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18 OSBORNE HILL DR - BUILDING INSPECTION (3) The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number. Date Applied: Building Official: SECTION 1:LOCATION Please indic e B ock#and.Lot#for locations for which a street address is not available) , irLt5w 6/vv No.and Street City/Town Zip Code Name of Building(if applicable) 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 Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑/Ou F�1 Is an Independent Structural Engineering Peer Review reqvired?1 [ Ye ❑ No 41 Brief Description of Proposed Work: rtstfU 1— Aeit) Sinn- f mdj DW ��It1Q. SECTION 3:COMPLETE THIS SECTION IF.EMSTING 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 Gr rup(s): SECTION 4.BUILDING HEIGHT AND.AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft) �7N SECTION 5:USE GROUP(Check as applicable) A. Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F. Facto F-1❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 H-4❑ H-5❑ 1: Institutional 1-1❑ I-2❑ I-3❑ Ill❑ M: Mercantile❑ R: Residential R-1 R-2❑ R-3❑ Rll❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: - SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA TB ❑ IIA ❑ 111111 IIIA ❑ M r TV ❑ 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 Inp7do Sewage Disposal• Licensed Disposal Site Public 4� Check if outside Indicate municipal A trench not be Prequired or trench or Private❑ or indentify Zonor on site system❑ permit is enclosed❑ Railroad right-of-way: rds to Air Navigation: MA Historic Commission Review ProcessNot Applicable❑ within airport approach area? Is their review comple d? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No V SECTION&CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:.._Use Group(s): Type of Construction: - Occupant Load per Floor: Does the building contain an Sprinkler System?: bLC Special Stipulations: /' I SECTION 9: PROPERTY OWNER AUTHORIZATION Name nd Address Trope Owner0 To # M MA oL ffn- Name(Print) No.and Street C' /Town j Zip Proper Owner Contact Information: p��J , xi�usp Z81-2m=M9� gt--(J'TI- ` 21a 1 @ QmPS C I� Title Telephone No.(business) Telephone No. (cell) e-mail addres If ap licable,the proper owner hereby authorizes Po X 780 offl Nam Street Address ty/Town State Zip to act on the pro;"owner's behalf,in all matters relative to work authorized by this building permit a plication. SECTION 10: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 0 andskiR Section 10.1 10.1 Registered Professional Responsible for �Construction Control +ma',l a r ss Registration Number Street Address JO Ci own State Zip Discipline Expiration Date 10.2 General Contractor Company Name n B012� 1 �lrl l S N an��N Sod ame of Per n Res onsible for Construction Lic ns No. and Type if Ap licable Os�xp# 780 � Street Address fty/Town State Zip Telephone No.(business) Telephone No. cell e-mail address SECTION IL•WORKERS'COMPENSATION INSURANCE AFFIDAVIT VLG.L c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents most be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the is ante of the building permit. Is a signed Affidavit submitted with this application? Yes No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(labor C f It 6 Total Construction Cost(from Item =$ and Materials) ( ) 1. Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ ,s led appropriate municipal factor)=$ 3.Plumbing $ O Note:Minimum fee=$ (contact municipality) 4.Mechanical (HVAC) $ '®0 5.Mechanical Other $ n�-75 Enclose check payable to 6.Total Cost $ pt,�u,. "� (contact municipality)and write check number here SECTION 11 SIGNATURE OF BUILDING PERMIT APPLICANT Lapphcation tering my name below,I her ttest under the and penalties of perjury that all of the information contained in this is true and accurate best my o e and understanding. TrtIs{2 78_L 1 39— Please print and sigst �Q^ �•H•R O.H.R.T. 1 Ti h _r_„ „Telephone No. Date Street Address CJI, Ciy' own 1SStattee (�~YZ.Iipp L+1 (`1' Municipal Inspector to fill out this section upon application approval: game Date ``.1 H® CERTIFICATE OF LIABILITY INSURANCE D2/2/2DD/YYYY) `� 12/2/2013 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 SnH NAME: an Donnell _ Eastern Insurance Group LLC PONE . (508)651-7700 FA% 233 West Central Street 'AIL .sdoanell@easterninsurance.com INSURE S AFFORDING COVERAGE NAICN Natick MA 01760 INSURERAAcadia Insurance Company 1325 INSURED INSURER B: DIBIASE CORPORATION INSURER C _ Osborne Hills Realty Trust INSURER D: P.O. BOX 780 INSURER E: .LYNNFIELD MA 01940 1 INSURER F: COVERAGES CERTIFICATE NUMBERCL1312224290 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 ADDL BUSH POUCYEFF POUCYEXP LTR TYPE OF INSURANCE POLICY NUMBER MMID D UNITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -X -COMMERCIALGENERALLIABIUTY DAMAGE I E ERERTE15 $ 250,000 A CLAIMS-MADEFZ OCCUR 0191229-17 /23/2013 /23/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO-FQT LOC - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Pet Person) $ ALL OWNED SCHEDULED P INJURY Jer acciderd AUTOS AUTOS BODILY IN ( ) $ HIRED AUTOS NON-O MED PROPERTY DA AGE $ AUTOS Per amident $ UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION s A. WOREMPLOOMPENI TION X TRY LIMWC STATIU OTH- Y/N ANY PROPRIETORIPARTNERrEXECUTIVE E.L.EACH ACCIDENT $ 100 000 RA OFFICEREMBER EXCLUDED? NIA (Mandatory In NHl CA028678e-14 /23/2013 /23/2014 E.1-DISEASE-EA EMPLOYE E 100 000 If yes,descdbe undar DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500 000 -.DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 10l,AddlUanal Remarks SclleduK N Tram span Is requin d) 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/PKG ACORD 25(201 0/05) ©f 988-20f 0 ACORD CORPORATION. All rights reserved. INSn25r9nnw ni Th.&rnpn namo and Inn.aro raniafaead mae4a.F Arnan ) 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 b Professional Land Surveyors 8• Civil Engineers ESSEX SURVEY SERVICE. 1958'- 1986 OSBORN PALMER 1911 1970 BRADFORD 8 WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN SALc M mAss. E`20G LET 36 `410 v q� P��o�sec 94,&U1X M 3r� ZS f5 4'- SZ,ao GSoilr DILL �iV� I here certify to th b}' y e Si9L�,h Building Inspector that the pro- ZONE: �( LOT AREA: 161V-L— LOT FRONTAGE: &IkE posed construction shown conforms to the dimensional zoning of FRONT YARD: ISf� SIDE YARD: bf-t-_ REAR YARD: 5,Oa Mass. � SCALE: �/' QU ��i�^ of rfgssti DATE: /VoV- Zl 2&�3 - - ,�, 4ISTOPRER G :- R nn REFERENCE: YL BK 46Z PG7� Cfflstopher R. 1g10. 731 l7e - 104 LOWELL STREET FGisTEF PEABODY, MASS.01960 - (978).531-8121 - - FAX:(978) 531-5920 P5- 033 i CITY OF SALEM ROUTING SLIP New Construction V Certificate of Occupancy— LOCATION , ` l4'"1/%/4/� ATE ASSESSORS . 9 DATE 93 Washington St. a cgs ,t ' A � DATE ' 93 Washington St. . PUBLIC SERVICES DATE } fl 120 Washington St. �V.ATER_ DATEu 120 Washingt St. vC°ROSS CONNECTION _DATE ��5 Jefferson Ave 1/I'LANNING DATE �120 Washington St. L CONSERVATION TE 120 Washington St. tS-Lal yette St. FIRE PREVENTIOi DATE 29 Fort Avenue S ia ; . '�,.'�+„r„ ,, , .s: � .•—; DATE` I20 Washington—St. VlLU1LDING INSPECTOR DATE 120 Washington St. Professional Land Surveyors B Civil Engineers ESSEX SURVEY SERVICE. 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN S/7LG M MASS. SU/CL- 6 LET 36 _ L6! 3! 