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27 OSBORNE HILL DR - BUILDING INSPECTION (2) 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 indicate Block I-and Lot#for locations for which a street address is not available) D� ® - 0 PA) No.and tmetp�27 City/Town Zip Code Name of Building(if applicable) SECTION 4iPROPOSED WORK Edition of MA State Code used_ If New Construction check here vror 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 ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No 0/Qu f�l Is an Independent Structural Engineering Peer Rev ew re)wred?,1 (� [ Pfll 11 Y ❑ No 41 Brief Description of Proposed Work: ( ,ari jr IV�L) Vli'1j I Q �itJP1� no 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 Group(s): SECTION 4:BUILDING HEIGHT AND.AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) ✓�/i 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: Hi Hazard H-1 ❑ H-2❑ H-3 H-4❑ H-5❑ I: Institutional 1-1❑ 1-2❑ I-3❑ 1 1❑ 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: SECT ION'6:CONSTRUCTION.TYPE(Check as applicable) IA IB ❑ ILA IIB ❑ MA HrB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit: Debris Removal: Water Sup�pI Flood Zone Information: Sewage Disposal: Licensed Disposal Site Public 4� Check if outside Flood Zone❑ Indicate municipal A trench not be required 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 Revio,Process: Not Applicable❑ Is Structure within airport approach area? Is their review comple d? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No SECTIONS 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?: NO Special Stipulations: /' t li SECTION?. PROPERTY OWNER AUTHORIZATION Name nd Address oProperty Owner ^ #. 980 I ('\ ) t MA QV�fn Name(Print) No.and Street C' /Town j Zip Property Owner Contact Information: , Title Telephone No.(business) Telephone No. (cell) e-mail addres If ap licable,the grope owner hereby authorizes O 1 ��iME, O PP�_�� 0 Name f Street 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 10.CONSTRUCTION CONTROL(Please fill out Appendix 2) (11 building is less than 35,000 cu.ft of endoseds ace and/or not under Construction Control then check here O and skip Section 10.1 r1-0.1 Registered Professional Responsible for Construction Control QLA Tele hone No ma I d a r ss Registration Number Street Address O CitYAown State Zip Discipline Expiration Date 10.2 General Contractor Company Name I BI.II M Zt 's CS 27� �+�7 l �5_ on��UbPfV SOS ame of Pen�Responsible for Construction ^Lic No. and Type if Applicable 7 IJSS/` # / V O IT' Iym p nv Il(1J_L_.li_o Street Address - ity/Town f� State Zip &I �8�'� -- 7 1 -344- OZ .6me in to�� i S� S�o� Tele hone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152,§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Acciden must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of th uance of the building permit. Is a signed Affidavit submitted with this application? YesV No O SECTION 11'CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor C Total Construction Cost from Item 6 — and Materials) ( ) $ 1.Budding $ Building Perot 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 $ Qp (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I here hest under the pains and penalties of perjury that all of the information contained in this application is true and accurate th s f kno a and understanding. Trlr _-7811 `L_ Please print and si a MW Q. .R,T, t Ti „ „'Telephone