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Home My WebLink AboutBuilding Permit # 5/12/2015 (2) BUILDING PERMIT Q20RTf� q' 0 ® &�.LHO /6�•y� TOWN OF NORTH ANDOVER pAPPLICATION FOR PLAN EXAMINATION 4( .y •� � np `«H:mow,H 1my Permit No#: qt Date Received �RA�Rarsn PP�ygS C US Date Issued: V-) MPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential �ew Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other e cV1/e( j , Floodplai ll1%e�lancls ® U1lae hed ®istnct { r U�lr/�ewe ,DESCRIPTION OF WORK TO BE PERFORMED: C� e ',L &L,� iA' ® & gar Identification- Please Type or Print Clearly OWNER: Name: Phone: fl Address: . ri Contractor. Name: � t� Phone: Email C-1 'L `enavi i J s1 ",-A 4 Address. ' 1 r a . a 7 ` Supervisor's Construction License: C a a l Cc, 1 Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER X) i' 6 Phone:� ?�j2 Address: �'�c�l ^ t: eg. No. Z:77 FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED CO jS BASED ON$125.00 PER S.F. Total Project Cost. $ I FEE: $ 1 tO Check No.: �� Receipt No.: L NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund v SibnaTure-z" `„ %,., . �. N 41 a;. t%ORTH A ftdover Town of An ier, Mass, 1212-01 O LAK& COC KICN&WICK X19,9 A04ATE o P'fa,�'t5 U BOARD OF HEALTH Food/Kitchen PhRMmIT L �ID Septic System LLCBUILDING INSPECTOR THISCERTIFIES THAT ..... ...L........... D.. ......................... ........................ ............ ..... o Foundation has permission to erect ........... buildings on . .. ... ... . - . .... ... . . ..... p ............... Rough Sn' t® be ®ccU led as ® ..........:.............................. chimney p' .. ........ .. ........... ....... ......................... provided that the person acceptin his r it shall 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR Rough UNLESS ION T Service ........... � .. ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required toOccup-v I',uildinRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or all To Be Done FIRE DEPARTMENT Until I s ece an ve y the Building Inspector. Burner Street No. Smoke Det. Property HERS Unknown Rating Type: Projected Rating Certified Energy Rater: Eric Wilder Lot 1 540 Boxford St. Rating Date: 5/5/2015 Rating Number: North Andover,MA 01845 Registry ID: Projected Rating: Based on Plans .�. Field Confirmation Required. —-- Estimated Annual AnnuaHEnergy Cost Use MMBtu Cost Percent HERS Index: 53 Heating 32.8 $1485 49% [ene Cooling 6.3 $89 3% Gene—W ral Inforrna 11�on � 14% Conditioned Area 2537 sq.ft. House Type Single-family detached Hot Water 8.1 $432 Lights/Appliances 22.5 $885 29% Conditioned Volume 20352 cubic ft. Foundation Unconditioned basement Photovoltaics -0.0 $_0 -0% Bedrooms 4 Service Charges $136 4% [MOCTotal 69.7 $3026 100% Mechanical Systems Features Heating: Fuel-fired air distribution,Propane,96.0 AFUE. Cooling: Air conditioner,Electric,13.0 SEER. = Criteria---- ..= Water Heating: Instant water heater,Propane,0.82 EF,0.0 Gal. This home meets or exceeds the minimum criteria for the following: Duct Leakage to Outside 98.00 CFM25. Ventilation System Exhaust Only:55 cfm,21.0 watts. Programmable Thermostat Heat=Yes;Cool=Yes Building Shell Features Ceiling Flat R-50.0 Stab None Seated Attic NA Exposed Floor R-30.0 Vaulted Ceiling NA Window Type U-Value:0.320,SHGC:0.300 Above Grade Watts R-21.0 Infiltration Rate Htg:3.00 Cig:3.00 ACH50 Foundation Watts R-0.0 Method Blower door test Eric Wilder Conservation Services Group Lights and Appliance Features 50 Washington St. Percent Interior Lighting 100.00 Range/Oven Fuel Propane Westborough,MA 01581 Percent Garage Lighting 100.00 Clothes Dryer Fuel Electric 508-836-9500 Refrigerator(kWh/yr) 550 Clothes Dryer EF 3.01 2003-017 Dishwasher(kWh/yr) 256 Ceiling Fan(cfm/Watt) 0.00 9901142 ff'M/Ratat-Residentfal Energy Analysis and Rating Sfyftware v'14.6.I This information does not constitute any warranty of energy cost or savings.©1985-2015 Noresco,Boulder,Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA. 02111 M sv www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 46&C Address--4,Q Ave- N p l City/State/Zip: LZ- U ® g Phone#: ►.re you an employer?Check the appropriate box: Type of project(required): ❑ I am a employer with 4. ❑ I am a general contractor and I 6. KNow construction employees(full and/orpart-time).* have hired the sub-contractors El am a sole proprietor or partner- listed on the attached sheet.# ? FJ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. VkWe are a corporation and its required.) officers have exercised their 10.F1 Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required,] employees.[No workers' q � 13F]other comp,insurance required.] ry applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. :)meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. w itn employer that is providing workers'compensation insurance for my employees. Below is the policy and job site grmation. prance Company Name: icy#or Self-ins.Lid.#: Expiration Date: Site Address: City/State/Zip: ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 tp to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of -stigations of the DIA for insurance coverage verification. ;Itereby certify tinder the pains and p enalties ofperjury that the information provided above is true and correct. - - latur Date: ne# ?fficial use only. Do not write in this area,to be completed by city or town official. ;ity or Town: Permit/License# ssuing Authority(circle one): .Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other 1�! Massachusetts -Department o�.Public Safety ! Board of Building Regulations and Standards �O,,,,,ucu67 auF,el-v i6i .. License: CS-076124 I-S William H Lumbarik 14 Bemis Circle I Tewksbury MA 1187 Expiration 02/1812017 Commissioner