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Home My WebLink AboutMiscellaneous - 121 CORTLAND DRIVE 4/30/2018 121 Cortland Dr. / Unit 14 � LaMarche Associates 5 North Road, P.O. Box 250 Chelmsford, MA 01824 i 800-349-1525 Fax: 978-256-8590 F November 11, 2015 1 Building Commissioner/Inspector of Buildings NORTH ANDOVER, MA 01845 I Board of Health/Board of Selectmen NORTH AiNDOVER, MA 01845 NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 3B � I Claim has been made involving loss, damage or destruction of the property captioned below, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be I applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location,'policy number, date of loss, cause of loss and LA file number. Insured: MEETINGHOUSE COMMONS CONDOMINIUM TRUST Loss Location: 121 CORTLAND DRIVE NORTH ANDOVER, MA 01845 Policy Number: 1120D36511 Date of Loss: 11/10/2015 Cause of Loss: Physical Damage I " LA File Number: MA-2-30605 I On this idate, I caused copies of this notice to be sent to the persons named above at the addresses I indicated above by first class mail. Thomas Bratkon Adjuster � I � I i LaMarche Associates,Inc.-800-349-1525 Page 1 of 1 HORT{ of TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION I SSAcNuse� I _ I Permit NO: Date Received: — — 61 I Date Issued: '�/�7�_ IMPORTANT: Applicant rnust complete all items on this page f, LOCATION-1 Z ) .�/`— <'(,�,� )� NI e2 1 101rn"was. a� I Prin PROPERTY OWNER M�� I MAP NO.: G_PARCEL: 3 Print ZONING DISTRICT: K TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 'One family ❑ Addition Cl Two or more family C Industrial L Alteration No. of units: J Repair, replacement ❑ Assessory Bldg J Demolition Ci Commercial J Moving(relocation) ❑ Other Foundation onl 0 Others: DESCRIPTION OF WORK TO BE PREFORMED I I Identification Please Type or Prin Clearly) OWNER: Name: �I lrQim Phone: �7F 68�Z � 3f f Address: I CONTRACTOR Name: Phone: 7 - �-L6 Address: ` V' Supervisor's Construction License:_ 0��-4)J '� I Exp. Date:J�zz) Horne Improvement License: �/ Exp. Date: ARCHITECT/ENGINEER k4 Name: Phone: Address: Reg. No. I FEE SCHEDULE:BULDLYG PERMIT••$10.00 PER$1000. 0 OF THE TOTAL E TIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 88� X i7 Y jn no x1.00=FEE:$ t I av , Check No. Receipt No.: Page I o f 4 0VM 0 A. t Aindover No. d /7 0 dover, Mass. /'7 • O �A COCNICMEWICK ' .9S0RATED BOARD OF HEALTH PERMIT Food/Kitchen Septic System THIS CERTIFIES THAT A ....V604 �G. ..... •••• BUILDING INSPECTOR ............................................. as permission to erect.. ........ buildings Foundation oft to be occupied as S'r" ........ ........ ................ �,,, Rough provided that the " ' !!� person accepting this er g P mit shall in eve ....................................................................... Chimney this office, and to the provisions of the Codes and By-Laws relatng tote Inspection,rm to the rAlterat'on and on file in Buildings in the Town of North Andover. Construction of Final VIOLATION of the Zoning or Building Regulations Voids this Permit. PLUMBING INSPECTOR D Rough PERM T EXPIRES 11 V 6 MONTHS Final UNLESS CONSTRUELECTRICAL INSPECTOR Rough ............... Service BUILDING INSP Occupancy Permit Required to Occljpy Buildin Final g Display in a Conspicuous Place on the Premises Rough GAS INSPECTOR No Lathingp Do Not Remove or Dry Wall To Be Done Final Until Inspected and Approved by the BuildingInspect-or. _ - - _ _ - -FIREDEPARTMENT - - - - - - - - - - Burner SEE REVERSE SIDE Street No. Smoke Det. 0 4+wc CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 017(7/17/200 Date: February 7 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 121 Cortland Drive MAY BE OCCUPIED AS Single FamilvDwelling IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. J Certificate Issued to: Mee tin house Co ns 121 Carterfield Rd ' North Andover MA RM Building Inspector II I NORTH TO" Of : Andover No. �- z=- A dover, Mass., � - 17 ' 04 - COCKICKEWICK-y1- - - ADRATED 7S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System N ( A yyyy�� AW40C .