The URL can be used to link to this page

22 AMANDA WAY - BUILDING INSPECTION (3) l� �025 ly ci< Z�44 � � s s 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. L.Date Applied: Building Official: SECTION I-LOCATION(Pleas indicate Block#-and,.Lot#for locations for which a street address is not available) No.and Street City/Town Zip Code Name of Building(if applicable) SECTION Z 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❑ 1 Repair❑ 1 Alteration ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other O Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes Iff No ❑iQ� F�1 Is an Independent Structural Engineering Peer Review r�t}a-red?`` (� Ye ❑ No 4( Brief Description of Proposed Work: C,ol1 fUCr �h� JI 1P �DW ��I 0, SECTION 3:COMPLETE THIS SECTION IF.DUSTING 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) Total Area(sq.ft.)and Total Height(ft) / t03 SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: EducaF: Facto F-1❑ F2❑ H: Lh Hazard H-1❑ H-2❑ H-3 H-4❑I: Institutional I-1❑ 1-2❑ I-3❑ 1-4❑ M: Mercantile❑ R Residential R-1 R-2❑ R-3❑ S: Storage Sl❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION'6:CONSTRUCTION TYPE(Check as applicable) IA 1110 IIA ❑ 1113 IIIA ❑ IIIB ❑ 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 be Licensed Disposal Site Public 4� 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 Rev ",Pnxrss: Not Applicable❑ Is Structure within airport approach area? Is thew review comple d? or Consent to Build enclosed❑ 1 Yes❑ or No❑ Yes❑ No SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:�—Use Gnmp(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: NO Special Stipulations: r � • ^ti , SECTION 9: PROPERTY OWNER AUTHORIZATION Name Add ress PropertyOwne I� T �® q80 L�In e MA Name(Print) No.and Street C /Town Zip Proper Owner Contact Information: , Title Telephone No.(business) Telephone No. (cell) +Re-mail',ddres If ap licable,the prope owner hereby authorizes P O Px�A ?80 �� OIL�IO Name 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) building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check here 0 andskip Section 10.1 10.1 Registered Professional Responsible � le for C�onssttruuccttioon Control -�si tyyne(Re ' ant) 11980 9Oo Telephone No ' marl a s Registration Number Street Address City{ifown State Zip Discipline Expiration Date 10.2 General Contractor Company Name I B tll -M s - CZt?-91 y n9 l �f) or)& ffV 5DC ;�a�me of Per gn Responsible forConstruction ^Lic ns No. and Type if Applicablle l q y O COX * /780 pit M CPC Street Address Town State Zip Tele hone No.(business) Telephone No. cell e-mail address SECTION IL•WORKERS'.COMPENSATION INSURANCE AFFIDAVIT M.G.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 issuance 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 and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ �[/ Building Permit Fee=Total Construction Cost x_(Insert here Z.Electrical $ QQ appropriate municipal factor)=$ 3.Plumbing $ 4.Mechanical (HVAC) $ Q�f - Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to b.Total Cost $ �/' r (contact municipality)and write check number here SECTI N 13:SIGNATURE OF BUILDING.PERNITT APPLICANT By entering my name below,I her attest under the and penalties of perjury that all of the information contained in this application is true and accurate bes f kn ge and understanding. Please print and sig ra 0—H.R•T LATi Telephone No. Date �.qy-0 Street Address Cit} own State Zip Municipal Inspector to fill out this section upon application approval: r • t Date Name C - �} 323 - CITY OF SALEM ROUTING SLIP Neil Construction !/ Certificate of Occ ---�upallcY LOCATION /i .iSSE5SORS:St. ATE 93 1Vashingto DATE 30 93 1VashI ttin 5t. DATE PUBLIC SERVICES �{ 120 Washington St. —Af DATE 't 3IN VIVA TER J 12��0 1Vashington St. /� DATE It �-eROSS CONNECTION !/ 5 J5 Jefferson Ave DATE rL:1NNINC A 1201Vashingt n t. DATE ? 4 e714 CONSERVATION 120 11 .shfngton S,.�z_z 55 D ATE 6 l� &I ECG' 4y l:afayette SL DATE • FFIRE PREVENTION \' _ 29 Fort Avenue D:1TE 120 1Vas'hi7�ton SL MtTE' , �ILDINC INSPECTOR 120 Washington St. —D 1TE b�fld �oB00�1 1��OQ��0�3a BQQo 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!lL1 MASS. 6 At IN,f2 1016 Zer 0 77 lei 50 "o y 3�= r� Gsa� I hereby certify to the Building Inspector that the pro- ZONE: LOT AREA:lVdkb � LOT FRONTAGE: I�DIV� posed construction ,shown conforms to the dimensional zoning of 1��i« SIDE 7CARD:IOr� REAR YARD: I FRONT YARD: I SCALE: n 4✓ DATE: lh0V Z 120/3 F stopher R. Mello PhS 3131,7 REFERENCE: FG By 9GL PG 14F �. 104 LOWELL STREET PEABODY, MASS.01960 (978) 531-8121 EnergyReg Rating Number Home Rating Certificate Rating ylr r Certified Energy Rater Nicholas Abreu Derby Model Rating Date 2/24/14 Salem, MA Rating Ordered For Osborne Hills Realty Trust Estimated Annual Energy�Lost NUse � MMBtu �., Cost percent 5 Stars Plus Heating - 57.2 $470 25% Projected Rating 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% �_.General Infoftmatlon mF, 1' + Nv Photovoltaks -0.0 $-0 -0% ......."..».� " u " T'T! r.v�m—�." ` ,i Conditioned Area 2092 sq. ft. House Type Single-family detached Service Charges $157 8% Conditioned Volume 17788 cubic ft. Foundation More than one type Total 107.2 $1893 100% MBedrooms 3 :: .,.0� 'N re vsr- :.�^ '+ ssxaassa s 6 ve-e ara'- 3 Mechanical'Systems Features d This home meets or exceeds the minimum terra for the following: '...`"` tic '. 4'..:`"°""""""' °"� " 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, 0.58 EF, 74.0 Gal. Duct Leakage to Outside 100.00 CFM25. Ventilation System None Programmable Thermostat Heat-Yes; Coot-Yes Building Shell Featli�es a qi: 1 A .� a-- . ,_ ��,:�� .�.y,.� �.r" 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 Walls R-0.0 Method Blower door test 50 Washington Street 3.n,.;v _- Westborough, MA 01581 Lights and Appliance Features P. ',, t4 y'I. w `' _� ts*a...s..".. _. _ d NN�N °r=m§:-«, : 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. RENIVR. t2-Residential Energy Analysis and Rating Softvvara v54.4.1 This information does not constitute any warranty of energy cost or savings. ©1985-2014 Architectural Energy Corporation, Boulder, Colorado. - RR rlZ 2 95 -l6 Professional Land Surveyors Et Civil Engineers ESSEX SURVEY SERVICE, 1958 - 1986 OSBORN PALMER 1911 - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAND - LOCATED IN SIJP MASS. ca � 2 ) r �orl6 Zir 11 � � PRBFaSED � sir 04 ELL mC 30 G ma I hereby certify to the `&Z:_111 Building Inspector that the pro- ZONE: LOT AREA:kO,fh: LOT FRONTAGE: kONZ�5' posed construction shown conforms to the dimensional zoning of FRONT YARD: 1Sfr SIDE YARD:/6-0 REAR YARD: G0 Mass. SCALE: {6�L" 6J �/ 2 III OF�smq�e QV ZI LOIJ OFiRISTOPHER /I DATE: o�N I R. MEW) y�B REFERENCE: L BK QG2 PG ?, Chf stopher R. Mei1 p 1M17 / L c/uTER�/ i. 104 LOWELL STREET PEABODY, MASS.01960 (978) 531-8121 FAX: (978) 531-5920 CERTIFICATE OF LIABILITY INSURANCE DATE/2/ DD/YYYYI 12/2//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 CONT CT SUSen Donnell NAME: Eastern Insurance Group LLC PNONE (508)651-7700 FAX 233 West Central Street DOAa .sdonnell@easterninsurance.ccm. INSURERS AFFORDING COVERAGE NAIC0 Natick MA 01760 INSURERA:Acadia Insurance Company 1325 INSURED INSURER B: DIBIASE CORPORATION I INSURERC: Osborne Hills Realty Trust INSURER D: P.O. BOX 780 1 INSURER E: .LYNNFIELD MA 01940 INSURERF: COVERAGES CERTIFICATE NUMBER' L1312224290 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 AUUIL WON POLICY SEE POLICY EXP LTRTYPEOFINSURANCE POLICY NUMBER MMIDDNYYY) IMNUDONYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY MAGE TO RIERTE� PRE ISES Ea occuYengei $ 250,000 . A CLAIMS-MADE FxIOCCLIR 0191229-17 /23/2013 /23/2014 MED UP(Any one person) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMWDP AGG S 110001000 X. POLICY PRO- jPCT 0LOC $ AUTOMOBILE LIABILITY COMBINED SINOLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS aaccidem 8 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LUIB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS I I$ A WORKERS COMPENSATION X: WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NN) 0286788-14 /23/2013 /23/2014 E.L.DISEASE-EA EMPLOYE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS balm E.L.DISEASE-POLICY LIMIT 1$ 500.000 DESCRIPTION OF OPERATIONS LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more apace Is requlredl 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/PEG ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. INS825l9MMfi1 Rr Thu arniin namu snd Inn.a.a runiafurod marks:of aCflRn Additional Named Insureds Other Named Insureds DDC RESIDENTIAL LLC Insured Multiple Names OSBODRNE HILLS REALTY TRUST Insured Multiple Names OFAPPINF(02/2007) COPYRIGHT 2007,AMS SERVICES INC