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HomeMy WebLinkAboutBuilding Permit #467-2017 - 1004 SALEM STREET 11/2/2016 �t itr��t BUILDING PERMIT 1 1� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ! � Permit NO: y�07 `�17 Date Received /I ^ d aJ"A °A^reo�PP�(5 Date Issued: l - 7,0/60' SSACHUS� IMPORTANT: Applicant must complete all items on this page LOCATION 1004 Salem Street North Andover MA 01845 Print PROPERTY OWNER Carmen Henriquez Print MAP NO:2.10/014.DPARCEL: 0031 ZONING DISTRICT:0000.0 Historic District yes Machine Shop Village. yes �Jno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family 0 Industrial X Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Air sealing, Blown in Class I Cellulose insulation to exterior walls Identification Please Type or Print Clearly) OWNER: Name: Carmen Henriquez Phone: 781-248-6905 Address: 1004 Salem Street North Andover MA 01845 CONTRACTOR Name: Eric Chartrand Phone: 978-652-2680 Address: _ 27 Sanborn Street Fitchburg MA 01420 Supervisor's Construction License: CS-106214. Exp. Date: 4/02/18 Home Improvement Licenser 174479 Exp. Date: 1/28/17 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.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner attached Signature of contractor ■ -4 NORTFI BUILDING PERMIT J 0* ,ED 6,91'0 TOWN OF NORTH ANDOVER 32 �, ` ` APPLICATION FOR PLAN EXAMINATION '. A' _ �. �• 1 _�'`��'�� y Ocwi�ia.K 1 co w 1• Permit No#: Date Received �9ssACHusE��S Date Issued: IMPORTANT:Applicant must complete all items on this page r �O, ATIOrN. fPrrit PROPE:RT3Yf`b1NNER .--- Y �-- _ 0.n 100ear4 StStructure-T yes no; EMAP GFAROEL _ ���Z0jN, DISTRI,CF tHistorici®ist:fict" ye-s no _ (Machine_ Shop Village s yes ono, j � � 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 _ D,,Septic ❑V11elh ti Floodplain, QWetlands. ilNatershed�Distnct - FWater/Sewer _ - ---- - — - -- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Address: -u-pervisor`s Constructio ',,16i0 h -hbLEWomeI' mprovemetcJl 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 S.F. �rotal Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund hag—re f:Agent/Ownert ,. Signature of contractor :r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r � Roofing, Siding, Interior Rehabilitation Permits Li Building Permit Application Li Workers Comp Affidavit ❑ Photo CopY Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit 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 Doe:Building Permit Revised 2014 ■ Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimming 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 - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS t Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street - 1DEPARTMENT, 'iT pumps ter'onsite #nb s - Located:at`1241 �.z._Mam�St�eet iF re Departmentg,s. gnature/date tGOMMENT S _ limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For department use) I ` I ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Permit Revised 2014 Location it AO 4 5�� �a No. 5►b? - a At 7 Date tll021l1e',to • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# SS-)_ 3 1 1 1 G !/' Building Inspector r '1 ttORTH - — O No. rltc- h ver, Mass,! ' — 00/ �! COCNICNl WKR y1. x.95 R-ATEO U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT r.�.4,,,.,,,,C OfA� .!!'. .N,,, ,,,,,,,,,,,,, BUILDING INSPECTOR ..... Foundation has permission to erect .......................... buildings on .........� A R'! ........., ....i �........�................ Rough to be occupied as ........... :......f.�oo �. :... ......#�S r' �� . ......................... 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 ......... .. W. - ...................................... """ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 w ww,.endlessmtnsolar.com A Home Perrormance Contractor a' I t 184 Cedar Hill Street,Marlborougb.&M 01752 CONTRACT NT i A T 508-357-2355 FAX 508-532-3562 s :,. ., - Page t PICOGRAM CMA-HPC PKOt;E DATE_F CLIENT0 WORX ORDER Carmen Hettriquez (781)'248-6905 09/1512016 425270 001)()4 SERYfCE STREET ,.••.._ ._ _._..-..w SILLING.STREET - 1004 Salem Street 1004 Salem Street. sERvrcE crTY,STATE.zn= E0.11NG cm.STATE,ZIP North Andover.MA 0 1845- North Andover,MA 01845- JOB DESCRIPTION AIR SEALING:Provide labor and materiais to seat areas of your home against wasteful,excess air Icakace. This work will he performed in concert with the use of special tends and diagnostic tests to assure that your home will be left with a hLotbful level of air exchange and indonr air quality.Material;;to be used to seal your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) Tbis whit require(2)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur.but the actual number of cfm is not guararic d. .At the completion or the weathcrization work,and at no Additional cost to the homeowner,a final blower door and/or C tnbustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. 517U.(xl WALLS:Funtish and install blown in Class I Cellulose to(153{)square feet of shingle and/or clapboard exterior walls.The hurt of the upper Course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the w(lod siding is reinstalled using stainless steel finish nails.Touch-up painting,if needed.will be the customer's responsibility. Invoicing will occur upon completion of installation.Homeowner hus received a copy of the CPA's Renovate Right Lcad-Safe information guide explaining the potential risk of the lead hazard exposure from tine weatherization work lobe performed.Your signature is your acknowledgement of receipt and agreement tO proceed. S2.841.1bo 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&801100 Dollars $841.60 AMiKORIZED SIGNATURE-F sEnrrgr -. CUSTOMER ACCEPTANCE __ ....�._._.,.... �w. f�TE:TAS CO Wn'HDRAWtJ EY US IF NOTEXECttTED Wtl'IfIN DATE OF ACCEPTANCE DAYS. hfps://mail.google.com/mai l/u/1l#inb©x/157308a9ff4a94b9?projector=l q!1 End �ess Enegy PERMIT AGENT AUTHORIZATION FORM ALL INFORMATION IS To BE TYPED OR LEGIBLY PRINTED 1, f ' , , do hereby authorize (ii rnneowne ame) the company or contractor, selected by Endless Energy* to obtain any and all necessary building permits at jytJ, A ',A4 ld�c A14- 61&�6 (street Mdress, iti/Town,stat ,Zip) Permit Authorization obtained by Endless Energy Homeowner of Above Listed Address: (Name Signed) -t 6".j /t� - �L/ ,!�6 (Name Printed) � — 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 1 Congress Street,Suite 100 < Boston,MA 02114-2017 s eJ` www mass.gov/dia V4'orkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganizatiorOndividual):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.M✓ I am a employer with 10 employees(full and/or part-time).* 7. E]New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8, ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.I I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E]Building addition 4.❑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 11.[:]Electrical repairs or additions proprietors with no employees. 12.E:]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E:]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14.�✓ Other Weatherization 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no 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 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. I do hereby certify under the pai nd penalties of perjury that the information provided a ve is tr a and correct. Sign Si tures Date: Ila Phone#:570-820-5990 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#: ` &mmomveald Office of Consumer Affairs andVusgulation == = r 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 174479 ' Tvpe: LLC Expiration: 1/28/2017 Tr# 261910 ENDLESS MOUNTAINS SOLAR SERVICE'S;. MICHAEL PITCAVAGE -� 288 KIDDER STREET - WILKES BARRE, PA 18702 Update Address and return card.Mark reason for change. Address ❑ Renewal F-] Employment host Card DPS•CA1 %r SOM-04/04•Gta1216 ,�. /z. a»vnuu re !z a`6 /-rtelt� License or registration valid for individul use only ;;a;;;, Office o`t�o�mer At�la�r�&Ru(siness�cgalahoq �� y -'.. jbefore the expiration date. If found return to: o,HOME IMPROVEMENT CONTRACTOR p ....` Registration:_174479 Type: Office of Consumer Affairs and Business Regulation _ Expiration: 112812017 LLC 10 Park Plaza-Suite 5170 ." ti ,_ Tr y�,,• ". ,:;_ ;;.:;:`,, Boston,MA 02116 ENbESS MOUNTAfNSSOLAR';SERVICES,LLC ENDLESS MOUNTAINS-;SOLAR SERVICES MICHAEL PITCAVAGE;.;;;.:- 288 KIDDER STREET � � WILKES BARRE,PA 18702 Undersecretary of valid without signature ENDLMOU-03 AMCCONE '4�oRo CERTIFICATE OF LIABILITY INSURANCE FDATE 1012 0/201 6Y) 1012012016 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 NAME: Sharon Zaccone Eastern Insurance Group PHONE Ext): AX No: 570 819-4000 1130 Hwy 315IC Wilkes Barre PA 18702 E-MAIL szaccone ane a.com ADDRESS: p p INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:HDI-Gerling America Insurance Company 41343 INSURED 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS INSD WVD POLICY NUMBER MMIDD MMIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR EGG000087616 05/0912016 05/09/2017 DAM ORE D PREMISES 100 000 Ea occurrence $ 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❑JERCOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO EAGCC000087616 05109/2016 05/09/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB CLAIMS-MADE 02524E150ALI 05/09/2016 05/09/2017 AGGREGATE $ 2,000,000 DED X RETENTION$ 100,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN EWGCC000087616 05/09/2016 05/09/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE9 $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I 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 Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main St North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 4 Masbachusens - Of ent drt�g ggUi3t7('n Ud iC sat et ani 3`"cafa?s s` CS-108214 ERIC CHART TU GaIr Ef 4STREEdNIA oaaao Loz 04/02/2018 27 Sanborn St Fitchburg MA 01420 978-652-2680