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16 OSBORNE HILL DR - BUILDING INSPECTION (2) 26"1 �/.� 13 - , 4 -�052 The Commonwealth of Massachusetts CA z Department of Public Safety F_ Massachusetts State Building Code(780 CMR) n Building Permit Application for any Building other than a One-or Two-Fartr Dv9,19 (This Section For Official Use Only) tll Dm Building Permit Number. Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block P and Lot#for locations for which a street address is not av ' e) No.and ireet City/Town Zip Code Name of Building(if kplica) SECTION 2•PROPOSED WORK Edition of MA State Code used If New Construction check here or check all that apply in the two rows below Lr Existing Building O Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 16 No 0 ON �t( Is an Independent Structural Engineering Peer Rev view r�{cored?,,`` (l 1 ` Ye ❑ No Brief Description of Proposed Work: C,nn�tfUC Nam) slr�al a 1 @mi�J �i�JP nq I SECTION 3:COMPLETE THIS SECTION IF.VaSTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION.4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) I 1A,* Total Area(sq.ft.)and Total Height(ft) s' SECTION S:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: HI Hazard H-1❑ H-2❑ H-3 H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ 1-4❑ M: Mercantile❑ R. Residential R-1 R-2❑ R-3❑ R4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION'6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ DIM ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to:780-CMR 111.0 for details on each item) Trench Permit Debris Removal: Water Sup�pl}� Flood Zone Information Sewage Disposal: A trench��{�'•(not he Licensed Disposal Site Public 4er Check if outside Flood Zone❑ Indicate municipal required B or trench or Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way. Hazards to Air Navigation MA Historic Commission Review Pro--- Not Applicable❑ Is Structure within airport approach area? Is their review comple d? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Ke5, Type of Construction XC5. Occupant Load per Floor: Does the building contain an Sprinkler System?: NO Special Stipulations: — SECTION 9: PROPERTY OWNER AUTHORIZATION Name nd Address Prope Owner `�T _� Box Vigo Un► Pi k CIA oafn Name(Print) No.and Street C' y/Town Zip Prope``y Owner Contact Information: , , RI D%5 SP Z813'��$'9.� 7 -$��0& 1 Pal n� Tide Telephone No.(business) Telephone No. (cell) e-mail addres If a I,c,a the Prope owner hereby authonZ� O MA- the �b I Name ° Poa-SSnn�lStreet Address ty/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 1o:CONSTRUCTION CONTROL(Please fill out Appendix 2) building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible le for ConstrmtHon Control T�I _l 1 S ., /ol- -9o'Iq O me(Re ' ant) #. Tele hone No mail a s Registration Number �. X 78o Street Address Ci own State Zip Discipline Expiration Date 10.2 General Contractor , Company Name B0I Ma& ,s _ COnS� on��rV So( �ame of Pe n Res onsible for Construction Lic ns No. and Type if Ap licable O X *- 780 '1h _ DIM0 Street Address ity/Town Stare Zip in�o i �e.homes, C(W Tele hone No.(business) Tele hone No. cell e-mail address SECTION 11:W ORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L:c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial AVe must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of ce of the building permit. Is a signed Affidavit submitted with this application? Ye ❑ SECTION 12.CONSTRUCIION COSTS AND PERMIT FEE. Item Estimated Costs:(Labor Total Construction Cost from item 6 =$ and Materials) ( ) 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ 3.Plumbing $ Note:Minimum fee=$ (contact municipality) 4.Mechanical (HVAC) $ 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTI N 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I here [test under the p ' and penalties of perjury that all of the information contained in this application is true and accurate bests y mow and understanding. ` Gl�i taSTP�— 75-�- - - 3 j Please print and signam O•FI•R.T. ` Ti __„ „Telephone No. Dace (�1 Street Address City, own State�te �(ZZ1 QC-.11 Zip Municipal Inspector to fill out this section upon application approval: Name Date CITY OF SALEM ROUTING SLIP New Construction Certificate of Occupancy LOCATION/ G✓' /li%�/`�/�i'ITE VZ ASSESSORS DATE__ 93 Washington St. R N}m CIYC" 1 �a` � t L '��;t�bu a� it ib '" '-^' r,.