--= DING INSPETHIS CERTIFIES THAT..1.I1��. . . ..... , ....... ................................. �� Found v .. t � has permission to erect........................................ buildings on t t l..... j1A... . .......D�........ ......:� .. R t0 be occupied 8s...�. ....... /. !!.�!. r(......�. a o...... Chimney it' � :....,..........:.. '. .ra � provided that the person accepting this permit shall In every respect conform to the-terms of the applicatiorr'on file in Fi 10-"zthis office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of C� Buildings In the Town of North Andover. PLUNMFiG INSP &TOR VIOLATION of the Zoning or Building Regulations Voids this Permit. 99ir!/ �� °� G C� � 7 PERMIT EXPIRES IN 6 MONTHS G ELECTRICAL INSP CTOR UNLESS CONSTRUR6u� A. __ _. .. .. .. . .. .. ... ........... ........... Service BUILDING INSP Occupancy Permit Required t0 Occupy Building GAS INSPECTOR 7/GC _ Display in a Conspicuous Place on the Premises Do Not Remove F. No Lathing or Dry Wall To Be Done FIRE DEPARTM Until Inspected and Approved by the Building Inspector. Burner Street No. ,a SEE REVERSE SIDE smoke Det: , C A L tkORTFi k �4 sS�CHUsfC APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION Building Permit# ADDRESS/LOCATION OF PROPERTY : /Z1 Co� 4�. ttrQ Map loyC Parcel 3 Lot Number I y SUBDIVISION Medl bem�rn�s DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: -9WC4 FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMP TED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY POLLARS $2% 0) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLIC BLE CODES SIGNED ROUTING CwNvEP.VA I ION 0 N ON�uR1 SDS CTI�iJ�L PLANNING 0 4 0 S DPW ;WATER METER Fok] H0� SEWERIWATER CONNECTION NOTE DPW MOST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE �OCCUPANCY/INSPECTION REQUEST DPW Signature File: OC form revised 2006 Date.......".!°........b... f NCRTM 1 TOWN OF NORTH ANDOVER o < p PERMIT FOR WIRING fl,`S3^GMUS� A This certifies that .....................611149e...`....tL.Pa.7............... has permission to perform ... ...... .....t-f.P?or .......................... wiring in the building of.......... ,�l '. L Ery 9 4. ............................... at........ r4-,,-9A..L>.....96.............. .North Andover,Mass. of Fee...,,5'..1/b........ Lic.No. ...................CTR.. . ............... . ELECTRIC'ALINSPECTOR P Check # .907 DEDIO}1WOMNKSMY Permit Na 6967 APPUCATTON FOR PERMIT TO PERFORM ELECTRICAL WO ALL WORK To BE POFORMED IN ACCORDANCE WrrH THE MASSACHUSM ELECTRICAL CODE,527 CMA 12:00 PRINT IN INK OR TYPE ALL INFORMATION) b PLEA Pl} De ' Town of North Andover To the Inspector of Wires; The undersigned applies for a permit to perforrn the electrical work described below. Location(Street&Number) 12-1 ( tLA�w;� I Owner or Tenant i Owner's Address &Zv�+� , ev Q ,A is this permit in conjunction with a building permit: Yes No E3 (Check Appropriate Box) 1 Purpose of Building s J 6,V-1,t qtr — u!Z-3 �Q Utility Authorization No. Existing Service Amps../Volts Overhead Underground 8�nd No.of Meters New Service Ampst Ze��tolts Overhead ® Underground ®� No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Wort + Na of Lich ft 0a" No.of Nat Tabs No.of Twofi msen Total Na -RUX;Fid 5winvn nor Pod- Abort/ belowQ�ps� KVA KVA x Na of Aeceptaah Oudea Na,of Oil Sumas M.of Emer aeM7 t.&ft Deny Units No.of Switch Ontleu �.._ No.of Ou Burners No.of Raq&m No.of Air CoreL Told FME AI.AftM$ No,of Zeros Toth r No.of Disposals No.of Hast Told Tact No.of Detectim and I, Po Taro KW _letdsttsy Devices No.of Dishwashers Space Ates Heaft Kw No.of sddndtras Devices i No.of Self Coresb w No.of Dryers Hestina tkrices Kw I ocd ® Mwddpd 10 Ot No.of Waw Hellas KW lYo.of No.of Comeetions sign Baihuis No.Hydra Mssssae Tabs Na of Motors Taal HP I I OTi3F.R• i I .� Irwsar�oe Puta�tbmeracFiett�ItafMateodaaelht3ataallswa � 'I ItmeaaaentlielrYYh4ascel�iiY � oritss�tielequirat�t YM Ihme9ftnitledvafdpaa tee heOfflz Im 1ryeuhnedmJzd'Kpir=iidtabfr WC(w�h1t thei1ft MMANU RAV L...1 1J L rlaltdva�tzdEhm tlWadsS Walt:bstnt itttp9nirnDa�Re� Ra* Arts! 5�ledundtr tsPbrtt ifsafp *w.. I' MMNAW ,J/t' 2a1v -- c;�,�e,M _�.7,=-) AdieM AL'Ili% cJUVl+ffRsiN5I1RAl+><EwAlYIItlatri ftatdtelioe� fteir�rtoeao►eagearfslegiivaiattsssx}iedbrMas�acta>seeac�iaall�ws arddiatmysi�tetamfthpmeftapp9c�ionfiaie�tiermR, — (Pleese check ane) Owner C3Agent (� 1�•••� Telephone No. PERMIT FEE S �� , . _ . , /� ' '- � � ,. � a J ...� _j — ._. -- ��,�- �- /'� t Q pORTI{� O t,�an es ti0 TOWN OF NORTH ANDOVER �' . ,>•': APPLICATION FOR PLAN EXAMINATION SACHUSE f Permit NO: Date Received: O Date Issued: IMPORTANT: Applicant must complete all items on this page j LOCATION PROPERTY OWNER M p e / Prin xs U C Print MAP NO.: L C PARCEL: 3 ZONING DISTRICT: � ) i 1 TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential XNew Building KOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑Repair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: j ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Prin Clearly) OWNER: Name: I G Phone: /7-`687-2 OC' gnature � Address: 1Z 1 , CONTRACTOR Name: Phone: 27F )-L6 Address: )J. Su ervisor s Construction License: / p Exp. Date: U g Home Improvement License: �/ Exp. Date: ARCHITECT/ENGINEER ISA )�.�" Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000. 0 OF THE TOTAL E TIMA TED COST BASED ON$125.00 PER S.F. Total Project Cost :$ Z 88Fr4L/} X 12.E l mo xIL.00=FEE:$ t 1 vU . Check No.: l t 3� Receipt No.:aa Page 1 of 4 i 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:BPFORM05 Page 4 of 4 iT — 4 I TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ ` Tanning/Massage/Body Art ❑ j Public Sewer Well ElTobacco Sales ❑ Food Packaging/Sales 11 Permanent Dempster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unr gistered n actors do not have access to the gu7z/// Signature of Agent/Owner Signature of Contractor Plans Submitted lans Waived ❑ Certified Plot Plan ❑ in ped Plans ❑ 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 ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ f COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ ' COMMENTS ! Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted �-9-,mD-13 Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp-Dumpster on site 'yds-no- Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 Building Setback (ft.) N Ul 469 germs Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided �j ( I N fA }� N1 DiMENSION l Number of Stories: Z Total square feet of floor area,based on Exterior dimensions. Total land area,sq.ft.: 30,2 A c NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.Jan.2006 1 I Building Setback(ft.) N A tl 469 gQrr� Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided �j(A' - � N /A NJ� I D . ENSION 1 ) Number of Stories: /Z Total square feet of floor area,based on Exterior dimensions. Total land area,sq.ft.: 30,Z A NOTES and DATA—(For department use) I i I I i I I I I �I Page'3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 I TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art ❑ Public