91) SZoo 656DUE DILL 012IV I hereby certify to the SifZ t-h Building Inspector that the pro- ZONE: �( LOT AREA: hbAr LOT FRONTAGE: MA E posed construction shown conforms to the dimensional zoning of FRONT YARD: 15f--f- SIDE YARD: &)rt- REAR YARD: '5Gr7- 57.4LE11 Mass. SCALE: / �lJ' erra DATE: Ivor Zl �C' * -HRISTOPHER R. isto Me - 3 1�131, REFERENCE: p� BK �U Z PG,�� her R. I o l-stop her IsTE� ✓' a+ PEABODY, MASS.01960 m` (978).531-8121 - FAX: (978) 531-5920 C/i`z /// /, S CITY OF SALEiVI ROUTING SLIP Nev' Construction Certificate of Occupancv�_ LOCATION 1SSESSORS 93 Washington St. DATE 93 �1�ftEffK. 1VashmgtoA- St. DATE PUBLIC SERVICES 120 Washington St. -R�DATE_ B 1//�VATER- D 1� 1201Vashingt St., DATE VCROSS CONNECTION S Jefferson Ave DATE t lt'LANNING i—Vv� �C'120 Washington St. t/ ONSERVATIONC 120 Washington St. DATE Ef EF-FR-tCjTL 48 Lafayette St. DATE FIRE PREVENTION 29Fort :lvenue I).VFE 1201V1shingtoit St. DATE ------------ xl3LILDiNC INSPF.C'TOR 120 Washington St. -----D`1TE E: L. Professional Land Surveyors £r Civil Engineers - 1986 ESSEX SURVEY SERVICE. 1958 1911 - 1986 OSBORN PALMER 70 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN Sqc� r� MASS- 6 1GT 36 19 41) (�Il„UoS�U ♦ N�zoo 5 GS ol1,u I4ILL 012 V,6 I hereby certify to the Si9ZE h Building Inspector that the pro- ZONE: �( LOT AREA: &NL LOT FRONTAGE: XlAlC posed construction shown conforms to the dimensional zoning of FRONT YARD: SIDE YARD: ld f r REAR YARD: �D SALE�I Mass. , SCALE: j DATE: NOv, 200 3 REFERENCE: iI9L BK 40 Z PG 77 Ct istopher R. Me110 PLS 3131r7 104 LOWELL STREET PEABODY, MASS. 01960 (978) 531-8121 �A, m7a1 R91-5920 ID Home Energy Rating Certificate - Registry Rating Number Certified Energy Rater Nicholas Abreu Hawthorne Model Rating Date 2/24/14 Salem, MA Rating Ordered For Estimated Annual Energy Cost Use MMBtu Cost Percent 5 Stars Plus Heating 71.6 $588 26% Projected Rating HERS Index: 70 Cooling 3.2 $155 7% Hot Water 23.2 $166 7% - Projected bating. Based on Pecans, Field Confirmation Required. Lights/Appliances 27.7 $1197 53% .. ; General Information t� r` - Pnocovolca;cs o.D $-o o% F -Conditioned Area 2498 sq. ft. House Type Single-family detached Service Charges $157 7% Conditioned Volume 21726 cubic ft. Foundation Unconditioned basement Total 125.7 $2262 100% n Criteria _ x' t,� ""� '.. Bedrooms 4 a ` 'w E3c u s. ' ' WTI This home meets or exceeds the minimum criteria for the following: Mechanical Systems Features,..�...» ._ EPA ENERGY STAR Version 2 Home Heating: Fuel-fired air distribution, Natural gas, 95..0 AFUE Cooling: Air conditioner, Electric, 13.0 SEER. Water Heating: Conventional, Natural gas, 0.62 EF, 40.0 Gal. Duct Leakage to Outside 120.00 CFM25. Ventilation System None Programmable Thermostat Heat=Yes; Cool=Yes �Bui{ding Shell Features E €i4 u Ceiling Flat R-40.7 Slab None Sealed Attic NA Exposed Floor R-30.0H��:.„„ Vaulted Ceiling R-32.5 Window Type U-Value: 0.300, SHGC: 0.300 Nicholas Abreu Above Grade Walls R-21.0 Infiltration Rate Htg: 4.50 Clg: 4.50 ACH50 Conservation Services Group Foundation Walls R-0.0 Method Blower door test 50 Washington Street T • +: ` fm ._ Westborough, MA 01581 Lights and Appliance Features �.»e ...,.m.,n ...,_. 508-326-7506 Percent Interior Lighting 50.00 Range/Oven Fuel Natural gas Percent Garage Lighting 0.00 Clothes Dryer Fuel Electric Refrigerator (kWh/yr) 691.00 Clothes Dryer EF 3.01 Dishwasher Energy Factor 0.46 Ceiling Fan (cfm/Watt) 0.00 The Home Energy Rating Standard Disclosure for this home is available from the rating provider. REt,A!Rake -Resfdcmmdat Energy Ana#ysls and Ratin;Software-e;4.4,g . This information does not constitute any warranty of energy cost or savings. © 1985-2014 Architectural Energy Corporation, Boulder, Colorado.