•twa*.ma ti. .x^!54,^'k°�i .>. rx 93"�VLashi.ngfld // PUBLIC SERVICES DATE 120 Washington St. q ATER 001, _DATE vvv 120 Washington St. Ross CONNECTION DATES `- 5 Jefferson Ave 1LANNING DATE 3 S 4 1200 Washington St. 60NSERVATION DAT l 120 Washington St. - S. w`'_ a,8,,� u�y Fea 3 ,1 a uurc .i'r 449 Lafawe t�St. 1 FIRE PREVENTIONL7 DATE 3 S ) 29 Fort Avenue BUILDING INSPECTOR DATE 120 Washington St. 3s- ��:llti0.� Professional Land Surveyors & Civil Engineers ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN:PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 . PLOT PLAN OF LAND LOCATED IN SALZFNI MASS. SZaa � - LET 35 LT36 L,734 t - 9� PRGOaS�r9 iy 74' 6;60(ZNL- RLL URiVL' I hereby certify to the SlZeAj ZONE: LOT AREA;/o�iC Building Inspector that the pro- LOT FRONTAGE: I�l-*( posed construction shown conforms FRONT YARD: ��/ SIDE YARD: 6 to the dimensional zoning of I REAR YARD: 3v�; S#ZEA4 Mass. SCALE: ll'�r Zl 2015 DATE: REFERENCE: r n17 L BK 4G7 PG 6G/ Chr topher R. Mello PLS r l°3i'�' / 104 LOWELL STREET Nu\ PEABODY, MASS. 01960 (978) 531-8121 FAX: (978) 531-5920 �'i� � i� i,Jl N o-"1 CITY OF SALEM ROUTING SLIP .NeirConstruction v I Certificate of Occupancy LOCATION V ASSESSORS DATE 3 S 93 Washington St. (/ PUBLIC SERVICES DATE 120 Washington St. WATER DATE vvv 120 Washington St. 1ROSS CONNECTION DATE 5 Jefferson Ave v ANNING DATE 120 Washington St. NSERVATION DATE 120 Washington St. / a . l/ FIRE PREVENTION(a : DATE_ 3 5 I 29 Fort Avenue p 4I1-DING INSPECTOR DATE 120 Washington St. . ,. . 77777 �/Z795 _ 35 Professional Land'Surveyors $ Civil Engineers ESSEX SURVEY SERVICE: 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN SOLE/ MASS. Zoo CUf 3� Ir5 �SY PRco'sL— ac LLLIAIt 3f{ _ fli 74' �zo�N 60v) VIL �fZir�L I hereby certify to the SjJLE�l Building Inspector that the pro- ZONE: LOT AREA:h'OVL LOT FRONTAGE: IrOJv posed construction shown conforms to the dimensional zoning of FRONT YARD: #ft SIDE YARD: I6F REAR YARD: 30 i S.fLLIP SCALE: l 40/ �JC��lp 0 AssgO DATE: � L( [, - tRISTOPHER /`(/ / yG N AMIn 3 pp REFERENCE: YL BK 4G-z PG ly Chri topher R. Me119 11 4 ?cLS�i3�32 J 104 LOWELL STREET PEABODY, MASS.01960 (978)531-8121 FAX: (978) 531-5920 I - Home Energy Rating Certificate RatingNiuber Certified Energy Rater Nicholas Abreu Derby Model Rating Date 2/24/14 Salem,MA Rating Ordered For Osborne Hills Realty Trust Estimated Annual Energy Cost �Y 6 5 Stan Plus Use MMBtu Cost Percent ' Projected Rating Heating 57.2 $470 25% HERS Index:70 Cooling 3.2 $153 8% Hot Water 21.6 $155 8% Projected Rating: Based on Plans - Field Confirmation Required. Lights/Appliances 25.1 $957 51% Generallnformation Photovultaics -0.0 $-0 -0% Conditioned Area 2092 sq.ft. House Type Single-family detached Service Charges $157 B% Conditioned Volume 17788 cubic ft. Foundation More than one type Total 107.2 $1893 100% Bedrooms 3 Criteria Mechanical Systems Features This home meets or exceeds the minimum cdteda for the following: Heating: Fuel-fired air distribution,Natural gas,95.0 AFUE. EPA ENERGY STAR Version 2 Home Cooling: Air conditioner,Electric, 13.0 SEER. Water Heating: Conventional,Natural gas,0.58 EF,74.0 Gal. Duct Leakage to Outside 100.00 CFM25. Ventilation System None Programmable Thermostat Heat=Yes;Cool=Yes Building Shell Features Ceiling Flat R-40.0 Slab None Sealed Attic NA Exposed Floor R-30.0 Vaulted Ceiling NA Window Type U-Value:0.300,SHGC:0.350 Nicholas Abreu Above Grade Walls R-21.0 Infiltration Rate Htg:5.00 Clg:5.00 ACH50 Conservation Services Group Foundation Wails R-0.0 Method Blower door test 50 Washington Street tights and Appliance Features Westborough,MA 01581 508-326-7506 Percent Interior Lighting 25.00 Range/Oven Fuel Natural gas Percent Garage Lighting 0.00 Clothes Dryer Fuel Natural gas Refrigerator(kWh/yr) 500.00 Clothes Dryer EF 3.01 Dishwasher Energy Factor 0.70 Ceiling Fan(cfm/Watt) 0.00 The Home Energy Rating Standard Disclosure for this home is available from the rating provider. REM/Rate-Residential Energy Analysis and Rating Software V14.4.1 This information does not constitute any warranty of energy cost or savings. 