:\DSA Project Files\Edgewood 0706\04.MA Energy Code Check\0706.00 Unit B.rck Page 1 of 1
♦a11.1.11ll 1-1k—— v\Vaal allll"t \1, 1 ulit It .J"'t,a.
ZIM Board of Buildim, Re!-ulations and Standards
Construction Supervisor License
a
License: CS 99769
Restricted to: 00
AARON SASSEVILLE
24 BUFFUM STREET
SALEM, MA 01970
Expiration: 7/2412011
( unuui,.i rner Tr#: 99769
r
CORD CERTIFICATE OF LIABILITY INSURANCE OF IDB DATE(MMIDDIYYYYI
WINDO-4 11/03/08
I ft>DucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
McLaughlin Insurance Agency HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
828 Lynn Fells Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Melrose MA 02176
Phone: 781-665-2775 Fax:781-665-0295 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA: Aspen Specialty Ins. Co.
INSURER B: United specialty Insurance Co.
AttnKaren Cochand ver Construction, Inc. INSURER C: OneBeacOn Insurance Grou
ttn Kar
13 Elm Street INSURER D: American Irwrnatu Companies
Manchester MA 01944
' INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW NAVE 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR TYPE OF INSURANCE POUCYNUMBER DATE MWDD DATE(MM/DD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
A X COMMERCIAL GENERAL LIABILITY GL000574-01 01/01/07 01/01/09 PREMISES Ea occurencs) $50,000
CLAMS MADE OCCUR MED EXP(Any e re person) $EXCLUDED
PERSONALBADVINJURY $1,000,000
GENERAL AGGREGATE $2,000,000
GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG s2,000,000
POLICY X JECT LOC
AUTOMOBILE LUU3ILITY
COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY $
C X SCHEDULED AUTOS FBIE07908 04/01/08 04/01/09 (Per person)
X HIRED AUTOS
BODILY INJURY $
X NON-OWNEDAUTOS (Peraocidera)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO
OTHER THAN EAACC $
AUTO ONLY: AGO $
EXCESSIUMBRELLALMILITY EACH OCCURRENCE $5000000
B X OCCUR 0 CLAIMSMADE CXA4GS708 09/25/08 01/01/09 AGGREGATE $5000000
$
DEDUCTIBLE
8
X RETENTION $
8
WORKERS COMPENSATION AND
EMPLOYERS'LUIBILITY X TORY LIMITS ER
D ANY PROPRIETDRIPARTNERIEXECUTWE WC6967012 03/20/08 03/20/09 E.L.EACHACCIDENT $500 000
OFFICERIMEMBEREXCLUDED7 E.LDISEASE-EAEMPLOYEE=$500,000
K yes,describe under
SPECIALPROVISIONS below E.LDISEASE-POLICY LIMIT $500 000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
RE: Edgewood Retirement Community Renovation and Expansion, North Andover,
MA Bank of America, N.A., their subsidiaries, affiliates and parent
companies; and their repective officers directors,trustees,managers,members
and employees are Additional Insured on all policies abover (except for WC &
employers liability) for liability arising out of the operations of Windover
CERTIFICATE HOLDER CANCELLATION
EDGEW-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
Edgewood Retirement Community NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Inc
575 Osgood Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
N. Andover MA 01845 REPRESENTATIVES.
i
AUTNO:M NTAVE
O
ACORD 25(2001108) V ACORD CORPORATION 1988
Construction, Inc. and its subcontractors are listed. for liability arising
out of the operations of the Construction Manager and its Subcontractors
on this project.