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HomeMy WebLinkAboutBuilding Permit # 3/7/2016 %40RTII 1"0.D BUILDING PERMIT 0 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit N4 Date Received ATM. Date Issued: CH INIPO,RTANT, Applicant MUSt complete all items on this page LOCATION ��,,,�,25,R[d66/Way X, r In-. POPE TY C"UVNEFt Lau :T 6666 6 q i nn m/o 210 PARCEL ',' DISTRICT ';-,:'ZONING" ' P:NO� no yes """rib age h6p,9ill TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ri One family El Addition ii Two or more family Ll Industrial X Alteration No. of units: 11 Commercial El Repair, replacement 11 Assessory Bldg 11 Others: 11 Demolition 11 Other ,E] ppptic, 0 Well 11 Flooldplain El Wetlands El Watershed District El Water/Sewbr, _,,-1,, Air sealing, Install 6" layer of R-21 Class I Cellulose to open attic space. Install ventilation chutes in rafter bays Identification Please Type or Print Clearly) OWNER: Name: Laura Tecce Phone: 781-760-9793 Address: 25 Ridge Way, North Andover, MA 01845 -540"1544 ­-­ CONTRAC'fOR"N; Phone* Pm�e` EndIe�sEi­' ­­1­­' 774 "I 84,ib/646�H i I I tt,,Ma rl bb _g Supervisor' License: E p Date", 08244 4/02'/1 8­,,,`,_,'�; H 6me, 1 Dafie 479 1/28/17 8/17/ , ,, ' ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2983.60 -FEE: $ 36.00 Check No.: Receipt No.: NOTE: ie—r:50—n,5—co—iirtr--a7-c:ting with unregistered do not have access" 1o_ 14egugarantyfi n I + P. Signature of Agent/Owner Signature of contractor �ORT1i F ...E ndu v V'r ' Q• �( _ ' Z _ ®j+ Q Y' OLy h ver' aSS, 10, 1 (0 LAKE COCKICKEWICK A0RATEO BOARD OF HEALTH Food/Kitchen Septic System P E R M IT �T I THISCERTIFIES THAT ........................ BUILDING INSPECTOR .................................................... . .......................................... . .. Foundation 91"has permission to erect.......................... buildings on . ......... ... �... Wj ............. g % Rough to be occupied as .4,Ar... . . ... ` .. y provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and tq, Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR 'z VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final A PERMIT EXPIRES IN6 MONTHS ELECTRICAL INSPECTOR ® Rough ? LES IO T S g { - Service ................. .. ...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occup y Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina' NoLathing or Dry Wall To Be Done FIRE DEPARTMENT v Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. tndiesv Muulvtnv ww w.andlesarrltneolar.cotn ad,ir 5rrvit ov Endless Energy Rome Performance Contractor 184 Cedar Hill St,Marlborough,b1A 01752 CONTRACT 774.540-1544 FAX 14011 784-3710 Page t PROGRAM CMA-RPC CUSTCUGA PHONE DATE CLIENT M WORK ORDER UlUra Tecce (781)760-9793 12/11/2015 423189 00001 SERVICE STREET BILLING STREET 25 Ridge Way 25 Ridge Way SERVILE CITY,STATE.IID BILLING CITY.STATE,IIP North Andover, MA 018454740 North Andover, MA 01845-4740 ,JOB DESCRIPTION AIR SkAIJN(it Provitle lahor and i taterials ut seal areaN of your honre against wasteful,excess air lV31tagc. 'This work will he performed in conceti with the out ol'\lxcial look,and ohugnostic Ics(s to assure[hilt your home will he lel[with a healthful level it[' air exclia nge and indoor air quality Materials to he liner I u+seal your hunt\can include caulks,litunis:uul other products. Primary anus for sealing include air leakage to attics,basements,attached rarapes and other unheated areas(windows arc not pt:nerally uddreaud,) (12)kwi-king hours.A reduction in cuhic feet per minute Ichw of air intiltnition will occur.but the actual nurnher of cine IS not gu runlrell. At the completion of the weatheri?ation work,and tit no additional cost to the homeowner.a final blower door and/or conihuslion s;dvty analysis will be conducItrd by the sub•cuntracttit to ensure the sa10y of the indoor air quality. $1,0211.(1(1 I>AMM INl is Provide lahor and ntalcrials to Install It 12"layer of It-39 unlaced lihergluss halts to 1721 square lee(for dannning putpc'xes. $184.50 A f l W 1'1,A'1':Provide labor and materials to install art"layer of k-21 Class I Cellulose added ion I 114(1)square feet of open attic \puce. $1,4?6.40 ATHC ACCESS:Provide labor and materials it)insulate the buck of I I I attic hatch with 2"ripid'1 hmitiax hoard.Weatherstrip the perimeter. $010) KNhaiWAl.l.11.00W Provide labor and nlatertak to install a 10"layer ill'deme packed k-35 Class I Cellulose added to(261 square lcet o1 kneewull Ilooi, $50.70 VI N1'11.ATION:Provide labor and ojaterialN to install 121 imufand exhaust hoc to existing hathnaan Ianls). MIIIt)M VENTILATION:Provide Iahor atilt materials it)install ventilation chutes in(66)roller hays to mainitin air flow. $132.00 6nile++Muun L,ln, www.andiseemtnoolar.corn Sinn.s,•��I,,,, Endless Energy Ho3ue Performance Contractor 184 Ceilm•till)St,Marlborough,INIA 01752 ®N_CONTRACT 774-,540.1,544 FAX(401)784-3710 I Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT WORK ORDER Laura Tecce (781)760-9793 12/11/2015 423189 00001 SERVICE STREET BILLING STREET -_ 25 Ridge Way 25 Ridge Way SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover, MA 01845-47,10 North Andover, ,MA 01845-4740 JOB DESCRIPTION Total: $2,983.60 Program Incentive: $2,492.70 Customer Total: $490.90 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Ninety&90/100 Dollars $490.90 ,d4CUSTA TH.R1Z..OATURE�oorgY C PTANCE RACT MAY r3EWITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ^� DAYS. ��� iii i A dime f d ss w ' Energy uuuum o u �i �V LLL____EEEME.