Sewer ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ F1Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to ProJ ject NOTE: Persons contracting wit4unristered n actors do not have access to the guarantyfu d Signature of Agent/Owner Signature of Contractor Plans Submitted tN lanCertified Plot Plan ❑ mped Plans ❑ 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 ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED, DATE APPROVED JJEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted } tij D-13 Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection signature&date Temp Dumpster on site "yes-no- Fire Department signature/date Building Permit Approved and Issued by: Page 2 of 4 _ 1 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. c Roofing, Siding, Interior Rehabilitation Permits i ❑ 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 I Addition Or Decks ❑ Building Permit Application ❑ 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) New Construction (Single and Two Family) i ❑ Building Permit Application j ❑ Certified Proposed Plot Plan j ❑ 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 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:BPFORM05 i Page 4 of 4 Of"OR7y 1 ... °L p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ,SSICHUSEt Permit NO: 1 Date Received: — O 4- Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER M R e�) Prin ms LL C Print MAP NO.: /bq C PARCEL: 3) ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ,XNew Building KOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Repair, replacement ❑Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED T R, 3��4J Identification Please Type or Prin Clearly) r r y ? a OWNER: Name: 1 l�(.0 Phone: gnature Address: 1 C6 4A CONTRACTOR Name: A Phone: 7 • -L6 Address: Supervisor's Construction License: D 3 �) Exp. Date: Home Improvement License: & l Exp. Date: ARCHITECT/ENGINEER N4 IA` Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$10.00 PER$1000. 0 OF THE TOTAL E TIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ Z Mr 414 X rZ �n d0 x1L.00=FEE:$ _33'� . t l CJO . � t mss. Check No.: Receipt No.: Page 1 of 4 /0// t v✓d -�"c4 Location k)�- C0l2 4" a Dn--J-/ No. alk Date Qf� MORTM TOWN OF NORTH ANDOVER F? •. 0� 9 Certificate of Occupancy $ CH t� Building/Frame Permit Fee $ �+ Foundation Permit Fee $ 2 U Other Permit Fee $ TOTAL $ Check # _ Buil ing Inspector ,AORTH Town of -- .. R Andover 0 No. d �� zo == A = - dover, Mass.; 000) • 7 • O COCMICME WICK RATE D C7 S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT Afe BUILDING INSPECTOR .................................. . ..t-k)....1116"1W..... Foundation has permission to erect........................................ buildings on w .... ..... .�............... Rough to be occupied as... Chimney . . `. .�I(...... .h►Co........................................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Final Buildings in the Town of North Andover. PLUMBING'INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rouge, - PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRU ELECTRICAL INSPECTOR Rough ............... ......... �Sp Service .. .. .. . ... ..... ............ BUILDING Final Occupancy Permit Required to Ocatpy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough na No Lathing or Dry Wall To Be Done DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner FIRE Street No. SEE REVERSE SIDE Smoke Det. , 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 compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********************** � APPLICANT M �I h , �O�S LLC C PHONE ,q?8-C87-Z 6-j LOCATION: Assessor's Map Number PARCEL 3 r SUBDNISION (" l ti �aC,� /�n7 LOT (S) _ _ c � STREET �`� ST. NUMBERi? l_ USE lNLY ******* ** 'RECO ENDAT_IONS F TOWN AGENTS: CO ERVATION ADM1NISfiRAT R DATE APPROVED --7 %. DATE REJECTED COMMENTS Ajb - ' i cT oKoc� (0 TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS IWA FOOD IN ECTOR-HEALTH DATE APPROVED DATE REJECTED J SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS 0" S a\N c PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVE AY PE IT , i FIRE DEPARTMENT i RECEIVED BY BUILDING INSP TOR DATE Revised 9\97 jm .' i _ _ �� !