01985-2014 Architectural Energy Corporation,Boulder,Colorado. �"1 ® ,d►coan CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YYYY) 1z/2/2o13 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 INSURERS), 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: Susan Donnell Eastern Insurance Group LLC PHONE (508)651-7700 FAX SS 233 West Central Street 'MAZE :sdonnell@easteminsurance.com INSURE S AFFORDING COVERAGE NAICN Natick HA 01760 INSURERA-Acadia Insurance Company 1325 INSURED INSURER B: _ DIBIASE CORPORATION INSURERC: Osborne Hills Realty Trust INSURER D: _ P.O. BOX 780 INSURER E: LYNNFIELD HA 01940 1 INSURER F: COVERAGES CERTIFICATENUMBERC3.1312224290 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. INSR ADDLSUBR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (M1WDDrYYYYI IMMIDD1yVVy) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY OA PREMISES Ea occurrence) E 250,000 A CLAIMS-MADE OCCUR 0191229-17 /23/2013 /23/2014 MED EXP(Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATELIMI_CTT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident AUTOS AUTOS ( ) $ HIREDAUTOS NON-OWNED PR OPERTYDAMAGE $ AUTOS Peraccidenl $ UMBRELLA DAO OCCUR EACH OCCURRENCE $ EXCESS DAB CLAIMS-MADE AGGREGATE $ DELI I I RETENTIONS IS A WORKERS COMPENSATION X WC STA IT- Fp- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100 000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory,In NH) 0286788-14 /23/2013 /23/2014 E.L.DISEASE-EA EMPLOYE $ 100 000 If yes,descrithe under DESCRIPTION OF OPERATIONS b I. E.L.DISEASE-POLICY LIMIT E 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101.AddlUonal Remarb Schedule,If more space Is re ndred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Salem ACCORDANCE WITH THE POLICY PROVISIONS. Salem, MA 01970 AUTHORIZED REPRESENTATIVE Susan Donnell/PRG ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r?MIVSI n1 Th.at npn...and Inn.ace m.iafarod mark..f anAlon r Additional Named Insureds 'Other Named Insureds DUC RESIDENTIAL LLC Insured Multiple Names OSBOURNE HILLS REALTY TRUST Insured Multiple Names OFAPPINF(0212007) COPYRIGHT 2007,AMS SERVICES INC C�rmoliwealth of Massachusetts = City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Permit No. B-14-672 FEE PAID: $1,755.00 PERMIT TO BUILL.J DATE ISSUED: 3/10/2014 This certifies that OSBORNE HILLS REALTY TRUST PAUL DIBIASE TR has permission to erect, alter, or demolish a building 16 OSBORNE HILL DRIVE Map/Lot: 90340-0 t " .._ as follows: New Construction - 1-2 Family CONSTRUCT NEW SINGLE FAMILY DWELLING DERBY MODEL PERMIT #652 14 t Contractor Name: PAUL A DIBIASE - tn, s3 DBA: PAUL A DIBIASE _ 3/10/2014 F` Contractor License No: CS27147 x BuildingOff fcial r Date This permit shall be deemed abandoned and Invalid unless the work authorized by this permit is commenced within six months after issuance. The Building Official may grant one or more extensions not to exceed six months each upon written request. All work authorized by this permit shall conform to the approved application andthe approved construction documents for which this permit has been granted. J. +'' ° Ms ar I ` ,, f j z xn r ryp rhC#f a xt *, All construction, alterations and changes of use of any building and structures shall be incompliance with the local zoning by-laws and codes. fu air T& -' ,i �'r, '- This permit shall be displayed in a location clearly visible from access street or road and shall be',maintained..open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all..applicable signatures by the Building and Fire Officials are provided on this permit. s ' Address numbers must be on the house/building at the time of inspections as required by M.G.L. Chapter,148,Section 59. If the address numbers are not present, inspections will not be done.and there will be a re-inspection fee of$25A0. a:. . HIC #: Persons conon tracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). si yF •i sg �p. Plan Review Comments: Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER.