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HomeMy WebLinkAboutBuilding Permit # 11/4/2015 i BUILDING PERMIT OF %AORTH TOWN OF NORTH ANDOVER 0`� APPLICATION FOR PLAN EXAMINATION A Permit IVo#: `-",2 016 Date Received � R °Teo Date Issued: L./ / ��SSgCHU5E��5 IMPO TANT: Applicant must complete all items on this page y i tri f 00 /ea r c u re es TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ew Building 46ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other x�r ��Se tierce ❑�Well���� �r k >� fr����r�� � Flood .lain�:, �rWetl`a ds;�� �, _,� � ❑�,�U1! fe:s �� �y �,� � ����,���., � �/� �, , ,� � ��r.ry �u . � �� ��,. ��� r {r � �r :� a r hedyDistnct✓r r�� � p�WaterhSewer .� �{� �,�rr�` ��, � �� .,r�T r�t�' � �,� ;�✓;��cr,� ,� ���Y��� �� � � r�yr,�rr" ,� �„ O=ORK OBE-PERFORMED: ' (--� ,a �krjDdE.SCMPT� Identification- Please Type or Print Clearly OWNER: Name: �y�r�� ¢;(� `� Phone:4 75 1479 Address: ;„.:r F�"`•,rit r.�r,.�r;>r,r M�f�r„ ;.ra r.-,.;rt✓ ,. /f r.r4 r s r S / ;j r .: k„u ;ter,:,x,, � .,,,.. c Y r r'' �.Y, :,� m,,;tr,JJr„?,�� �,,rr*5,re J ..: �''x�.rtwi yrr ✓ t' ..� z. :�r�. s„ .. ,,.vr ..,�, 1 rr .. ,,�'� ,f, � f � ,�<!�/r :;,,. - � 1" ✓//' L .„�u"�''bz's',¢�/*}� y�jr{�5-.:Y f�.k�7/. '� ✓ r -'� t`f r..l f s r �I r f� �r 'f {t.i � '�$/`w``y'j, � r f r r r ',ii sd"',.v,�',;S-�.eL'�,'.'�,v.:, ''"��m-.r.,,.r�,f ^f�x F,;r s{r {7r',✓r'rar'rrri'.' t rr ,. „�,f:. r ..,:1 /ter {',:% tet"�rr •c,fi r y fi l�" r � '� sr�,..s,,f,rk�ir r f ✓ rix,r f/ �Fer f Y r r rtn ,� r 1 m ✓t-";.� ,� rrrr�".r S �Contracto� amen ,, ,���;r�✓4,� C� �� r Phone� � � ��rr¢r �� ,��������;��� �/t r� � r ar,r ',,r" Ns'y f' y�r,.-"✓7" 5,. s..r fir✓r kr..{✓e r ,:4r l:� .r�.ry f,.. :t r',t+f.,x r;:r, ,�.;,:,r ✓w'""f;,,,r,�7v ,Ij. _ r xwi`*u,'-r�rrf !4l 1r rpr z' flr rh l' ,f+A ,`�c f�rr rr" :ut11."✓xP§{`'l::f yz" rJs�,l 'r _.f .,t r'�E171a�1 ..����I�.r/ »n,�r�S�Yr".�'�r^� ,�i.���!',.: �/r,rit.,ti✓'F?ffl'?,2 ,x���:,��Ix< r.�r�,....Mti�,,.td.� t2z;�`r,.m�,..,-. .�,r,�` r�.;��a;,.: �i c%�.,:-; e&Y�,h',arh��r".,'rI"„�,. r �Add.reS$,'t >{t” r s; �f✓ moria``r�`��.�'�er���` lt �f ����"i%� ��"r�c�t�sez'"�r���z�m� z ��`,� f , � `��`` /% ✓' ,�:r r.c� r 5r ?�'--l� r s {r�f y '`f l ,r,�' ., �`S�' r,,.,J ����; 1tP'r'/ �`J�fp' „ .� r - ,y �� ,,:I � r s r Ff k r $. rrr c;' ': "�`� ,�'" � r.-� �„ ^�"rte �-"� / E �i." �i vr�r .z �5 t- rr✓� w .�� .. � '.: � � tri�� ��`s 1',cr`r� ���>''c.r."1`✓r r ...d �� ��"zn; - :r��."'� ��r�` .f` u%�,:,"r2.wir' lr r l' {,orf;.i r jw„I,;.✓ ., > �r-,,., : . � a 1✓.I.,t i; ARCHITECT/ENGINEER Phone: 8 .7, 5 ;2 Address: Reg, No. a ?-76Y FEE SCHEDULE:BULDING PESMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. *®f w Total Project Cost: $ FEE: $�� ` ®� �`� (�.z, C-0 ------------- Check No.: "`® Receipt No.: 5`6 NOTE: Persons c ntracting pit ti unregistered contractors do not have access to the guaranty fund �T !Signature,of Agen caner<" f �Signafiure of contactor;° t%ORTH ndo' ver town of AAA. 2 �c _E. ...•.q, No. ® _ C% h Ver' SSS' a �. O LAKE �• r COCNtC NI WICN �®A04ATEo PC 1S U BOARD OF HEALTH Food/Kitchen PtR1W11T TW LD Septic System THIS CERTIFIES THAT .........l. C?r^.. 1'.. U ....... . t� 60 :................................ BUILDING INSPECTOR .. ........ ............. ........... _ has permission to erect .......................... buildings on ..... Foundation .,�....................... to be occupied as ................ fi ....... Rough ........................... Chimney provided that the person accepting this permit shall in every respe&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 MONTHS PERMIT XI I 6 MONTHS ELECTRICAL INSPECTOR LES T TI TARTS Rough Service ......... ...... ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building 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. Smoke Det. Registry ID Home Energy Rating Certificate Rating Number EH0604 NAND MollyTowneRd L-15 Certified Energy Rater Ian Rex Lot-15 Molly Towne Rd Rating Date 6/13/2015 North Andover, MA 01845 Rating Ordered For lie Efi Estimated Annual Energy Cost 5 Stars Plus Use MMBtu Cost Percent Projected Rating Heating 125.9 $2470 48% HERS Index' 51 Coaling 3.5 $182 4% Hot Water 21.1 $393 8% Projected 1 lsdeans - Field ConfirmationRequired. Lights/Appliances 38.9 $1927 37% General Information Photovoltaics -0.0 $-0 -0% Conditioned Area 5752 sq. ft. House Type Single-family detached Service Charges $190 4% Conditioned Volume 50899 cubic ft. Foundation More than one type Total 189.3 $5163 100% Bedrooms 5 Criteria Mechanical Systems Features This home meets or exceeds the minimum criteria for the following: Heating: Fuel-fired air distribution, Natural gas, 92.0 AFUE. 2009 International Energy Conservation Cade Heating: Fuel-fired air distribution, Natural gas, 92.0 AFUE. Cooling: Air conditioner, Electric, 13.0 SEER. Duct Leakage to Outside 190.00 CFM25. Ventilation System Exhaust Only: 103 cfm, 12.0 watts. Programmable Thermostat Heat=Yes; Cool=Yes Building Shell Features Ceiling Flat R-43.7 Stab R-0.0 Edge, R-0.0 Under Sealed Attic NA Exposed Floor R-30.0 Vaulted Ceiling R-36.0 Window Type U-Value: 0.300, SHGC: 0.300 Ian Rex, RTIN: 1454792 Above Grade Walls R-21.0 Infiltration Rate Htg: 3.50 Ctg: 3.50 ACH50 The Energy Hound Foundation Watts R-18.0 Method Blower door test 11 Broadway Suite 3 Lights and Appliance Features beverly, MA 01915 978-233-1433 Percent Interior Lighting 94.00 Range/Oven Fuel Natural gas Percent Exterior Lighting 8.00 Clothes Dryer Fuel Electric Refrigerator(kWh/yr) 590.00 Clothes Dryer EF 3.01 3 Dishwasher Energy Factor 0.00 Ceiling Fan (cfm/Watt) 0.00 Certified Energy Rater: Ian Rex- RENVRate- Reside tiae Energy Analysis and Rating Software v1 .5, - This information does not constitute any warranty of energy cost or savings. ©1985-2014 Architectural Energy Corporation, Boulder, Colorado. The Home Energy Rating Standard Disclosure for this home is available from the rating provider. cfp 15A.pdf 1 / 1 X i I I i • EASEMENT LOT1 5A f / EXISTING I WETLANDS FOUNDATION ELEV,=207.0' , } k } � MOLLY TOWNE RD ZONING DISTRICT R-2 MIN. AREA 21,780 S.F. MIN. LOT WIDTH = 100' MIN. FRONTAGE = 100' MIN. FRONT SETBACK = 20' MIN. SIDE SETBACK* = 20' MIN. REAR SETBACK a 20' THE STRUCTURE MAY BE PLACED UPON A SIDE LOT UNE WITHOUT A SIDE SETBACK, PROVIDED THAT THE ADJACENT LOT TO WHICH THE ZERO SETBACK IS LOCATED HAS THE REQUIRED SIDE YARD SETBACK.) FOUNDATION LOCATION PLAN THE HOR ONITFIAAL SETiffMCK PRIMARY EN1S OFF THE CLOCALLRxs ro APPLICABLE ZONINO BY-LAWS IN EFFECT WNEN CONSTRUCTED. DOES NOT CONSIDER ANY GIN& RICnoH5 SUGW AS COWNANTS,WETLINAS,FASEMENM OROERS or COmwNs,Erc.) CLIENT. NORTH ANDOVER REALTY rws DRAwva SHALL Nor B£usED BY THE CL£Nr FOR ANY PURPOSE OTHER"UN THAT 0Un1N£D ABOVC,CXCEPr WITH THE THIS CERTIFICATION IS MADE AND LIMITED WRITTEN PERMISSION OF CHRISTIANSEN t SEROL NTC. FURTHERMORE THIS DRAWWG IS VIE COPYRIONTED PROPERTY TO THE ABOVE CLIENT. Or CHRISTUNSEN d SERGI INC.AND ANY UNAUnTORIZED USE IS PRON1817E0.CNRLST14 TAKES NO R£ST'ONS1810TY FOR THE UNAUn{OR *1140 OR ANY 1NFOR- LOCATION: MOLLY TOWN RD, NORTH MATXIN coHrATNED U T orf ANDOVER, MA. o MICHAEL SCALE: I" = 60' DATE: 10/19/15 c , y CHRISTIANSEN SERGI 91 PROFESSIONAL ENGINEERS A �J� LAND SURVEYORS 160 SUMMER ST. HAV£RilR4MA, 01830 TEL. 878-373-0.370 i NO, 97066010 Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DIYYYYY) 10/7/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: M.P. Roberts Insurance Agency PHONE (978) 683-8073 A/XNo: (978) 683-3147 1060 Osgood Street ADDRESS: sandi@mprobertsinsurance.com North Andover, MA 01845 PRODUCER 2440 INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A:ASSOCIATED EMPLOYERS INS CO '.. NORTH ANDOVER REALTY CORP INSURER B: 12 MARTINGALE LANE INSURER C: ANDOVER, MA 01810 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IEXP LTR TYPE OF INSURANCE ADL SUBR POLICY NUMBER MM/D Y/YEFF POLICY M DDYYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ CLAIMS-MADE E1 OCCUR MED EXP(Anyone person) $ PERSONAL&ADVINJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMITAPP LIES PER PRODUCTS-COMP/OP AGG $ POLICY PRO-JECTLOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANYAUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) N ON-0 W NE D AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DEDUCTIB LE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTNE Y/N WCC-500-5010734-201 3/13/15 3/13/16 E.L.EACH ACCIDENT $ 500,000 OFFICERMIEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rem-irks Schedule,if more space is regui red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPRES TIE r ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndlustrialAccidents r 1 Congress Sheet,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERN11TT01G AUTHORITY. Applicant Information ( Please Print Le ibl Name (Business/Organization/Individual): Address: R M(Ar t t u o C� City/State/Zip: n�' JLv'*\ 0` ��> Phone#: C� 1 �� ���) i, 776 U` Are ou an employer?Check the appropriate box: Type f project(required): 1.WI am.a. . employer with : employees(full and/or part time).* 7. FA New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.F1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑ ❑ 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5. I am a general contractor and I hhired rethe sub-contractlid the ors listed on e aacesheet. ❑ 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.F]We are a corporation and its of�cers have exercised their right of exemption per MGL c. 14.F1 Other 152,§1(4),and we have na.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit#his affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-coniraclors have employees,'they must provide their workeis'comp.policy number. I am an employer that ispi ovidiiig ivorkets'compensation insurance for my employees.'Below is the policy anal joh site information. f Lnsurance Company Name: Policy#or Self-ins.Lie.#: Wcc, '5l1Q•, SV P L 7 Expiration Date: 311 VIC Job Site Address: 90 MCI(y' I UW Vl� � City/State/Zip: _M 1"(4o% u/, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here ;••tify and r thepains and penalties ofpef jury that the it formation provided/above is true and correct. Si na (, � Date: Phone Official use only. Do not write in this area,to he completed by city or tolvn official.. 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#: Irc of Budding Regulabons and Stand2rds L.ae ae. CS-063503 w EMS - 3 21.JOHNSON CI \ ;FORTH ANDOViR Y,. _�. €37119/2017