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HomeMy WebLinkAboutBuilding Permit #947-16 - 1004 SALEM STREET 3/7/2016 A4Y W�c/�, 'V ✓ OORTH f BUILDING PERMIT ?a°4t``° ^6.6 0- y TOWN OF NORTH ANDOVER ° t APPLICATION FOR PLAN EXAMINATION Permit N0: q4q Date Received tecw<w1 A9A°AA7t0�pP�1� \ 7 ` - Date Issue . SSACHUS� IMPO :Applicant must complete all items on this page LOCATION 1004 SalgrStreet North Andover, MA 01845 Print PROPERTY OWNER Carmen Henriquez Print MAP NO: 104.D PARCEL: 0031 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑Two or more family ❑ Industrial IXAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer 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 CONTRACTOR Name: Endless Energy Phone: 774-540-1544 Address: 184 Cedar Hill Street Marlborough, MA 01752 Supervisor's Construction License: 108214 Exp. Date: 4/2/18 t Home Improvement License: 174479 Exp. Date: 1/28/17 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. a Total Project Cost: $ 3285.44 FEE: $ 30.00 Check No.: Receipt No.: NOTE: Pe,rsons c ntr c ing with unregistered contractors do not have access to the guaranty fu Signature of A Signature of contracto I BML®IMG PERMITtaoRry 0, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#• Date Received 7QADRR rED PPp Ly �SSacHus��c Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ®Welk Y+® FSI.© plant INetl�.,antls� { atershed@ Distr�icti. Watery e DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: J� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER&F, Total Project Cost: $ FEE: $ _ 4 Check No,: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract rinkler Plan And Floor/Cross Section/Elevation Plan Of Proposed Work With Sp Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered ,products ®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit I dum q � ®TE: All p P In all cases if a variance or special permit was required the Town clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWRAGE DISPOSAL r Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature f COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Y 1 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street T _ FIRE ^DEPAR�TtV1ER1Te"mp burnpsteron site yes 5 + �• no' ` � R� i�. §` Off � + ;Located at 12 Wa street .f j �1tM�A4t4�; SYf4 Y�,"..� lYf`.k :Fifre Dep+a+rtments,�gatur�e/dater► ;cn �} � ,y.� �r6 , r��}+Y'l`_�1.�'r'�' ;4�������L��'�� ',+•�C��r;:' .a , r.�� i'--"`tT ; b �r �'x�J�'�;',�''"E°C,�+�+`S�`i'�"�� � S' �"'°.�'.�,.,,�'x'�►� ° COMIVIENTS '"� r. � E Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes N® DANGER ZONE LITERATURE: Yes Mo MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine MOTES and DATA--(For department use) El Notified for pickup Call Email Date Time Contact Name Doc.Building Pon-nit Revised 2014 t--NoLocation/00 / 1, )t-- N o. . - —1,14, Date ` / y + • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee 40 Foundation Permit Fee $ Other Permit Fee $ F TOTAL $ Check# 30088 Building Inspector r 1 NORT1i Att" . ve' 'o O 0 No. h ver, Mass o , cocN�cNew�cK 1' �.9 A°RATED ►Pa�,�g5 S U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System THIS CERTIFIES THAT TAW1 ..!.j.A0&V........................................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ."I......... ..........o 0 .................. - Rough to be occupied as ....... ...� .. ....... .. .M�'.,t ... ..................................... Chimney provided that the person accepting this permit shall in every respect conform a 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 3a- UNLESS CONSTRUC^N TS Rough Service ......... ... ...... ............ ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place onthePremises — Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. vuww.amerlcanlnstailatlons:aotn Endless Energy Home performance Contractor 184 Cedar Hill St,Marlborough,MA 01752 CONTRACT 774-540-1544 FAX(401)784-3710 Page 1 PROGRAM CMA-HPC PHONE DATE CLIENT# WORK ORDER CUSTOMER Carmen Henriquez (781)248-6905 12/10/2015 425270 00001 3ERvi"STRM eILUNO STREET 1004 Salem Street 1004 Salem Street SERVICE CITY,STATE,aP BILLING CITY.STATE.ZIP North Andover,MA 01845- North Andover,MA 01845- JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primaiv areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (10)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of efm is not guaranteed. At the completion of the v+eatherization work.,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the subcontractor to ensure the safety of the indoor air quality. $850.00 AIR SEALING:Provide labor and materials to install Q-1on weatherstripping and a doorsweep to(1)door(s)to restrict air leakage. $75.