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HomeMy WebLinkAboutBuilding Permit # 3/7/2016 00RT#1 9 BUILDING PERMIT � ���4`�`� '6.a�0 �..� TOWN OF NORTH ANDOVER 0 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ii u�mwiiwu �„ AgpAT20 Date Issued" CHU`�+''�� IMP : Applicant must complete all items on this paEe i�c r � ,, / / / / / o r / la // /1 / r ert� �ez rr1� MOM r / //, ice, //,/// , ///ri ����� „l//,,,/, //��/// / ! r TYPE OF IMPROVEMENT PROPOSED YSE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial [XAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se tic" ❑` ell /% ; Flaod lain C Wetlands % `'Watershed D�stnct r �^y " ,,, p „ „ , , , 1".... / � i, / /ii of r,/ �,"1�✓atG M'���i eUVE'r... ,r;,,.., ��//,,,,/„ Air sealing, Install 12” layer of R-38 unfaced fiberglass batts for damming, Install 6" layer R-21 Class I Cellulose to open attic, Install insulating cover for attic access folding stair, Install insulated exhaust hose to existing bath fan, Install ventilation chutes in rafter bays Identification Please Type or Print Clearly) OWNER: Name: Carmen Henriquez phone: 781-248-6905 Address: 1004 Salem Street North Andover, MA 01845 ri '<;, ,,,,., / ✓iii,.. „/ ,�/i,ri�/// ,r%/!/,/, �„ ./ ///�,,//Oi /iOii ///// , o /// r,,, /i ri /, ri r rr r, rr aaw o r // rr,%/ "N' /0 ri r.� /rir rr ... to erulsor.,s Cons ruc ion.Lic n e� x ,,/Dafe� ,,,; , i r , / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER�S.F. Total Project Cost: $ 3285.44 FEE: $ 30.00 Check No.: t 6 'i Receipt No,: NOTE: I' rsorls ebilirliefing with unregistered contractors cla not have acces s to tlae g" c�r�a n unty fa� Signaten,6 of Agent/Owner �n Signature of contractor ---.;. , a ,t%ORT IL I wre"" W, n.do V I 0 F"WW" IL 14�h ver, Mass, L L JAII K I ArEto) U BOARD OF HEALTH Food/Kitchen �RMIT L D Septic System dL* ..........1_11 BUILDING INSPECTOR 4", 1 l8tERTIFIES THAT ........... * ........................... .... ......................................................... Foundation as permission to erect.......................... buildi XQNA­*�....... ngs on .1.00.4....... Sid a a ... .................. III! jj� Rough bv% 4 ................... e occupied as .......Z Chimney 'I e that the person accepting this permit shall in every respect co of the application ............................. Final file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and onstruction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough -VIOLATION of the'Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU N TS Rough Service ..... ....................................... ......... ... ...... ....... Final BUILDING INSPECTOR GAS INSPECTOR QccyBancy Permit Required to Occupy Buildin Rough Final Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. www.americaninstallations.com F,ndle,ss Energy Home Performance Coutrael0l' IS4 Ceilov Ifill St,Marlborough,MA 01752 CONTRACT 774-540-1544 VAX(401)784-3710 Page PROGRAM CMA-HPC PHONE DATE CLIENT# WORK ORDER CUSTOMER (791)248-6905 12/10/2015 425270 00001 Carmen Henriquez UILLINQ STREET SERVICE STREET 1004 Salem Street 1004 Salem Street BILLING CIM STATE,ZIP SERVICE CITY.STAYE33P North Andovei-, MA 01X445- North Andover, MA 0 1845- JOB DESCRIPTION AIR 8FAHNU 1,lovide labor and materials to:;eelas,o :;eel arei)'oul exec s au`leaika a; This,work will IV performed TrIconeelt with the use ol""pecial look tests to assure that your holue will be 101 vvith It heulthfid level of, airexclianfre laid indoot air duality.IVIlAterialS to I'W MINI 10 S(Ntl your home wart include caulks,toatias and otherrItoduots Primary C Hed areas(windows are not getleriflIN areas for scaling include air leakage to attics,Nuserrients,atmehed garages and('ille r LI fill N knldfessed) (Ili)working