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25 OSBORNE HILL DR - BUILDING INSPECTION (2)
i 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 .J ('This Section For Official Use Only) i Building Permit Number: Date Applied: Building Official: SECTION 1 LOCATION(Please indic e B ck.#and Lo #for locations for which a street address is not available) �b �r�C o 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❑ Alteration ❑ 1 Addition❑ 1 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 No ❑/Ou Is an Independent Structural Engineering Peer Revt'1ew re_qL,�_ired?,,11 (l [ f Ye ❑ No g Brief Description of Proposed Work:�I, asicud N �) SII'1Ij 1 ft11 I� SECTION 3:COMPLETE THIS SECTION IF.E)USTING.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): I Proposed Use Group(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) SECTION 5.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: High Hazard H-1❑ H-2❑ H-3 H-4❑ H-5❑ I: Institutional 1-1 ❑ 1-2 1 R: Residential R-1 R-2❑ R-3❑ R-4❑ 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 ❑ ITB ❑ MA IITB ❑ IV ❑ VA ❑ VB ❑ SECTION 7.SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit. Debris Removal: Water Suppl Flood Zone Information: Sewage Disposal: Licensed Disposal Sire Public 7 Check if outside Flood Zone❑ Indicate municipal e trench not be Po A or trench or Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA t-listoric Commission Review Process: 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): Re5, Type of Construction: - Occupant Load per Floor: Does the building contain an Sprinkler System?: Nd Special Stipulations: SECTION% PROPERTY OWNER AUTHORIZATION Name nd Address Prope Owner #. IA O-1--t- n 9ne _ ►11t� T -Pc� x 98o Lin Name(Print) No.and Street C /Town Zip Proper Owner Contact Information: , Title Telephone No.(business) Telephone No. (cell) ,,,, Ae-mail add(r�esu If ap licable,the properi owner hereby authoOnzes O 1 Y 1/3. I`1 l b Name PP�ddress ty/Town 1 1S Itarte Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. 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 O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control- me(Re ant) Tele hone No mail a s Registration Number Street Address Ci own State Zip Discipline Expiration Date 10.2 General Contractor Company Name B I)I 08(a.se- CS -2aIL!Q Con4 Qr)30t�il Sod ,Name of Pe n Responsible 760 onsible for Construction Lic No. and Type if Applicable 0. nox ' 'apt C19y_4 Street Address 'ty/Town State Zip -334A 781 -344- o2 InAo (�, 8 i1 S{' 6MeS, cam Tele hone No.(business) Telephone No. cell e-mail address SECTION 11--WORKERS'COMPENSATION INSURANCE AFFIDAVIT- M.G.L.c.152J 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial AccidprAmost be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the uance of the building permit. is a signed Affidavit submitted with this applicatio Yes No ❑ SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor 6 It (from Total Construction Cost( om Item -$ 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 (HV AC) $ 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ Q�Q/ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I her a t under the d penalties of perjury that all of the information contained hr this application is true and accurate. a st my� w and understanding. Q M Please print and si ame 1E Q.ii•R T Ti Telephone No. Date TO �X 7� �► l� DA � Street Address Ci own ��,,�, State Zip Municipal Inspector to fill out this section upon application approval: Name Date CERTIFICATE OF LIABILITY INSURANCE 12i2i2o ) 13 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 Ileu of such endorsement(s). PRODUCER CONTACT SIIean Donnell NAME: _ Eastern Insurance Group LLC Px.NE (508)651-7700 FAX o: 233 West Central Street MAIL .sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC N Natick MA 01760 INSURERAAcadia Insurance Company 1325 INSURED INSURER B DIHIASE CORPORATION INSURERC: _ Osborne Hills Realty Trust INSURER D: P.O. BOX 780 INSURER E: LYNNFIELD MA 01940 INSURERF: 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. LSRR TYPE OF INSURANCE POLICY EFF POLICY EX im POLICY NUMBER MM1D M LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL UABILITY DAMAGE TO RENTED 250,DOD PREMISES Ea occenence $ 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 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO- LOC $ AUTOMOBILELINMUTY C BINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA IJAB OCCUR EACH OCCURRENCE $ EXCESS LU18 CLAIMS-MADE AGGREGATE $ DED RETENTION$ 1 1$ A WORKERS COMPENSATION X WC STATU- GTH- ANDEMPLOYERS'LMBILITY YIN "MT ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,00 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) 0286788-14 /23/2013 /23/2014 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,d85ai0e under DESCRIPTION OF OPERATIONS low E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddMonal Remadrs Schedulb If more spew Is mqulred) '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/PXG ACORD 25(2010f05) 01988.2010 ACORD CORPORATION. All rights reserved. INS0251?n1rn51 nt The Arnpn ne.end Inn.ew naniefe.ad medra.f anion jl Additional Named Insureds Other Named Insureds DUC RESIDENTIAL LLC Insured Multiple Names OSBOURNE HILLS REALTY TRUST Insured Multiple Names OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC • F!2 295 -I� Pr6' sional„Land Surveyors @Civil Engineers ESSEX SURVEY;SERVICE " 1.958 - 1986. OSBO,RN ,ALMER 1911'-'1970 BRADFORD 8 WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN MASS. (54b QZZ X Lo7 13 3 [cT- L� `30 0 alot G2.aa OSga�2�v , ice .00 v I hereby certify to the 5/ 1 ZONE: /5 LOT AREA:�{7/i1y LOT. FRONTAGE: IrUJZ Buildingeco Inspector show the pro- ZONE: posed construction shown conforms FRONT YARD: 15fr SIDE YARD: Id A- REAR YARD: r to the .cl mensionbb zoning of S�LEM Mara. f7 „er>�anR SCALE:/ 4D/ ��11 C'r ".y,1� M DATE: NOV 27 2013 ' RHE 5V " REFERENCE;: BK, 90Z, PG 79 Chr , opher` . Mej gi 1 7 104 LOWELL STREET s: PEABODY, MASS.01960 r c;- (978)531-8121 FGX• 107A1 FAi-FWn, o Zs0� �l�a �� CITY OF SALEM ROUTING SLIP Net, Construction C/ Certificate of Oc u .�1 LOCATIONt n� VSSESSORS 93 Washington St. DATE GKUBLIC SERVICES 12200 Washington St. DATE b L ! iv1_t 'ER 120. Washington SL DATE 41CROSS CONNECTION 5 Jefferson Ave DATE PLANNING _ 120 Washington St. DATE Ze-ONSERVATION� 120 Washington St. —DATE 1 .6 L1sECTR►r:nr Y �;. `I8 .t' Laf 'e ttP St. _' 3'rTVi' x} s.n �� G/FIRE PREVENTION 29 Fort Avenue DATE / 36 ashington St. • .M��:� _ . cR:�E>,,;r�l,.,, , �7,,;`>« � Tµ,,;.�, �CILDING INSPECTOR 120 Washingto❑ St. U,1TE t f ri e fld ��l Professional Land,Suiveyors 6 Civil Engineers ESSEX SURVEY SERVICE 1958 - 1986911 -'1970 OSB 1 ORN PALMER 1911 - 1972 BRADFORD & WEED PLOT PLAN OF LAM LOCATED IN S/1L�ht MASS. 62. l�rf! 07 13 su. w DGEZCrAG' 17� I hereby certify to the Building Inspector that. the: pro- ZONE: IS LOT AREA:#Ohl/ LOT FRONTAGE: MUN� PastheCO nsional zoningcof orms r /Qff REAR YARD: Mass. FRONT YARD: �,j/�r SIDE YARD: SCALE:/ '' 40 ' u' DATE: NOV Z7 ZO13 Chr- opher R. Plel o PLSIAI39, REFERENCE: F'L BK 4 , PG 71 u3: 104 LOWELL STREET PEABODY, MASS. 01960 (978) 531.8121^^ Home Energy Rating Certificate Rating Number Certified Energy Rater Nicholas Abreu Essex Model Rating Date 2/24/14 Salem, MA E\ Rating Ordered For Osborne Hills Realty Trust �" '`�1 '° �.,�... :;.� a 4 , Estimated Annual°Energy£ostx Use MMBtu Cost Percent 5 Stars Plus Heating 47.6 $398 20% Projected Rating HERS Index: 70 Cooling 3.8 $184 9% Hot Water 20.7 $151 8% Projected Rating: Based on l ians - Field Confirmation Required. Lights/Appliances 25.6 $1105 55% General Information r � 'i � � "z `T Photovoltaics -0.0 $-0 0% Conditioned Area 2138 sq. ft. House Type Single-family detached Service Charges $157 8% Conditioned Volume 18362 cubic ft. Foundation More than one type Total 97.7 $1996 100% Criteria �, 4 71. Bedrooms 3 ., _ _ =- ,L This home meets or exceeds the minimum criteria for the following: Mechal Sms'Featurest r x ' _• i$s " _ a _ ' rs�. „,.�-•x„.• .�„„u' m.�' , ';;,c,,,,,aa„'2;..'�3 'a.�, u. ry .�..��,�,a,,. '�3,.kw �: �___ f3 EPA ENERGY STAR Version 2 Home nica yste Heating: Fuel-fired air distribution, Natural gas, 95.0 AFUE. 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; Coot-Yes - woas sxt .s.ru rs Building Shell Features . r l,, Ceiling Flat R-40.0 Slab None Sealed Attic NA Exposed Floor R-30.0 __.°.,.f,.::a„-„_ �x..a.:•-.. ;1' „. >;s- „rap-;,�,.,.; .,..-:? 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 Walls R-0.0 Method Blower door test 50 Washington Street axe ,_ ... r ,p • tea? _ -t Westborough, MA 01581 LigFits and Appliance'Features' :s § y � ' 508-326-7506 Percent Interior Lighting 25.00 Range/Oven Fuel Natural gas Percent Garage Lighting 0.00 Clothes Dryer Fuel Electric Refrigerator (kWh/yr) 550.00 Clothes Dryer EF 3.01 Dishwasher Energy Factor 0.78 Ceiling Fan (cfm/Watt) 0.00 The Home Energy Rating Standard Disclosure for this home is available from the rating provider. REM/Rate -Resicential Energy Analysis and Rating Softwpre v14,4.1 This information does not constitute any warranty of energy cost or savings. © 1985-2014 Architectural Energy Corporation, Boulder, Colorado.