No. Date Street Address CiL own State Zip -U1(�1' Municipal Inspector to fill out this section upon application approval: -t"+"""' Name Date Ai kzvCERTIFICATE OF LIABILITY INSURANCE °ATE 2/2/2013 (MM/DDrm7 1 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 ATE THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE R(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 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 endoreement(s). PRODUCER CONTA T SU M Ban Donnell NAE: Eastern Insurance Group LLC PHONE (508)651-7700 FAX 233 West Central Street E-mAIE ,adonnell@easterninsurance.com a INSURERS AFFORDING COVERAGE NAICM 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 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 LTR TYPE OF INSURANCE POLICY NUMBER MMIDCY EFF MWDDYEXPDIYYYn LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ed occunen E 250,000 A DLAIM$-MADE 1 OCCUR 0191229-17 /23/2013 /23/2019 MED EXP(Any one person) $ 5,000 PERSONAL A ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 1,000,000 7X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acnr ern $ _ ANY AUTO BODILY INJURY(Per person) E ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNEDPROPERT-DAMAGE $ er eccltlent UMBRELLA DAB OCCUR EACH OCCURRENCE $ EXCESS LWB CLAIMS-MADET AGGREGATE S LIED RETENTIONS $ A WORKERS COMPENSATION STTU- OTH- ANDEMPLOYERS'LIASILITY YIN X WC A ANY PROPRIETOR/PARTNER/EXECUTNEOFFICERIMEMBER E.L.EACH ACCIDENT (Mandatory In NH) CLUDEDT NIA FCA0286788-14 /23/2013 /23/2014 $ 100 000 Ifyeo.desulbe.nder E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) 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. INS02.5 mmnnsl M Th.Ar-..nplT mma and lnnn aro ronialarod mvka of aCflpn 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 1')Z 2 Professional Land Surveyors 8 Civil Engineers ESSEX SURVEY SERVICE: " 19$8 - 1986 OSBORN PALMER 1911 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCA IN SA1ID MASS. h-i5 31 a D(uELI Avl(' b �s' G 3, 156oaA- I hereby certify to the 516, - ! Building Inspector that the pro ZONE' R� LOT AREA: hlfj� LOT FRONTAGE: Aloz& posed construction shown conforms to the dime�nsional zoning of FRONT YARD: �v� SIDE YARD: IGfi REAR YARD: gaff SXZk �7 Mass. SCALE: l �D DATE: 1k)h Z/ Z013 (�,tl51 HER yG �1 n �7 REFERENCE: BK 1,4Z- PG Chri pher R. Me to PL .0, 317).19 o.31317. ), J 104 LOWELL STREET TE ' PEABODY, MASS. 01960 �` N;_ ; (978)631.8121 FAX;(978) 531-5920 7� CITY OF SALEM ROUTING SLIP New Construction Certificate of'Occu—panc LOCATION AAMAre AT E dl ASSESSORS DATE 93 Washington St. V 4L� 93 as Wi� VPUBLIC SERVICES� DATE... 11131tol l 120 Washington St, � TER XA . t, DATE 120 Washington St. tze P OSS CONNECTION DATE_ 5 Jefferson Ave b/pLANNING 2� z DATE-2- 120 Washington St. VONSERVATION::: DATE. 120 Washington St. EL i' .4,1w, V/FIRE PREVENTIOPPC DATE 29 Fort Avenue 6,f,p r ton'-,�- gs la - �ZLDING INSPECTOR DATE 120 Washington St. ' 15�1Z795 ��0'� b�'Jod rJ��00� ��OQ'��D�a. •BOQo Professional Land Surveyors Et Civil Engineers ESSEX SURVEY SERVICE.,, d958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND LOCATED IN MASS. UY�IV Sv�4G� d,� sZ r a s Allcoc5rl� • 115�5a2�i"C" d�l�� lJ��r/ I hereby certify to the 16z—x? Building Inspector that the pro- ZONE: LOT AREA: IbAi, LOT FRONTAGE: A10A,& posed construction shown conforms to the dimensional zoning of FRONT YARD: 16�) SIDE YARD: 1d)`y- REAR YARD: 30FP S fZ.W Mass. SCALE: A^ DATE: Z I� '` '®`'IRtSTOPHER yN�1` //�Y l ZO/3 R � 71 sl MFtin ' yl. REFERENCE: BK j0Z PG 21� Chri pher R. Me lb-FU 1317�� /r 104 LOWELL STREET l c/s' n f•� 'r PEABODY, MASS. 01960 (978) 631.8121 FAX-(978) 531-5920 9411z 0 56" CITY OF SALEM ROUTING SLIP Ne,v Construction Cerfiticate 0t.0 ccupalic.)p LOCATION ��V g, ;9DATE tl_ASSESSORS ZIA6 93 Washington 3z. �DATE Z4j�;�O/ ap fl, D, §t iq PUBLIC SERVICESj� 120 Washington St. DATE 1431ty � ,A T E R 120 Washington St. —DATE_, CROSS CONNECTION Qk-X, ll 5 Jefferson Ave -------L.DATE_!fth �PLANNING 120 Washington N. �DATE. ��— I z + VNOISERVATION 120 Ivasilingtol, St. _ DATE !;� 48 �//FIRE PREVENTIO 29 Fort Avenue DATE Ir as hi ingtol, St. Amtim�z �3UILDING INSPECTOR 120 Washington St. ------�D,kTE---------- Professional Land Surveyors Fr Civil Engineers 1986 19 ESSEX SURVEY SERVICE. ' 5 1970 OSBORN PALMER 1885 1972 BRADFORD & WEED PLOT PLAN OF LAND LOCATED IN Sf3l�W1 MASS. PAovcse-o O �G,EGcJwG � s- 115�3o2NC 9&_L OdIVr I hereby certify to the 6X LE7�? r� Building Inspector that the pro— ZONE: K L1YT AREA: /�✓ZA/� LOT FRONTAGE: /��ti� to posed construction thedimensioal zoningwn conforms FRONT YARD: 16il— SIDE YARD: ldfr REAR YARD: 3olzT SALE/�l Mass. SCALE: DATE: /I U V Zl Z0�3 r REFERENCE: /C IIK �OZ PG Chris pher R. Me to PLS 3T317 104 LOWELL STREET PEABODY, MASS. 01960 " (978) 531-8121 Registry "' Energy Rating Ce in C i Rating Nu be,rr.. .: Certified Energy Rater Nicholas Abreu McIntyre Model Rating Date 2/24/14 Salem, MA Rating Ordered For Osborne Hills Realty Trust �� ;Estimated Annual Energy'Cost ;:�: , Use MMBtu Cost Percent 5 Stars Plus Heating 39.8 $338 25% Projected Rating HERS Index: 70 Cooling 0 $0 0% Hot Water 16.0 $120 9% Projected Rating: Based on (Tastes - Field Confir rna ion Required. Lights/Appliances 18.4 $759 55% Photovoltaics -0.0 $-0 -0% General Information i F � ,� w „v, � q� � e� - Conditioned Area 1088 sq. ft. House Type Single-family detached s Service Charges $157 11% Conditioned Volume 9789 cubic ft. Foundation Unconditioned basement Total 76.2 $1374 100% Bedrooms 3 "' Criterlav' 'r �--� , ` "' Iti chC meal Syst_e_ms Features �' P This home meets or exceeds the minimum criteria for the following: xt „.,,,.,,w,.,,.,,,.. _ ....q,:�,,,,..,,,•..K, ._ -.N, i'iu ..,,,*..�_;., B .,'„ . sa „m3, ,r:a� ate.... _• EPA ENERGY STAR Version 2 Home Heating: Fuel-fired air distribution, Natural gas, 95.0 AFUE. Water Heating: Instant water heater, Natural gas, 0.82 EF, 0.0 Gal. Duct Leakage to Outside 40.00 CFM25. Ventilation System None Programmable Thermostat Heat=Yes; Cool=Yes Building Shell Features . MM R. ^�SNB3 rPIri4.�-,-9Yk,4=-anL,H Ceiling Flat R-40.0 Slab None * �� * n Sealed Attic NA Exposed Floor R-30.0 _.4„,,,--„;;; „,.„ „„ ^*, ;+.. . .,.,v ±t..a... >,.'�: sn r Vaulted Ceiling NA Window Type U-Value: 0.300, SHGC: 0.350 Nicholas Abreu Above Grade Walls R-21.0 Infiltration Rate Htg: 4.00 Clg: 4.00 ACH50 Conservation Services Group Foundation Walls R-0.0 Method Blower door test 50 Washington Street —^ srw al s°�ys Westborough, MA 01581 =Lights and Appliance!Feature $ a 17 BE N 508-326-7506 z Percent Interior Lighting 60.00 Range/Oven Fuel Natural gas Percent Garage Lighting 0.00 Clothes Dryer Fuel Electric 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 An21ly59s and Rating Software v14.4.1 This information does not constitute any warranty of energy cost or savings. 0 1985-2014 Architectural Energy Corporation, Boulder, Colorado.