�������ZATION FORM ALL INFORMATION IS TO RE TYPED OR LEGIBLY PRINTED I, le , do hereby authorize (Homeowner's Name) the company or contractor, selected by Endless Energy*, to obtain any and all necessary building permits a �0,r�"� �"Sia� (Street Address,City/Town,State,zip) Permit Authorization obtained by Endless Energy Homeowner of Above Listed Address: /I*j 74001?�� a e S' ) (Name Printed) Endless Energy Representative: (Name Signed) y„ —1A. Y1i 1 fl (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 ma`ss,.ave 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 IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston, HA 02114-2017 wwwmass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 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.FM 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.F I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. E] We are a corporation and its IO.F Electrical repairs or additions 3.F 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.E:] Roof repairs insurance required.] t c. 152, §1(4),and we have no 13AN Other Solar employees. [No workers' comp. insurance required.]_ *Any applicant that checks box ft 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. TContractors 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. lain(tit employer that isproviding workers'compensation iiistir(iiicefor ti�vemployees. Below is the policy and jab site ill rillatioll. 'to Insurance Company Name: HDI-Gerling America Inc Co. Policy#or Self-ins. Lic. 4:000087615 Expiration Date:5/9/16 Job Site Address:. 25 Ridge Way 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 under Section 25A of MGI,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 WOR]", 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 certify under the pal t,ndpwafties ofpeijtiiy that the information provided above is true and correct. 2/05/16 r Dat e: Si Hulot 0 AlazA-- Phone#: 5708205990 Official use only. Do not write in this area, to be completed by city or tolvil official. 7, City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ® DATE(MM/DD/YYYY) AC®R® � CERTIFICATE OF 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(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 Sharon Zaccone NAME: Eastern Insurance Group HCONN. Ext: (570)819-2000 FAX AIC No:1570)819-4000 613 Baltimore Drive ADDARESS:szaccone@easterninsurancegroup.com INSURERS AFFORDING COVERAGE NAIC# Wilkes Barre PA 18702-7980 INSURER A:HDI-Gerl:Lng 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 -INSURER E: Wilkes Barre PA 18703 INSURER F: COVERAGES CERTIFICATE NUMBERklaster 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 I AtSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD I WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREM SESOEa occu ante $.c.) 100,000 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 $ 2,000,000 POLICY❑ PRO [—] LOC PRODUCTS-COMP/OPAGG $ 2,000,000 X JECT OTHER: Employee Benefits Liability $ 1,000,000 O AUTOMOBILE LIABILITY Ea acccideDISINGLE LIMIT $ 1,000,000 '.. X ANY AUTO BODILY INJURY(Per person) $ '.. A ALL OWNED SCHEDULED AUTOS AUTOS EAGCC000087615 5/9/2015 5/9/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ 5,000 Medical Expense UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ '.. DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYSTATUTE ER Y/N E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A OFFICEtory 1. H)EXCLUDED? EWGCC000087615 5/9/2015 5/9/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 A (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 7 DESCRIPTION OF OPERATIONS I LOCATIONS I 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(901401) and Business Regulation Q 2 , ov/.- llqlnlewq�qa� Office of Consumer Affairs g 10 Park Plaza d Suite 5170 Boston, Massachusetts 02116 Home Improvexnent;.C.ontractor Registration Registration: 174479 ? Type: Supplement Card Expiration: 1/28/2017 ENDLESS MOUNTAINS SOLAR ERIC CHARTRAND 288 KIDDER STREET WILKES BARRE, PA 18702 Update Address and return card.Maris reason for change. . E] Address [] Renewal ❑ Rrriployment Lost Card SCA 1 t; 20M-05/11 C�X& T�rsrti��zax<stnrc�C�� CTlr.;dcrc�!!•3ells Rice of Consumer Affairs&Business Regulation License or registration valid for individui use only !7`, __-g. before the expiration date, If found return to: IVIE IMPROVEMENT CONTRACTOR p =. Office of Consumer Affairs and Business Regulation Y=_ .Kegistration:;�7�479_;:. Type, 10 Park Plaza-Suite 5170 Expiratiot% j'2gj2pj7 Supplement Card Boston,MA02X16 ENDLESS MOUNTAINS-,s& ,ZS ICES,LLC ENDLESS MOUNTAIN :SOli4R_SEF2VICE5 ERIC CHARTRAND 288 KIDDER STREET "— WILKES BARRE,PA 18702 Undersecretary Not valid without signature +rl assacn i U5r{� acar Qur3tr4n 3n Cl� S��nuarcy CS_908274 � ERIC CHAR 394 ELM STRExr Gardner MA 01440 04102/2018 27 Sanborn St Fitchburg MA 01420 978-652-2680