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Home My WebLink AboutBuilding Permit # 11/2/2016 H BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION - a Permit NO: 9(02 7 Date Received_ �R Q+i'ITco npp�'t7 Date Issued: l t J4 (� SSgcHVS� IMPORTANT: App Iicant mast complete all items on this page LOCATION 1004 S616M Street North Andover MA 01845' Print PROPERTY OWNER, Carmen Hbnriguez Pr�r�t IAP NO:21QIa14 DPARCEI-: '0031 ZONING DISTRICT Qaflo a Historic 1]istrict' yes no' Mach ne Shop Village yes; not TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family 7 Addition F1 Two or more family ❑ Industrial iXAlteration No. of units: U Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑!Septic ❑We]l 11 Floodplain ❑Wetlands CI Watershed District D!Nater/Sewer. Air sealing, Blown in Class I Cellulose insulation to exterior walls Identification Please Type or Print Clearly) OWNER: Name: Carmen Henri uez Phone: 781-248-6905 Address: 1004 Salem Street Borth Andover MA 01845 CONTRACTOR Name Erre Chartrand PI1C7ne:. .i 97 -652-2680 .i. Address_ 27 Sanborn Street 1=fehburg MA 01420 Supervisor's Construction License. Exp Date; CS-108214 4102I18 HomeImprovement License Exp pale; 174479 1I28117 .. 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: $ 3,011.60 FEE: $ 36.00 Check No.. 5523 Receipt No.: 1 1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ..attached Signature ofcontractor`. F tkORTy q Town of z :� _ �, 6Andover No. 46To- 26a - �ah ver, Mass, 02 COCNfC Kt wJCK 1' Rwreo S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .................I ..rpir ........0 .�".+I!1�!..'�.............. . ...... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .........r® .,....... ! ..".� ........� ......... Rough to be occupied as ........... ..... ��. .. ..... .S.�1A 0. ......................... chimney 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 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough ......, ... .�.�............................................ Service ti BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Brxildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT , Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 9/20/2016 Image(89).jpg Endless Energy www,andlessmtnsolar.corn ur Home Performance Contractor 184 Cedar Hill Streel,htarthorouph,titin 01752 508.357.2355 FAX 508-532-356Z CONTRACT Page 1 PROGRAM CeraTOrdkla PROW" CAT iE CLIENT a WORK OnDan Carmen Henriquef. (781)248-6905 09/15/2010 425270 00004 SERVICE STREET _.... ..... ._.., _. _... _. BILLING ETREET 1004 Salem Street 1004 Salem Street aERYYG€GYT Y,aTA7&,ZYP BILLING CITY,STATE,ZIP North Andover.MA 01845- North Andover, MA Q1845- JOB DESCRIPTION AIR SEALING:Provide labor arid materials to seat areas of your home against wasteful,excess air leakage, This work will he peribrnred ill concert with the Ilse of special orots and diagnostic tests to as'sore*lbal yrrur home kvilt be left with It haarithtut level of stir exchange and Nidonr air quality maleriads tea be used to seal your homer Can Include caulks,Ikmttts and other products. primary areas for,sealing include stir leakage to atlics,lrasetnents,attached garages and other Unhealed arc as(windows are not generally addressed.) This will require(2)working hours.A reduetion in cubic feet per minute(crm)of air infiltration will occur.bill(he dual number of ef"ru Is not gua rantced. At the completion ol'the evcalherixation work,and at Ila additional cost to the InonVOwner,YI nnal WOWCr dour and/orc(onhusnou sa ety analysis will be Conducted by the sub-contractor to ensure the Nafely of the indoor air quality, 5 WALLS;Curnislr and install blowta at Class I Cellulose to(1536)square Bret of shingle antrJor clapboard exterior walls,'I'hc tract or the upper course ot`your wood siding is cart to drill holes into the wail sheathing behind,The holes are their plugged and the wood siding is roinstailed uNing stainless steel finish nails."Touch-up traintiag,if needed,will be the cusminer'w rcaponsihility, Invoicing will occur upon completion of installation.Homeowner has received a copy of the D'A's Renovate Right lead,Safe iRfornration gaidc explaining the potential risk of ific lead hazard exposure from tilt!WeRtherization work a.)he performed.Your signature in yerur ackncrealetltletrTent of receipt and agrcettrcttt to proceed. 52,h4 1.60 Total: $3,011.60 Program Incentive: $2,170.00 Customer Total. $841.60 WE AGREE HEREBY TO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Eight Hundred Forty-One& 601100 Dollars $841.60 °� aY f GosTdLeeR,,. AUTaiORIZED,9kONATURE�En as Enmr AGCEPT'ANICE NOTETRIS COPITITAe"T1nAY"181E 46DRAWN BY US U`NOT EXECUTED YRTNtN DATE OF ACCEPTANCE •: _... DAYS. https://nl all,googIe,com/mai I/0/ffinbox/l57308a9ff4a94b9?proj ectcrr=1 1t1 4) 2 n(,:,i r i�:, ol j y ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED f'H� me) do hereby authorize the company or contractor, selected by Endless Energy*, to obtain any and all necessary building permits at A, �-ec mm Tow t ,zlp� ---— L�� (streot " d ity/ n,$to Permit Authorization obtained by Endless Energy Homeowner of Above Listed Address. (Name signed) (Name Printad� Endless Energy Representative: f $1 ed) (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 Mass ave program, This form rnUSt Contain only the people you want to pull perr"nits in your name To make changes to this form, You must submit a new form This form wW delete and replace any previous authorization forni and the information contained thereon, The Coinnioiiweallh of Massachusetts Depai-iment of'Industrial Accidents I Congi -ess Street, Suite 100 Bostoti, MA 02114-2017 www.ntass.gov1dia Workers'Compensation Insurance Affidavit: Btiilders/Conti-,,ictors/Electi-iciaiis/Pltinibet-s. TO BE FILED WITH TME PERMITTING/WTHORITV. Applicant Information Please Print Legibly Narne (Btisiness/oi-gaiiizatioii/individLIal):Endless Mountains Solar Services Address:288 Kidder St City/State/Zip:Wilkes Barre PA 18702 Phone #:570-820-5990 Are you an employer?Cheek the appropriate box: Type of project(required): 1.0 1 am a employer with 10 —.employees(frill and/or part-time).* 7. ❑New construction 2.[-]1 am a sole proprietor or partnership and have no employees working for tric in 8. FIRemodeling any capacity.[No workers'comp.insurance required.] 9. n Demolition 3,0 1 am a homeowner doing all work myself'.[No workers'comp.insurance required]t 10 n Building addition 4.E:]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I Ln Electrical repairs or additions proprietors with no employees. 12.F]Plumbing repairs or additions 5.r-j 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.F-]Roof repairs These sub-con(ractors,have employees and have workers'comp nISUralICC.1 14.[Z]Other Weatherization 6.[:]Weare a corporation and its officers have exercised their right of exemption per M61,c. 152,§1(4),and we have no employees.[No workers'crimp.insurance required.] L *Any applicant that checks box#I mast also fill out the section below showing their woikers'conipensatiori poliey information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such. -Contractors that check this box most 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 most Provide their workefs'eonip.policy number. I ani an employer that is providing workers'contliensation insuiwitceor ray employees. Beloiv is the poliqy and job site inji7rniation. Insurance Company Nat-ne:HDI-Gerling America Ins Co ........... Policy#or Self-ins. Lic. #:000087616 Expiration Date:5/9/17 Job Site Address:1004 Salem Street City/State/Zip:N 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under tlrehrrir rrrdlrerrcrlties qf'j)eijwy prat the iii/brination provided 10 ve is ti to and correct. Sign bU Date: /leo Phone#:570-820-5990 Official use only. Do not write in this area,to be coinjileted by city or town official, City ol-Town: Permit/License Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Cityff'own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Pei-son: Phone#: Vi\ Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cantkactor Registration Registration: 174479 Type: LLC Expiration: 1128/2017 Tr# 261910 ENDLESS MOUNTAINS SOLAR SERVICES., MICHAEL PITCAVAGE 288 KIDDER STREET - WILKES BARRE, PA 18702 Update Address and return card.Mark reason for change, Address ❑ Renewal 0 Employment ❑ Lost Card OPS-CAi 0 90na-0404•GM216 } w Office o e UlTOonsnmer Atuer A airs psi Inness gu anon License or registration valid for individnl use only �l� •rr �,, HOME IMPROVEMENT CONTRACTORbefore the expiration date, If found return to, Registration: 179479 Type: Office of Consumer Affairs and Business Regulation tF41 Expi€anon 1/2812017 LLC 10 Park Plaza-Suite 51'70 Boston,MA 02116 ENC) ESS MOUNTAINS SOLAR,SERVICES,LLC ENDLESS MOUNTAjNS.'SOLAR S. RVICES MICHAEL PITCAVAGE 288 KIDDER STREET WILKES BARRE,PA`I$702 • Uadersccretary �-of valid without signature 4 ENDLMOU-03 J4SZACCONE A��Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4�. � 10/20/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Sharon Zaccone _ Eastern Insurance Group PHONE FAX (570 819-4000 1130 Hwy 315 E-MAILo Ext AIC No: 1 Wilkes Barre,PA 18702 ADDRESS:$Zaccone@apnepa.com INSURERS AFFORDING COVERAGE NAIC# INSURER A;HDI-Gerling America Insurance Company 41343 INSURED �u INSURER B:StarStone National Insurance Company 25496 Endless Mountain Water Services,LLC INSURER C_HDI Global Insurance Company 286 Kidder St INSURER D: _ Wilkes Barre,PA 18703 INSURER E; INSURER F COVERAGES CERTIFICATE NUMBER: 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 ADDLR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AGE T0-R-MTP0- CLAIMS-MADE OCCUR EGG000087616 05/0912016 05/09/2017 PRE uM SES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 2,000,000 �^ ]i PRO- POLICY !ECT ❑LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO EAGCC000087616 05/09/2016 05/09/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NPROPERTY DAMAGE $ HIRED AUTOS AUTOS UTOS ED Per accident --- $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ 2,000,000 j EXCESS LIAR CLAIMS-MADE 02524E150AL1 0510912016 05/0912017 AGGREGATE _ $ 2,000,000 DED X RETENTION$ 1001000 $ WORKERS COMPENSATION PER OTH. AND EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETORlPARTNERIEXECUTIVE Y❑ N!A EWGCCO00087616 05109/2016 05/09/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1 000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , r DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If 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 Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St North Andover,MA 01845 AUTHORIZED REPRESENTATIVE s O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I a .v a CS-108214 394j+'. AjAND S7Fa(,f 71r CjJ1Cx , A4A Uj$a(1 0410-1/2018 27 Sanborn St Fitchburg MA 01420 978-652-2680 i