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HomeMy WebLinkAboutBuilding Permit # 3/7/2016 OORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date lssued:--'�„-,� SS CHU IMPORTANT: Applicant must complete all items on this page r.M 56— 41NG 2"q`%$'J�/'Vk I /,,,,;/D„/,�,,/,,,,/„,,,,/, TYPE OF IMPROVEMENT PROPOSED USE Residential ' Non- Residential ,0 New Building XOne family 11 Addition 11 Two or more family F1 Industrial XAlteration No. of units: El Commercial El Repair, replacement 0 Assessory Bldg 0 Others: 11 Demolition 11 Other S e ..........- FocapIa"JiQ”/ t I afi`dg 0 wgo'so; District jg M11 10/11 11/111-1/ "A m "A' -1 Air sealing, Install Q-Ion weatherstripping and doorsweep to 3 doors, Install 10" layer of R-35 Class I Cellulose to open attic Identification Please Type or Print Clearly) OWNER: Name: Marilenin Vasquez / Luis Diaz Phone: 978-853-0100 Address: 42 Sargent Street North Andover, MA 01845 A /�/'Vgagmlm"/ pwa N iii ess,/g 1 0 A e*///////. ..... 5 CC)NTRACTO.R game di.. .......E, 4 id w'W/ IBM /a '1118'�// Z / ,r � /.... / //%%/// „% ////!///%%////// �% /%rrr/////; ,.,/�/,ry ///„ii ,/,/,/„ /rri„Di ARCHITECT/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: 1952.32 FEE: $ 30.00 Check No.: t Receipt No.. —�-:)-477/11- NOTE: Persons e07h-Practing with unregistered contractors(Io not have access to the gar ranty fun hatureofAgent/Owner Zq,-00�J Signature of contractor ;0 4 AM' fown o TO NORTH nduvcFa Lt _ ® � � � T h ver, Mass, LAKE "t � COCMYE DIC Nl WICK �' A04A U � BOARD OF HEALTH tiz t Food/Kitchen Septic System ,$ THIS CERTIFIES THAT .. DAW*........ ................... .................. BUILDING wsPEcroR ission to erect Foundation ; has�permbuildings.......................... buildin ...° '�.......�� .T...... .......... Rough occupiedas ........ ... ��.��.... .........�!.... .. .... .. .. ........................................ Chimney ti p�ouided that the person accepting this per 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 "�. ;ConstructionofBuildings in the Town of North Andover. PLUMBING INSPECTOR Rough 1/IOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT E I ESI 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ST S Rough Service ............... .. ..... ... ........ .............. .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinz Rough z,= Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT01 MIT T LL) ®�® Until Inspected and Approved by the Building Inspector. Burner �� Street No. Smoke Det. 3' a W,ry waurterricnnlnsinllationn.com Endless Energy Horne Perrorrnatrce C'utrtrACUi° „a, ire 184 Cedar 11111 St,r0ar•lborotrph,MA 01752 CONTRACT 774.540-1544 FAX(401)784-3714) Page 1 P1tC){TRAM (',MA-HP(,' CUSTOMER ...... ......._... PHONE DATE CLIENT P WORK ORDER Mnrilenin Vasquez (978)853-0100 12/08/2015 425308 00001 SERVICE 87"9E7 BILLING S'ROrr 42 Sargem Sheet. 42 Satrgem Street SERVICE CITY,STATE,ZIP 61M.I140 CITY,STATE,ZIP North Andover,MA 01545 North Andover, MA 01.545 JIB DESCRIPTION Ant St4 AL1NG' Provide labor and materials to seal arias of your laonoc against wasteful,excess air feaka8e.. '1"hls work will be perionne d in conct"I with the,use of 2spaaruial loots and diagnostics tesks to assure that your homey will be left with a healthful levcl of air exclaanee and indonw iur r)tralit"y.Mal efhds tea be used to seal yourhome earn inelude caulks,foarms and other prrwhtt`,%. priorary areas for waling include air leakage to attics,fmseaams,athiched garages and cotter unheantcd areas(windows tux:not g;esra:rally" addressed) (8)working hours.A rcchatAiun in cubic;feet per minute(cfnr)orair infiltration will Occur,but the ac,taal number of chra is not puaarantecd. At tire completion of the weatheritaation welts.,and at no additional cost to the hornc°owner,a final blower door and/or combustion sarfety analysis will he c.undut�acel by the sulraontractor to ensure tlie:±afctly of the irrd(ml air quality. ti68t1.CN;) ACR SEALIPsQ Provide labor and materials to install Q-ton we,alhersarippinp and at doorsweep to(3)door(s)to restrict ail,leakage. $2250) DAMMING', Provide WWI anti maicTiats to hrstall a 12"layer of R-38 unfaced filvrplans battw to(2 4)stlnasc feet t"era ctntnatnlnpv purposes" S49.20 ATFI`FLATi'r+ovide laatmr and rnateraatw to install a 10"Layer of ft-3`i Class t Cc lluloxe added to(540)square feet of ollen attic Space, $793,80 ATTIC ACCESS:Provide labor and materials to install(1) new,hnnshed plywo(Ad,with 2"rigid 1'hcrruax board,weatherstripped Otic spoacc ac'cesM jnnvh. Plinio coal;and/aa paint is not includeal. $115,00 C RAWLSPAC'.K Piovide tabor and maorials to install(1 16)square teur of fa nal polyethylene over open ground in desi+nined CniWlspaac,e/ear then b.awment area-S. S9932 Www,american installations.Com Endiess Energy Home Performance Contractor 184 Cedar Hill St,Marlborough,MA 01752 NTR ACT 774-540.1544 FAX(401)784-3710 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# V10RK ORDER Marilenin Vasquez (978)853-0100 12/08/2015 425305 00001 SERVICE STREET BILLING STREET 42 Sargent Street 42 Sargent Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE,21P North Andover, MA 01845 / North Andover,MA 01845 JOB DESCRIPTION Total: $1,952.32 Program Incentive: $1,834.24 Customer Total: $318.08 WEAGREE HERESYTO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH MOVE SPECIFICATIONS.FORTH€SUM OF ***Three Hundred Eighteen &08/100 Dollars $318.08 AUT RR SIONATUR.