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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 *..—i t 'I E IN -6m.siteo. rnp§ter Pt T' AM o 2aa Me dMa` f, 4 .111 t . WE'! j Zfl, "Y 4 0 pre/ Fire Dep iq- a rp P F%, da X, R�l M N'N k �T IS 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 @7 57 U) 0 10 0 CD 0 Z U) 9-4. o CD CL C*) 0 CL c U) > 0 0 CD 0 CL = cr CD CD 0 03 Go C (D = 0 U) CL CD 0 S' = CO CD U) 0 -0 z CD 0 0 f -4L 0 CD a 0 (D 1-7-1 < 0 O'o 0 co. cn U) m C.L '0 7CD C-) Cr) ;mu z o 72. cn 0 = CD T. 0 0 CL 0 Fn =r . CA ID CD F 0 N P 'COD CD 0 CLOJ > CL 04 lob: 0 CWD CD -0 CL 0 o< X 0 U)- 2 0 --h C=n -0 z CD 0 0 54L = 9 cr 0 =r r -I - .. S. CD U) U) < m 0 U) o 2L:4 (a r2- 0 EL M CD U) CD U) 2: rL CD io CD U) CD 0 =r CD CD U) 0 P > CD CD CL C: fD m m M m z Z m m 0 r- m �o 0 ao =' m -n X 0 orq =r Cl) -n 2L =r m Cl) -n 0 =3 CL cu ft 0 M m 0 Ln m Ln (D 3 -n 0 0 m -- 7z A: (D 0 > 0 m > 0 (:) M X z a c n X m Cl) C-) o 0 0) cn ol: WE < 0 O'o 0 co. cn U) m C.L '0 7CD C-) Cr) ;mu z o 72. cn 0 = CD T. 0 0 CL 0 Fn =r . CA ID CD F 0 N P 'COD CD 0 CLOJ > CL 04 lob: 0 CWD CD -0 CL 0 o< X 0 U)- 2 0 --h C=n -0 z CD 0 0 54L = 9 cr 0 =r r -I - .. S. CD U) U) < m 0 U) o 2L:4 (a r2- 0 EL M CD U) CD U) 2: rL CD io CD U) CD 0 =r CD CD U) 0 P > CD CD CL �e 0 .60 0 0 a A xp < (D z fD m m M m z m m 0 -n LA (D n rD �o 0 ao =' m r- m Q > M m 0 -n X 0 orq =r M m 0 -n 2L =r m o aq -n 0 =3 CL cu ft 0 M m 0 Ln m Ln (D 3 -n 0 0 m -- 7z A: (D 0 > 0 m > �e 0 .60 0 0 a A xp < 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