HomeMy WebLinkAboutBuilding Permit #626-2017 - 373 RALEIGH TAVERN LANE 12/8/2016\4
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
% One family
'9 Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
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OWNER: Name:
Address: 3 q3
Identification Please Type or Print Clearly)
ale °, `�Cavev n Ln
Phone: Q-+8 J 7--� (—ygyb
Address: 30 3 l W � NrIA-) t'"ni rev `'Cly 01,84S'Reg. No. l g aL100)
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ IS -"3(.0 FEE: $ 17q
Check No.: 4Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Plans Submitted ❑
Plans Waived ❑
"d,
Certified Plot Plan ❑ Stamped Plans ❑
iYPSOF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/MassageBody A- : Q
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 - U FORM
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
Signatu
CONSERVATION Reviewed on Sianature
COMMENTS
HEALTH
COMMENTS
.l -
Reviewed
Sianature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Com
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes
Located at 124 Main Street
epartrnent signatureldate
COMMENTS
Located 384
no
ood Street
-Nmension
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 droprequires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc.Building Permit Revised 2014
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be ob
Roofing, Siding, Interior Rehabilitation Permits
N®TE:
❑ 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
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
❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ 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)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
a Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy o CContract
o Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
40TE: 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
Doc: Building Permit Revised 2014
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E n G I n E E R S
Project Number: U1977-0072-161
December 5, 2016
ACE Solar
342 North Main Street
Andover, MA 01810
ATTENTION: Eric McLean
REFERENCE: Frangules Residence: 373 Raleigh Tavern Lane, North Andover, MA 01845
Solar Panel Installation
Dear Mr. McLean:
Per your request, we have reviewed the layout and photos relating to the installation of solar panels at the above -
referenced site. The following materials and components are proposed in the installation of the solar panels.
Roof Structure: 2x6 Rafters @ 16 O.C.
Roof Material: Composite/Asphalt Shingles
Based upon our review, it is our conclusion that the installation of solar panels on this existing roof will not adversely
affect the structure of this house. The design of solar panel supporting members and connections is by the
manufacturer and/or installer. The adopted building code in this jurisdiction is the Massachusetts State Building Code,
8th Edition (2009 IBC) and ASCE 7-05. Appropriate design parameters which must be used in the design of the
supporting members and connections are listed below:
Ground snow load: 50 psf per Massachusetts amendments to the IBC (780 CMR)
Design wind speed for risk category II structures: 100 mph (3 -sec gust).
Wind exposure: Category C
Our conclusion regarding the adequacy of the existing roof is based on the fact that the additional weight related to the
solar panels is less than 3.0 pounds per square foot. In the area of the solar panels, no 20 psf live loads will be present.
Regarding snow loads, it is our conclusion that since the panels are slippery, effective snow loads will be reduced in the
areas of the panels. Solar panels will be flush -mounted, parallel to and no more than 6" above the roof surface.
Regarding wind loads, we conclude that any additional forces will be negligible due to the low profile of the flush -
mounted panel system. It is our conclusion that any additional seismic loadings related to the addition of these solar
panels is negligible.
During design and installation, particular attention must be paid to the maximum allowable spacing of attachments and
the location of solar panels relative to roof edges. The use of solar panel support span tables provided by the
manufacturer is allowed only where the building type, site conditions, and solar panel configuration match the
description of the span tables. Attachments to existing roof joist or rafters must be staggered so as not to over load any
existing structural member. Waterproofing around the roof penetration is the responsibility of others. All work
performed must be in accordance with accepted industry -wide methods and applicable safety standards. Vector
Structural Engineering assumes no responsibility for improper installation of the solar panels.
Please note a representative of Vector Structural Engineering has not physically observed the roof framing. Our
conclusions are based upon the assumption that all structural roof components and other supporting elements are in
good condition, free of damage and deterioration, and are sized and spaced such that they can resist standard roof loads.
Very truly yours,
VECTOR STRUCTURAL ENGINEERING, LL(
Roger T. Alworth, P.E.
Principal
RTA/haz
!016
9138 S. State St., Suite 101 / Sandy, UT 840701 T (801) 990-17751 F (801) 990-17761 www.vectorse.com
ACESOLAR
1"(w11 1i1)III L'\J) 1,WJWk'
Owner's Authorization Form
For Permit Applications
The sole purpose of this form is to provide ACE Residential Solar, LLC, dba ACE
Solar, with the necessary permission from Owner to file Permit Application(s)
for such Project work as agreed upon between the Owner and the Owner's
Authorized Company (ACE Residential Solar, I.I.Q.
Owner's Name:�
Solar Project Address:
I
Please Sign below to grant permission for ACE Residential Solar, LLC to apply
with your local AHJ for the necessary permits to install your Solar Installation.
J rr\..
Owner's Signature:
Owner's Authorized Company: ACE Residential Solar, LLC
Company Address: 342 North Main St.
Andover, MA 01810
Applicable Licenses: MA NIC #182429
MA PE License: 52468
NH PE License: 12863
AO CERTIFICATE OF LIABILITY INSURANCEDATE(MWDDIYYYY)
C R,
09/21/2016
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: H 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 an this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
MICHAUD, ROWE AND RUSCAK INSURANCE ASSOCIATES, INC.
CONT
E•CT Krista McMahon
PHONE 978) 688.8829 No:
DORM
ADORM: kmcrnahon mrrinsurance com
INSURE S AFFORDING COVERAGE NAIC11
P.O. BOX 188
INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666
NORTH ANDOVER MA 01845
INSURED
INSURER e :
INSURERC:
ACE RESIDENTIAL SOLAR LLC
INSURER 0:
PRODUCTS-COMPIOP AGG $
INSURER E :
342 NORTH MAIN ST
INSURER F!
ANDOVER MA 01810
COVERAGES CERTIFICATE NUMBER: 86964 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
lR
LT
TYPE OF INSURANCE
POLICYNUMBER
POLICYE F
POLICY
LIMITS
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE F-1 OCCUR
N/A
EACH OCCURRENCE $
DAMAGE TO ENTED
PREMISES Ea occurrence $
MED EXP (Any one ) $
PERSONAL & ADV INJURY $
GENT AGGREGATE LIMIT APPLIES PER
POLICY 0 JPECT M LOC
OTHER
GENERAL AGGREGATE $
PRODUCTS-COMPIOP AGG $
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNEDSCHEDULED
AUTOS NON-OSWNED
HIRED AUTOS AUTOS
N/A
COMBINED E IM $
(Ea accident)
BODILY INJURY (Per person) S
BODILY INJURY (Per accident) $
PPROPEERRTYDAMAGE $
$
UMBRELLA UAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
N/A
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENTION$
A
wORKERSCOM
AND EMPLOYERS LIABILITY
ANYPROPRIETOR/PARTNEWEXECLMVE YIN
OFFICER/MEMBERExCLUDED+ WA
(Mandetory In NN)
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DRIPTION OF OunderPETIONS below
NIA
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6HUB9F43435116
01/20/2016
01/20/2017
TH$
PPENSATION x : TUTE I I E
EL EACH ACCIDENT $ 1,000000
EL DtSEASE•EAEMPLOYEE $ 1,000,000
EL DISEASE - POLICY LIMIT $ 1,000,000
N/A
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACRD 101, Additional Remarks Schedule, may be attached H mora space Is required)
Workers' Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay
claims for benefits to employees in states other than Massachusetts If the insured hires, or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the
Issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification
Search tool at www.mass.gov/fwd/workers-compensabonfinvesbgations/.
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.
1600 Osgood Street AUTHORIZED REPRESENTATIVE
North Andover MA 01845 Daniel M. Cr y, CPCU, Vice President — Residual Market — WCRIBMA
0402R.21114d ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
ACERE-1 OP ID: KM
CERTIFICATE OF LIABILITY INSURANCE r(MMfOOIYYYY)ATE
09/09/2016
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 poiicy(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
Michaud, Rowe And Ruscak Ins.
P.O. Box 188
North Andover, MA 01845
Michaud, Rowe & Ruscak
INSURED Ace Residential Solar LLC
Mark Kiley
342 No Main St
Andover, MA 01810
11"' c"
NAME; Michaud, Rowe & Ruscak
PHONE N e,nr 978 688 8829 JAIICC, No);.978 557 2130
:Nautilus Insurance t
:Travelers Insurance
:Safety insurance Co
OnAnernru uuaaaca.