hours.A reduction Ili cubic feet Per MinUtc 01-o)Ot'air infiltration will occur,but the actual 11111111-ol'ofto is not guaraliteed At the completion ofthe weadlert/,afiorj work,laid at no additiorial cost to die boiand cowner,a inull blower door aral/or combustion -colitfactor to ensere file$N14ty of the indoor air(ILUdIty safety analysis will be conducted by the ub $850,00 AIR SFAJNG:I)roviale labor and tHaHnials to install(;-Ion cl(ionswccp tea(I)doc)rrs)tea restrict air leakage. $75.00 DMMIN(j:Provide labor and materials to install a 12"Ili ver ot'R-3 8 Land od fiberglass baits to,(192)square I'eet for du i Ortin fig $393,60 A--ITIC FLAT:lIrmikle labor and laraterjuls to install a 6"layer oaf R-2 1 Class I t"eflulose addM to(969)square teet of open aTic spa", STORAGE BARRIEW Iforneowner I%TeSI)onsible,f0f tile Mlawal 01,111C stored items blocking tile installation orvveadlerization work,ill the atfic, Reirroval tinauzi occarr prior to the wlwdulol work start. AT HC ACCESS:f1rovide lalxar and triaterials to Install(1) eaii(Y looved,iosulatilig cover t"or the attic access folding stair A small flat surface 01)AYWood Will Ile created raorard the opening within theatre This will aIlow,the cover's integral Weil ther-stri p]ang o I Qsaiet air leak-alre. $213TO labIli and materials to install(T)iusulated exhaust hose w vj�7 dh rool'triounteJ f1alapax verli 10 c\11an"t existing IoaitTiraxant Pants h. $356.25 VFN'IILATIONllro6felahot and Materials to install velitilatio r chutes ill(76)rafter bays to Inaintion air flow, $152,00 t www.americaninstallations.com Endless Energy Home Performance Contractor 184 Cedar Hill St,Marlborough,MA 01752 CONTRACT 774-540-1544 FAX(401)784-3710 Page 2 PROGRAM CMA-NPC CUSTOMER PHONE DATE CLIENT# WORK ORDER Carmen Henriquez (781)248-6905 12/10/2015 425270 00001 SERVICE STREET BILLING STREET 1004 Salem Street 1004 Salem Street SERVICE CITY.STATE,23P BILLING CITY,STATE,ZIP North Andover, MA 01845- North Andover, MA 01845- JOB DESCRIPTION Total: $3,285.44 Program Incentive: $2,676.58 Customer Total: $608.86 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF ***Six Hundred Eight& 861100 Dollars $608.86 AUTH I010NA�TURE-Endle ner CUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE VATHORAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE --- — —{—�u�--�-- -- - DAYS. / si` '7/ loam I iii Energy PERMIT AGENT AUTHORIZATION FORM .ALL INFORMATION IS TO BE'TYPED OR LEGIBLY PRINTED ,r ww do hereby authorize (H meowner ame) the company or contractor, selected by Endless Energy*, to obtain any and all necessary �, building permits at c � � Strse. f t dress, ttylTown,S at ,zip) Permit Authorization obtained by Endless Energy Homeowner of Above Listen Address. (Name Signed) (4Z Ir (Name Printed) ✓M 7 4 +w.mmmmmiii wmm Endless Energy Representative: __. (Name Printed) This form supersedes any previously submitted letter(s) of authorization. *Endless Energy retains the right to select the contractor based on availability, location, and affiliation with the MassSave program. This form must contain only the people you want to pull permits in your name. To make changes to this form„ you must submit a new form. This form will delete and replace any previous authorization form and the information contained thereon. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 iviiii,minass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BLIsiness/Organizatioti/IndiviciLial): Endless Mountains Solar Services Address:288 Kidder St City/State/Zip:Wilkes Barre PA 18702 Phone #:570-820-5990 Are you an employer? Check the appropriate box: Type of project(required): 1.X I am a employer with 10 4. E] I am a general contractor and 1 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.R I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its I0.Fj Electrical repairs oi-additions 3.R I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13A Other Weatherization comp. insurance required.] *Any applicant that checks box#I must also fill Out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an emplQver that is providing workers'compensation insurance for ittv employees. Below is the policy and jab site information. Insurance Company Name: HDI-Gerling America Inc Co. Policy# or Self-ins. Uc. #:000087615 Expiration Date:5/9/16 Job Site Address: 1004 Salem Street City/State/Zip:North Andover/MA/01845 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required Linder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certij�under thepains andpenallies oj'perjwy that the information provided above is true and correct. Signatur 4�r�12_ 2/05/16 Date: Phone g: 5708205990 Ofjicial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License 4 Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Pei-son: Phone#: DATE(MMIDDIYYYY) CERTIFICATE LIABILITY INSURANCE 1/25/2016 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(les) 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 Sharon Zaccone NAME: Eastern Insurance Group PHONE Ex (570)819-2000 AIC No; (570)819-4000 613 Baltimore Drive E-MAIL szaccone@easterninsurancegroup.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Wilkes Barre PA 18702-7980 INSURER ANDI-Gerling America Ins Co 41343 INSURED INSURER B: Endless Mountain Water Services, LLC, DBA: Endless INSURERC: Mountain Solar Services, DBA Endless Energy INSURER D: 286 Kidder St INSURERE: Wilkes Barre PA 18703 INSURER F: COVERAGES CERTIFICATE NUMBERktaster 15-16 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR D WVD POLICY NUMBER MM/DDM YY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGA CLAIMS-MADE �OCCUR PREMISES TO RENTED 100,000 PREMISES Ea occurrence $ � EGG000087615 5/9/2015 5/9/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2f000,000 X POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: Employee Benefits Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 _ - A X ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED EAGCC000087615 5/9/2015 5/9/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Pe PERTYtDAMAGE $ HIRED AUTOS AUTOS Medical Expense $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE YNIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? A (Mandatory in NH) EWGCC000087615 5/9/2015 5/9/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Sharon Zaccone/SZ � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 omni) 4C s a 7.7:17--- I, "; e, A r CS'108214 ERW CHARTRA 1) 394 FJ�31 STRI, N Gardn,r k4 \ / 0H# 04102120 18 27 Sanborn St Fitchburg MA 01420 978-652-2680 ................. .-M-1 1�•1�'li��l/t'�?if,Gl�/(,�'i, , Z t'1-��1 f Consumer Affairs a'nd Business Re ulatlon Off ce o g 10 Park Plaza Suite S 170 Boston, Massachusetts 02116 Home Improvement,Contractor Registration Registration: 174479 Type: Supplement Card ENDLESS MOUNTAINS SOLAR SERVIES, Expiration: 1/28/2017 C ERIC CHARTRAND 288 KIDDER STREET WILKES BARRE, PA 18702 - - - Update Address and return card.Mark reason for change. SCA I 5 -'oM-DEVI i (� Address El Renewal [] Employment Lost Card �'��e rYi r-rra,rza�e!r,nrcfl�r`c�iTl r.�ocrc�rcaell° Gfflee of Consurner Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: iA Office of Consumer Affairs and Business Regulation C� }7egistration ..�74.4..79 Type 10 Park Plaza-Suite 5170 ExpIratron .':1!28/2017 Supplement Card Boston,MA 02116 ENDLESS MOUNTAINSSOLARS.ERVICES,LLC ENDLESS MOUNTAIN$,--.4R SEF2VICES ERIC CHARTRAND 288 KIDDER STREET WILKES BARRE,PA 18702 Undersecretary Not valid without signature