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass batts to(192)square feet for damning purposes. $393.60 ATr1C FLAT:Provide labor and materials to install,a 6"layer of R-21 Class i Cellulose added to(969)square feet of open attic s�ce. $1.220.94 STORAGE BARRIER:homeowner is responsible for the removal of the stored items blocking the installation of weatherization work in the attic. Removal must occur prior to the scheduled work start. $0.00 ATI1C ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flat surface of plywcrod will be created around the opening within the attic. This will allow the cover's integral weather-stripping to restrict au leakage. $237:fi5 VENTILATION:Provide labor and materials to install(3)insulated exhaust hose with roof mounted flapper vent to exhaust emsting bathroom fan(s). $356.25 VENTILATION:Provide labor and materials to install ventilation chutes in(76)natter bays to maintain air flow. $152.00 www.ameficaninstallations.com Endless Energy Home Performance Contractor 184 Cedar Hill St,Marlboro*,MA 01752 CONTO AST 774-540-1544 FAX(401)784-3710 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CUENTX WORK ORDER Carmen Henriquez (781)248-6905 1211012015 425270 00001 SERVICE STREET BILUNG STREET 1004 Salem Street 1004 Salem Street SERVICE CITY,STATE,LP BILLING CITY.STATE,AP 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&86/100 Dollars $608.86 NATURE-EndWf9f2fCUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHORAWN BY US IF NOT EXECUTED W NIN DATE OF ACCEPTANCE DAYS. t C www.americaninstallations.com Endless Energy I Home Performance Contractor 184 Cedar Hilt St,Marlborough,MA 017.52 CONTRACT 774-540-1544 FAX(401)784-3710 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT F WORK ORDER Carmen Henriquez (781)248-6905 12/10/2015 425270 00001 SERVK:E STREET BILLING STREET 1004 Salem Street 1004 Salem Street SERVICE CITY.STATE,HP 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&86/100 Dollars $608.86 AU NATURE-Ertl n CUSTOMER ACCEPTANCE / NOTE:THIS CONTRACT MAY BE WRHORAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE DAYS. / J" i� Endd ess 4 . 7Enevgy PERMIT AGENT AUTHORIZATION FORM ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED 1, �� , do hereby authorize (H meowner ame) the company or contractor, selected by Endless Energy*, to obtain any and all necessary building permits at11-0 ,sa . '1�' (Street Alidress,Citifrown,Stat4,Zip) Permit Authorization obtained by Endless Energy Homeowner of Above Listed Address; (Name Signed) � ' YfI14144� (Name Printed) Endless Energy Representative: (Na Si 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 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. C7 The Commonwealth of Massachusetts Department of Industrial Accidents m Office of Investigations ' d 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia 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.❑ I am a employer with 10 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition an working for me in i employees and have workers' � y capacity.p �'• 9. E] Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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 q ] 13AOther 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. $Contractors 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 employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:HDI-Gerling America Inc Co. Policy#or Self-ins. Lic.#: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 under 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signatur /'Vl( 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(MMIDDIYYYY) A��o® 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 PHONE (57O)819-2000 AIC No:(570)819-4000 613 Baltimore Drive E-MAIL ADDRESS: g p'rou szaccone@easterninsurance com INSURERS AFFORDING COVERAGE NAIC# Wilkes Barre PA 18702-7980 INSURER A:EDI—Gerlin 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 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 ADDTYPE OF INSURANCE IVSD WVDSUBR POLICY NUMBER POLICYDEFF MM/DD/YYYY LIMITS EXP LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE X❑OCCUR DAMAGE 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 $ 2,000,000 X POLICYJECT 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 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED EAGCC000087615 5/9/2015 5/9/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Medical Expense $ 5,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION OTH AND EMPLOYERS'LIABILITY STAT YLITE ER ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA 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 1 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 INS025/9m4011 Uassach 8�ar e3ci4+'TIe 1 a fl, s ani { fur ctrnp fe to f . ."cic Safe' t'Ons ,. d r:irz n i� r. L'dr -;eRse CS_108214 TRAERIC�R 394 EI A4 SrRE T GardnerDgq EEE 01440 04/02/2018 27 Sanborn St Fitchburg MA 01420 978-652-2680 �(d Office of Consumer Affairs Business Regulat>on I, 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 174479 Type: Supplement Card Expiration: 1/28/2017 ENDLESS MOUNTAINS SOLAR SERVICES ERIC CHARTRAND 288 KIDDER STREET - WILKES BARRE, PA 18702 Update Address and return card.Mark reason for change. SCA 1 t: 2OM-05/11 `" [] Address C) Renewal ❑ Eniployment Lost Card :`'/fie 1`l..orri�rzanrarr.'c%�.��i-��(/l t9:itccludeC�` Yr)Uffice of Consumer Affairs&Business Regulation License or registration valid for individul use only a '% before the expiration date. If found return to: �. ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation ,�egistration;.,..1`7�4'7g,;,;. Type: 10 Park Plaza-Suite 5170 PR Boston,MA 02116 L= Expiration :1(2g/2017: Supplement Card ENDLESS MOUNTAINS;SOLA_.,_.. ICES,LLC ENDLESS MOUNTAIN LA ERIC CHARTRAND 288 KIDDER STREET WILKES BARRE,PA 18702 Undersecretary Not valid without signature