/I)7/191.G9tClJF.CIGf� 0,,.�l�Cll.Q'ICI.f�tLl ! BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 055417 Birthdate: 04/05/1960 Bxpires:,04/0512006 Tr.no: 21033 Res#raated: 00 THOMAS D ZAHORUIKO w 121•CARTERF4ELD RD N ANDOVER, MA 01845 Acting C �'� .,e, The Commonwealth of Massachusetts i Department of Industrial Accidents ? Office of Inl,estigations 600 Washington Street Boston MA 02111 t - wwmnrass.goildia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nanne (Business/Organization/individual): Address: City/State/Zip: s IJg-v�6�,r ,iLt a�� Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ i am a employer with 4. ❑ I am a general contractor and 1 2.'6�employees(full and/or part-time).* have hired the sub-contractors 6. New construction 1 am a sole proprietor or partner- listed on the attached sheet. * 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. q. [:] Building addition [No workers'comp.,insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] employees. [No workers' comp. insurance required.] 13 ❑ Other *Any applicant that checks boa#1 must also fill out the section below showing their workers compensation policy information. '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. 1 am an employer that is providing workers'compensation insurance for nay employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: 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 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 covera rification. I do hereby certify ender th ails and pe allies perjury that the information provided above is true and correct. Si nature: Date: Phone#: q2F "4 Y `7_ 3S I Official use only. Do not write in this area,to be completed by city or town of�cia/. 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#: Permit.Number MECeheek Compliance Deport Checked By/Date Massachusetts Energy Code MECcheck Software Version 3.3 Release lb Data filename:Untitled I f TITLE:The Portsmouth at Meetinghouse Commons CITY:North Andover STATE:Massachusetts HDD:6322 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) i DATE:02/23/06 DATE OF PLANS:2/07/06 PROJECT INFORMATION: Meetinghouse Commons North Andover,MA 01845 COMPANY INFORMATION: Meetinghouse Commons LLC COMPLIANCE:Passes Maximum UA=477 Your Home=447 6.3%Better Than Code Gross Glazing j Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1:Flat Ceiling or Scissor Truss 1628 OA 30.0 50186 I Wall 1:Wood Frame, 16"o.c. 2356 0.0 13.0 Window 1:Vinyl Frame,Double Pane with Low-E 379 0.340 129 Door 1:Solid 35 0.340 12 Floor 1:All-Wood Joist/Truss,Over Unconditioned Space 1628 0.0 19.0 70 i Furnace 1:Forced Hot Air,90 AFUE Air Conditioner 1:Electric Central Air, 10 SEER 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 MECcheck Version 3.3 Release 1 b and to comply with the mandatory requirements listed in the MECcheck Inspection Checklist. The heating load for this building,and the cooling load if app ate,has been determined using the applicable Standard 'Design Conditions found in the Code. The HVAC equipm t lected to heat or cool the building shall be no greater than 125%of the design load as specifie in Sections 7 C 1310 and 34.4. Builder/Desi er Date 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(F) Up to 1„ Up 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 Ranee(F) 2"Runouts 1"and Less 1.25"to 2" 2.5'to 4" Heating',Systems Low Pfessure/Temperature 201-250 1.0 1.5 1.5 2A 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) 4 i MLLTINGHausL COMMON5 AT 5MOLAK FAKM Y • A i I L F.