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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
POLICY EFF POUEY EkP
ICT" TYPE OF INSURANCE POLICY NUMBER MIDDIYYYY MMIDD LIMITS
A IX
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
COMMERCIAL GENERAL LIABILITY
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of North Andover
ACCORDANCE WITH THE POLICY PROVISIONS.
1600 Osgood Street
EACH OCCURRENCE $ 1,000,00
North Andover, MA 01845
CLAIMS4AADE X� OCCUR
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NN636658
01/19/2016
01/19/2017
PREMISES Eaocarrence 5 100,00
MED EXP (Any one Parson) S 5,00
PERSONAL &AOV INJURY S 1,000,00
rGI-LGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE S 2,000,00ICY
PRODUCTS-COMP/OPAGG S 2+000,0011
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BODILY INJURY (Per person) $
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AND EMPLOYERS' LIABILPY
ANY PROPRIETORIPARTNERIEXECUTIVE Y / N"""WC
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addltlonal Remarks Schedule, may be attached if more space Is required)
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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.
1600 Osgood Street
AUTHORIZED REPRESENTATIVE
North Andover, MA 01845
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ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
Name
The commonwealth of Massachusetts
Department of Industrial Accidents
1 'Congress Street, Suite 100
Boston, MA 02114-2017
" www.massgav/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricions/Plumbers.
TO BE FUM WITH THE PERMITTING AUTHORM.
N
Address:-3L,IVB A-Aat tU .
City/State/Zip: N,� oJ e r 1 tA k 16lVa Phone #: 0U
Are you an employer? Check the appropriate boa,
Type of project (required): .
L® I am a employer with ! employees (full and/orpmt-time),*,
7. New construction
2.[]l am a sola proprietor or partnership and have no employees working for me in
$. Remodeling
any capacity. [No workers' comp, insurance required.]
.
9. ❑ D.emolition
3.aI am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4. 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
❑
ensure that all contractors either have workers' compensation insurance or are sole;
10 [) Building addition
11. n Electrical repairs or additions
proprietors with no employees.
12. [] Plumbing repairs or additions
5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet,
13. �Raof repairs
These sub -contractors have employees and have workers' comp, insurance.$
14. [ i Other QV
6.Q we are a corporation and its officers have ok.emised their right of exemption per MOL c.
152, § 1(4); and we have no employees. [No workers' comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this ofiidavit indicating they aro doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContmetors 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 empiayees, they must provide their workers' comp. policy number.
1 am an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company
Policy # or Self -ins.
Job Site Address:S_31 UfiA 1 U.(,/fL::Az La 1, P City/State/Zip: Mof4\&AW M bt$`�5
Attach a copy of the workers' c pensation policy declaration page (showing the policy number and expir tion 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 her4y certdfyjier the pains and penalties of perjury that the information provided above is true and correct:
Signature. Date: 411((,
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 #:
(29L����
1,
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
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Home Improvement C6,iator Registration
�.�..�W.__.�.._....... Registration: 182429
Type: LLC
Expiration: 6119/2017
ACE RESIDENTIAL SOLAR LLC
ERIC McLEAN
342 NORTH MAIN ST
ANDOVER, MA 01810.
SCA 1 0 20M-06NI
Cc!Jite (pw»tmta?ttvea6t�t a�(�JI�LaGGariztl6P.lYd
Office of Consumer Affairs & Business Regulation
OME IMPROVEMENT CONTRACTOR
Registration: x312.429 Type:
Exolration:v 6hi1;?t3 LLC
ACE
ERIC McLEAN `i
342 NORTH MAIN ST`
ANDOVER, MA 01810
TO 267589
to Address and return card. Mark reason for change.
u-_ddress (M Renewal M Employment Lost Card
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 S270
Boston, MA 02216
Undersecretary Not valid without signature
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NORTH ANDOVER, PAA 01845.0000
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No. (0a C) I
Check # I AI'S L4
U
Date lol I T (go I (,
TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $ q
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector