HomeMy WebLinkAboutBuilding Permit #946-16 - 25 RIDGE WAY 3/7/2016� 4h4,�U` ,A
Permit 10' (V
Date Issued:
LOCATION 25 Ridae Wa
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received '6
TANT: Anplicant must comolete all items on this
Print
PROPERTY OWNER Laura Teece
Print
MAP NO: 210 PARCEL: 098.13 ZONING DISTRICT: 0087 Historic District yes no
Machine Shop Villaqe ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
0 Addition
[I Two or more family
0 Industrial
N Alteration
No. of units:
E) Commercial
o Repair, replacement
0 Assessory Bldg
El Others:
0 Demolition
El Other
D Septic El Well
El Floodplain 0 Wetlands
[I Watershed District
D Water/Sewer
I
I I
rafter bays
Identification Please Type or Print Clearly)
OWNER: Name: Laura Tecce Phone: 781-760-9793
0
iaress: zo Kiage way, Norm Anaover, IVIA U1040
CONTRACTOR Name-. EndlessEnergy
Phone: 774-540-1544
Address:
184 Cedar Hill St, Marlborough, MA 01752
Supervisor's Construction License: Exp. Date:
108214 4/02/18
Home Improvement License: Exp. Date:
ARCH ITECT/ENGINEER
Address:
Phone:
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.:. �(!a� 4 Receipt No.: 9/) 7)
NOTE: Persons cokia'�tinj_with unregistered contractors do not have acc�essw to the gularanty
f, —1 1 -'el ;P1 A-1
Agent/Owner a±1t2j2JA Signature of contractwr!���___�"
,8igRature of h�f z I
I*
i
io
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 No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G rnin.sl 00 -sl 000 fine
NOTES and DATA — (For department use)
.... . . . .... .. ..... .. ... .... . ..... ...... . ...... ....... . .... .. . .
Ell Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
-1 . F-1
Plans Submitted "
Plans Waived Certified Plot Pl�n Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Well
Private (septic tank etc. El
Tauning[Massageffiody Art F1
Tobacco Sales El
Pennanent Dumpster on Site El
Swimming Pools El
Food Packaging/Sales El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
I
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On Signature'.
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
I Planning Board Decision: Comm
Conservation Decision: Comments
Water & Sewer Connection Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
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Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding5 Interior Rehabilitation Permits
4� Building Permit Application
4. Workers Comp Affidavit
4, 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
4, Photo Copy of H.I.C. And C.S.L. Licenses
�6 Copy of Contract Of Proposed Work With Sprinkler Plan And
-�6 Floor/Cross Section/Elevation Plan
Hydraulic Calculations (if Applicable)
,4. Mass check Energy Compliance Report (if A,pplicable)
ed pro uc s
4. Engineering Affidavits for _ngineer
OTE: 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 cornp Affidavit ns (One To Be Returned) to Include Sprinkler Plan And
4- Two Sets of Building Pla
Hydraulic Calculations (if Applicable)
Copy of Contract
2012 IECC Energy code
Engineering Affidavits for Engineered products
10TE: 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
Location
No. Date
Check #
TOWN OF NORTH ANDOVER
Certificate of Occupancy $--
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Building Inspector
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Indless Mountaim www.andimmintolar.com
AtIlAr servitv% Endless Energy
Home Performance Contractor
184 Cedar Hill U Marlborough, INIA 01752 CONTRACT
774-.W4544 FAX (401) 784-3710
Page I
PROGRAM
CMA -HPC
CUSTOMER PHONE DATE CLIENT 9
WORK ORDER
.attra Tecce (781)760-9793 12/11/2015 423189
00001
SERVICE STREET BILLING STREET
25 Ridge Way 25 Ridge Way
SERVICE CITY, SYATE; ZIP BILLING CITY. STATE, ZIP
North Andover, MA 0 1845-4740 North Andover. MA 0 1845-4740
JOB DESCRIPTION
AIRSVALINC: 11mvide labor anti I"alcrials to scal areas ofyour lionic ailaiteu wastefid. exccss air luakage. 11iis work will he
perjormcd in concetl with the list: lools and diagnonait; tests it) tissum that your horric will he left with a healthful level of
air exchange and incloor airtluality, MateriaN to he use,] lit scal yoor honic can include caulks, loams and other protiucts.- 11rimary
aft -alt for sealing include air leakage to utticq, hasements, attached garap"� anti tither unheated areas (windows are not generally
addre.�sc(h ( 12) working hours. A reduution lit cubic feet por ininuie Icfin) nfair infillration will wcur, but the actual nurnheroft:1,111
is fall gumilice(L
At tho completion ofthe weatherization work. and at it(, additional cost it) the horneowner. a final blower door anct/or cornhuslion
saletv analysis will he conducted by the suh-contractor lit ensure the safety (if the indoor air quality.
$1,020.00
DAMMINQ Provide labor anti materials (1) als�lall it 12"layer Of R-114 unfaved Aherrlass hatts 1(, (72 1 square feet lordanitning
A ITIC 11 AT: Provide labor anti inaterials to install it 6" layer ofR-21 I Cla." I Cellu lose added it, 11140) square I - cc( ofopen attic
$1,436.40
A'1'1'1(' ACCUNS: Priwide labor and materials lo insulate the back of 0 ) attic hatch with 2" ri�i(I'Mermax board. Wcalhersirip the
KNEIVALL 11 DOR: Provide labor and inutunaIx lit install a ID" laver of dense packed R-35 Cla.ss I Celluloscadded it) (2hi square
ofklicewall lloor,
$50.71)
VENTILATION: Provide labor and materials to imiall 12l insulaled exhaust hose lit existing hathnioni fants).
VENTUATION: Novitle labor and niaterials it) install ventilation chutes in (60) taller hays lit maintain air now.
S1320)
Fndless Mountains
suht servivo Endless Energy
Home Performance Contractor
184 Cedar M11 St, Marlborough, MA 01752
774-540-lS44 rAX (401) 784-3710
Lama Tecce
SGAVICE STREET
25 Ridge Way
smicE CITY, 's 7TjT e, Z I P
North Andover, MA 0 1845-4.7,40
www.ondlessminsoler.com
CONTRACT
Page 2
PROGRAM
CMA -HPC
PHONE DATE
(780760-9793 12/11/2015
BILLING STREET
25 Ridge Way
BILLING CITY. STATE, ZIP
North Andover, MA 0 1845-4740
JOB DESCRIPTION
CLIENT 0 WORK ORDER
423189 00001
Total:
Program Incentive:
Customer Total:
WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE wi'rH ABOVE SPECIFICATIONS, FOR THE SUM OF
***Four Hundred Ninety & 90/100 Dollars
THOAIZE6 10� 446AE�-Mwl..�io;fqy
I,
N "0
0 : THIS CO TRACT MAY 13F WITHORAW14 BY US IF NOT GXECUTED WITHIN
- DAYS.
AN.E
CU$To C PTAN E
DATE OF ACCEPTANCE
$2,983.60
$2,492.70
$490.90
$490.90 1
Endless
Energy
I PERMIT AGENT AUTHORIZATION FORM
ALL INFORMATION IS TO BE TYPED OR LEGIBLY PRINTED
Teccp, , do hereby authorize
(Homeowner's Name)
the company or contractor, selected by Endless Energy*, to obtain any and all necessary
building permits
Cityrrown, State,
Permit Authorization obtained by Endless Energy
Homeowner of Above Listed Address:
Endless Energy Representative:
(Name Printed)
(Name Signed)
(Name Printed)
a
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
Vlj'�ssw,tave 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, MA 02114-2017
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information — Please Print Legibly
Name (Business/OrganizatiorAndividual): Endless Mountains Solar Services
Address: 288 Kidder St
Citv/State/Zim Wilkes Barre PA 18702
Phone #: 570-820-5990
Are you an employer? Check the appropriate box:
V I am a employer with 10
4. E] I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
R I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comi). insurance
comp. insurance.'+
required.] 5. F-1
El I am a homeowner doing all work
myself [No workers' comp.
insurance required.] t
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'
comi). insurance required.]
Type of project (required):
6. New construction
7. Remodeling
8. E] Demolition
9. Building addition
10. Electrical repairs or additions
I I.E] Plumbing repairs or additions
12.FJ Roof repairs
13M Other Solar
*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 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 insurancefor my employees. Below is the policy andjob site
information.
Insurance Company Name: HDI -Gerling America Inc Co.
Policy 9 or Self -ins. Lic. 9: 000087615
Job Site Address: 25 Ridge Way
Expiration Date: 5/9/16
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 h ereby certify under th e p ndpenalties ofperjury that the information provided above is true and correct.
Z_ �/ .# t — , - :7 1 e .4 �,4 f A 2/05/16
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#:
7 0
AC40RO CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIDDIYYYY)
r 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:
HONE
1C, . (570) 819-2000 FA (570)819-4000
PLA N Ext): (Alt, Nol:
Eastern Insurance Group
_
E-MAIL szaccone@easterninsurancegroup. com
613 Baltimore Drive
-ADDIRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A HDI -Gerling America Ins Co 41343
Wilkes Barre PA 18702-7980
INSURED
INSURER B:
INSURERC:
Endless Mountain Water Services, LLC, DBA: Endless
INSURER D:
Mountain Solar Services, DBA Endless Energy
INSURER E:
286 Kidder St
�INSURERF:
.Wilkes Barre PA 18703
COVERAGES CERTIFICATE NUMBER:Kas ter 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
LTR
TYPEOFINSURANCE
ADDLSUBR
POLICY NUMBER
POLICY EFF
lMIWDD1YYYY1
POLICY EXP
(MMIDDIYYYY)
LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
A
CLAIMS -MADE Fx7OCCUR
DAMAGE TO RENTED
PREMISES (E. CcurrnC.I $ 100,000
EXP (Any one person) $ 5,000
EGG000087615
5/9/2015
5/9/2016
-MED
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE $ 2,000,000
POLICYF PRO -
1 JECT F—] LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
Employee Benefits Liability $ 1,000,000
OTHER:
AUTOMOBILE LIABILITY
BINED INGLE LIMIT $ 1,000,000
C(EaMa ident)S
BODILY INJURY (Per person) $
A
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
EAGCCO00087615
5/9/2015
5/9/2016
BODILY INJURY (Per accident) $
PROPERTY DAMAGE $
(Per acciden I
NON -OWNED
HIRED AUTOS AUTOS
I
Medical Expense $ 5,000
UMBRELLA LIAB
I
OCCUR
I
EACH OCCURRENCE $
AGGREGATE $
EXCESS LIAB
CLAIMS -MADE
DED I I RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $ 1,000,000
A
OFFICER/MEMBER EXCLUDED? F—]
(Mandatory in NH)
NIA
EWGCCO00087615
5/9/2015
5/9/2016
E.L. DISEASE - EA EMPLOYEE $ 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
ACORD 25 (2014101)
INS02512014011
@ 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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
ACORD 25 (2014101)
INS02512014011
@ 1988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
0 e
ffic' of Consumer Affairs 2�d
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement'...Contractor Registration
................
ENDLESS MOUNTAINS SOLAR SEI
ERIC CHARTRAND
288 KIDDER STREET
WILKES BARRE, PA 18702
SCA I "; 20M -05/1i
(7RXI *11111-1111.2impffIlly
of Consumer Affairs & Business Regulation
E IMPROVEMENT CONTRACTOR
ENDLESS MOUNT�!�
ENDLESS MOUNTAIN$,. -SC
ERIC CHARTRAND
288 KIDDER STREET
WILKES BARRE, PA 18702
Type:
Supplement Card
LLC
Undersecretary
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, MA 02116
Not valid without signature
So Ce,
arcf Of au,"Cl, Pattment at p
9 Reg uo'lc S,7fet
Ulations anc, St
anciarcl,
-1cense CS.1082,4
3E9p4jECLCM"SU A A])
TRERT
Gardne"U 01440
0410212018
27 Sanborn St Fitchburg MA 01420
978-652-2680