-71, - --T IT 1 I j__._._ _ _moi � ;uTT � l �j.� •� _ L� ! j 1• f --- _ -_ - - �- -- i -7-T L. Fl --i-j r T - I I ' , I I S -L. i --j j The Fortsmout6 at Meetinghouse Commons ! North-Andover,.MA - 1_2-1-Cortland-Drive ((-,Init-)4) FO TS1ytQ( �r1 Scale: 1/-1 = 1'O" Date: 07/071ZO06 jheet 1 Meetinghouse Commons LLC, North Andover, MA 8-6 6 8-0 i..9 Z-q ! s-a , 2 `� 2-9 11-31 2-3 T - L t AAAST'EPC �;-— — -- — — -- � -6�tlrnz� Rao1•�1 G � c��T l Lf 0 0 ' ! 0 l r [ ' � CY3 a f� T/F/ t+ �Q; o o ! 9 RD i��r��, +4j�tr � !i •LOO r uP W11.C. 4 t�rL _ I d L2Y<oQQRLLL_ t rs • O bUFiSi ' OP�1� Suts� coYCR Roost TO T_dv3� A ` 41WRA&;E wfTRN oN\ 4 I 7 , ! . 0 L___JL r CovE'RC� PoRck - QD Ck oti I i3-o 3 (J `{4- O GLA, FF: 1768 sf GLA, SF: _ _ 636 sf - - _ 484 sf Tke Portsmouth at Meetingkouse Commons Tot. GLA+ Gar. 2888 sf North Andover, MA 121 Cortland ]rive ((Anit i+) Front Porch: 148 sf Scale: Vl' = 1'0" jute: 07/07/2006 Sheet 2 Deck: 144 sf Meetinghouse Commons LLC North Andover, MA :�q�o • Z o g b II l^ Q 1 J 4 _ - L AL L7' PAfl foR cot n).8�{�r^ DROP �o Ns�Dkrik LV TSD 1 O Aa- ok 4alY !— - -� — — — e— — - — —• . —�-� — I — — - — QUO;111 C3 5 Q« 2orr p d VJ AA I- to" } 7 1 O`r N s- E 3000 car rcxe-tC Ll R-n AL _ o 0 I , i Rt G 3000PsZ 11Q � � :i SLS -3i�cr C'EC-Alfr? - tI v: > � � 3E��1atG So:L N N Q 9 22 -v 8-0 fH-v 414_6 The Portsmouth at Meetinghouse Commons, North Andover,-MA 12.1-Cortland-Drive'{u Flit }4}— - - - - - - — -. - - t'o u 1V D l�� 1 o S� I Q.�St M�NT PL I�3� - - - — - - - - — - Scale: 1/8" _ 1'0" Date: 07/07/2006 Sheet 3 Meetinghouse Commons LLC Norte,Andover, MA 2V �y -v Zp IZv Z-6 tt-v 2 s-� 5•0 a � Q � a ' I � N 111 2 -Y ID e) ►t o t 0 0 N ` O > > 44 — h J Iv O0' r • S� G6 N� fir;� t'( The Portsmouth at Meetinghouse Commons, -- -- — _ _ North An—,43ver, MA i'2.1"Cortland-E)rive-Unit 14 -- --%5cale: i/8" = i'o" ])ate: 07/07/2006 jheet 4 Meetinghouse Commons LLC, North Andover, MA WINDOW & DOOR SCHEDULE Interior Doors, 2-8 X 6-8 unless specified 34 1/2X 82 %2 D-1 Entry Door, Twin Sidelights 681/2X 83 D-2 Entry Door 381/2X 83 D-3 . _ Slider w/transom 72 X_96 1/4 D-4 Slider 72 X 82 1/2 D-5 Entry Door, Single Sidelight 53 1/2 X 83 A Double-hung single 34 1/4 X 65 1/4 B Double-hung twin mull 68 X 65 1/4 - ,- -; C Double-hung triple mull 1011/2X 65 1/4 I l D Double-hung single 34 1/4 X 57 1/4 E Double-hung twin mull 68 X 57 1/4 F Double-hung triple mull 101 1/2 X 57 1/4 G Double-hung single 22 i/4 X 65 1/4 H Double-hung single 341/4X53 1/4 I Double-hung twin mull 68 X 53 1/4 L Double-hung w/transom 34 1/4 X 79 M Glider 60 1/4 X 42 1/4 4\1 I N Double-hung twin mull w/transom 68 X 79 P Transom 34 1/4 X 30 1/4 Q Transom twin mull 68 X 30 1/4 S Double-hung 301/4X 49 1/4 T Double-hung triple mull w/transom 1011/2X 79 U Double-hung twin mull 68 X 49 1/4 v ROOF X Round stationary 24 X 24 Tke Forat Meetingkouse Commons, North Andover, MA 1 21 Cortland Drive ((-Init - �i 4)5ca�e: 1/8" = 1'o" Date: o7/o7lzoo6 56eet 5 - Meetinghouse Commons LLC, North Andover, MA �f J P � ,SLY. RAPTO, l6 CTYP� CF-?LI tLnoR 4T ST U.J 1 1 } � I 1 � ` � ?��z 3� , — �•G_ SL-'�3 � L'2Z2_6 ?T °=��_ >� I t L� �Lrr:•t o hs R 2q - — — 7 LILLY $�T - m y" Pc T yptc,NI- SFC-T[ot t `yF1cAt_ Jk1i_ ?ORCh SET �L a I -j"he Portsmouth at Meetinghouse Commons, North Andover, MA 121 Cortland Drive unit 14) - jcale: varies -Date:-o7/o7/-2006_ Sheet 6 Meetinghouse Commons LLC, North Andover, MA