•Endless ners To EPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN D E OF EPTANCE — .. bAYS. 1?4111, o less "Inergy PERMIT ENT AUTHORIZATION ALL ED 1, do hereby authorize (homeowner a me) the company or contractor, selected by Endless Energy*, to obtain any and all necessary building permits at (atreet Addl,Cftyrrown,state, ip) Permit Authorization obtained by Endless Energy Homeowner of Above Listed Address: (fume Signed) (Name Printed) Endless Energy Representative: 44d(6,ae s geed) !!i� '71 e (Name Pted) This form supersedes any previously submitted letters) 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, AL4 021142017 wwwmass.gov1dia 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): I I am a employer with 10 4. [:] I am a general contractor and 1 6. F-1 New construction employees (full and/or part-time).* have hired the sub-contractors 2171 1 am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have 8. E] 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 10.❑ Electrical repairs or additions 3.n I am a homeowner doing all work officers have exercised their I Ln 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 1AM7 Other Weatherization employees. [No workers' 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. TContractors that check this box Must attached all 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 ant an employer that is providing workers'compensation insurance for my emplqvees. Below is the policy andjob site information. Insurance Company Narne: HDI-Gerling America Inc Co. Policy# or Self-ins. Lic. #:000087615 Expiration Date:5/9/16 — Job Site Address: 42 Sargent Street City/State/Zip: North Andover/MA/01 845 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 t10 hereby certify under the pains and penalties of perjury that the information provided above is true and correct. nat& ,I4 Date: 2/05/16 Phone#: 5708205990 Official use only. Do not write in this area,to be completed by city or town official. 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) ®® 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 GroupPHONE Ex (570)819-2000 AIC No;(570)819-4000 613 Baltimore Drive E-MAIL szaccone@easterninsurance rou com ADDRESS: g p' INSURERS AFFORDING COVERAGE NAIC# Wilkes Barre PA 18702-7980 INSURER A:HDI-Gerling America Ins Co 41343 INSURED INSURER B: Endless Mountain Water Services, LLC, DBA: Endless INSURERC: Mountain Solar Services, DBA Endless Energy INSURERD: 286 Kidder St INSURER E: 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 LIMITS LTR D POLICY NUMBER MM/DDIYYYY MM/DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO A CLAIMS-MADE �OCCUR PREMISES (E.occurrence) ccurrence) $ 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 X POLICY❑JECT PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident 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 Peraccident Medical Expense $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A 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 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 NS025 onl4m i Mel 0 , CYC tiLtilfi' � (d( Office of Consumer Affairs a d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home lmprovemeAt,.,Contractor Registration Registration: 174479 Type: Supplement Card Expiration: 1/28/2617 ENDLESS MOUNTAINS SOLAR SERVICES; ERIC CHARTRAND 288 KIDDER STREET WILKES BARRE, PA 18702 Update Address and return card.Mark reason for change. SCAJ 210M-05111 Address El Renewal [—I Eniployment Lost Card —JQ�Omce of Consumer Affairs&Business Regulation License or registration valid for individul use only -"�ME IMPROVE CONTRACTOR before the expiration date. If found return to: -M IMPROVEMENT W1 A Consumer Affairs and Business Regulation Office of 9 ,744...-.-.q 10 Park Plaza-Suite 5170 egistration:� .-1 Type: ra Expiration:'m:11'(28/2017`:; Supplement Card Boston,MA 02116 ENDLESS MOUNTAIN'S SOLAR S,�RVICES,LLC ENDLESS MOUNTAINS,-*.5 W,...§ERVICES ERIC CHARTRAND 288 KIDDER STREET WILKES BARRE,PA 18702 Undersecretary Not valid without signature rr, (1,rIg Jr CS-108214 ERIC'CIIART 3RA 94 1q,M STREET Gardner ET 01440 0410212018 27 Sanborn St Fitchburg MA 01420 978-652-2680