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Home My WebLink AboutBuilding Permit # 5/12/2015 (2) INORTy BUILDING PERMIT" TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Receiveda�1>y �SsgcHusk�R Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 6XFe&P e&T � Print PROPERTY OWNER_ Print 100 Year Structure yes gno MAP/0S-e--'- PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE ResicJential Non- Residential clew Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other e p ti g It 'eF['oodplain aWe41 nds ® 1%Vateop spec D str`ictl X ' yabs eb/ DESCRIPTION OF WORK TO BE PERFORMED: G e Identification Please Type or Print Clearly OWNER: NamePhone: Address: Contractor Name , ` �.. � Phone; ' ` Email Qt r 1cro, Address: `: w ; * Li 1 s Supervisor's Construction License: - �' `� Exp. Date: r� a Home Improvement License: Exp. Date ARCH ITECT/ENGINEERGr Phone: d Address:l aAA1 0+ &acc'P6/0 N A=0Reg. No.' 2-7 7 FEE SCHEDULE;BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ e)-J o — FEE: $ Check No.: i Receipt No.: (3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gna . r. ar u Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art 0 Swi'nming Pools 0 Well k, Tobacco Sales El Food Packaging/Sales El Private(septic tank, etc. Permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM 4�-PLANNING & DEVELOPMENT Reviewed On 5-q-1!5 Signature_ COMMENTS /9?0" 6001 A- (ped 40T I )-or 2 CAn1,1-ed -DOeS AJ07- ()%cj)JtL6 > k CONSERVATION Reviewed on Signature COMMENTS Uorc -2 HEALTH Reviewed on. Signature COMMENTS A�� VK o44 A-a � �� Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comme Water& Sewer Connection/s DrivewaV Perm DPW Town Engineer: Signature: Located 384 bsciodd Street .......... FIRE LIEPARTIVIENT RR q 1`1 13,117 0 C V-Eff-q AM tAORTH fown ofIt E1111 ower ® - za5 h ver, Mass, Z. 2-6 COC MI C ®�4ATED U BOARD OF HEALTH Food/Kitchen PER T Septic System THIS CERTIFIES THATL BUILDING INSPECTOR ............ 1111.A .............. .. ........ .. 1111. ... 1111. .. 1111 .. ..... ..... has permission to erect ....... g ,,, .b4ard.9i.,,... .. .. } Foundation ............. 1111.. Idin son 1111... 1111. . Rough tobe occupied as ........... ..... .. . 1111... . ........® .. ....... ................................................................. Chimney provided that the person accepting his permit shall in eve 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 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LES S ARTS Rough Service ............. ...... yrs-I...!...... ..::................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Builclinz 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 021.1 UT' . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): L /1/'C' Z-L Address: 6CC 5&7X 6VA)I— City/State/Zip: G OUPhone#: Lre 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. P&New construction employees(full and/or part-time).* have hired the sub-contractors F1 am a sole proprietor or partner- listed on the attached sheet. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9• ❑Building addition [No workers'comp.insurance 5. K We are a corporation and its required.] officers have exercised their 1011 Electrical repairs or additions F1 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 ] 1311 Other comp.insurance required.] iy 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. yt itn employer that is providing workers'compensation insurance for my employees. Below is the policy anti job site grmation. urance 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 tinder 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 ip 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. hereby cert tinder thepains andpenal 'es ofperjury that the information provided above is trite and correct. lature: \ Date: ne# � �2-/aS-® g ?fficlal use only. Do not write iii 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 `nnfarf Parenn• PhnnP V! Property HERS Unknown Rating Type: Projected Rating Certified Energy Rater: Eric Wilder Lot 2 550 Boxford St. Rating Date: 5/5/2015 Rating Number: North Andover,MA 01845 Registry ID: Estimated Annual Energy Cost Projected ��hig: Based n 1 r: - Held �� °ifir� i' Required. E-- � — —___1 Use MMBtu Cost Percent HERS Index: 53 Heating 32.8 $1485 49% Ge nerallnformation tooting 6.3 589 3% Conditioned Area __-Home ft. House Type Single-family detached Hot Water 8.1 $432 14% Conditioned Volume 20352 cubic ft. Foundation Unconditioned basement Lights/Appliances 22.5 $885 29% Photovoltaics -0.0 $-0 -0% Bedrooms 4 Service Charges $136 4% — ----- -- —� Total 69.7 $3026 100% Mechanical Systems Features Heating: Fuel-fired air distribution,Propane,96.0 AFUE. —— -� Criteria Cooling: Air conditioner,Electric,13.0 SEER. Water Heating: Instant water heater,Propane,0.82 EF,0.0 Gat. 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 Slab None Sealed 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 Clg: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 ry t Dishwasher(kWh/yr) 256 Ceiling Fan(cfm/Watt) 0.00 9901142 �ytt RIJ:WRrate-RerfdentiM Energi Analysis wind Rating Software V14.6.1 This information does not constitute any warranty of energy cost or savings.01985-2015 Noresco,Boulder,Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. Massachusetts-Department of,Public Safety Board of Building Regulations and Standards 1.V11�L1 Ult1Ul1 JLLII�l YlJU1 License: CS-076124 William H Lumbars ' 14 Bemis Circle _ 'r Tewksbury MA 6187 x_< .-wool" Expiration 02/18/2017 Commissioner