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Home My WebLink AboutBuilding Permit #Exception - 700 SHARPNERS POND ROAD 5/1/2018 06-10-' 14 13:24 FROM- Cross Ins Manchester 603-641-5062 T-706 P0001/0001 F-044 DATE(MWDDNYYY) CORA CERTIFICATE OF LIABILITY INSURANCE 6/10/2014 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 Ileu of such endorsement(s), PRODUCER CONTACT Kari Reaves NAME! FIAI/Cross Insurance PwoNE (603)669-3218 FAX (603)665-6531 7100 Elm Street E-MAIL kree3veSQGropeagency.Com INSURERS AFFORDING COVERAGE NAIC 9 Manchester NH 03101 II45URERA:W0St American Insurance Co. INSURED ESE Instulation, Inc. INSURERB:Ohio Security Insurance Company Energy Saver Enablers INSURERC:Ohio Casualty Ins Co 52 Fitzgerald Drive INSURER Arne ri,Csri Alternative Insurance INSURER P: Jaffrey NH 03452 IN$URERP: COVERAGES CERTIFICATE NUMBER.13-14 A11/14-15 WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVt 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 ADDLISUBR POLICY EFF POLICY EXPLIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMl D VYV MMIDonYY GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 -MUEE TO X COMMERCIAL GENERAL LIABILITY PREMISES EaENTEoccurence $ 3000000 A CLAIMS-MADE Q OCCUR BKW55684497 /31/2013 /31/2014 M20 EXP(Any one Person) $ 15,000 PERSONAL&AOV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEWL AGGREGATE LIM17 APPLIES PER; PRODUCTS-COMP/OP AGG $ 21000,000 M POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINOLP LIMIT Fa arrid�in 1 000 000 B X ANY AUTO BODILY INJURY(Per person) 6 ALLOWNED SCHEDULED A955684497 /31/2013 /31/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTYtDAMAGE $ AUTOS Uninsuredmolorlatcombined 5 1,000,000 X UMPRELLA LIAR X OCCuFt EACH OCCUARENCE S 11000,000 4.. EXCESS LIAR CLAWS-MADE AGGREGATE $ 1,000,000 DEO X RETENTIONS 10,00 5055684497 /31/2013 /31/2014 $ D TH- WORKERS COMPENSATION 2A2WC0000371-02 X ,WC STATUOFIY LIMLY CA AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N (3n•) NX & MA E.L.EACH ACCIDENT $ 500,000 OFRCEMFMBER EXCLUDED? Q N/A (Mandatory in NH) 11 o£$xCora included /B/2014 /8/2015 E.L.DISEASE•EA EMPLOYEE $ 500,000 it yes. uriclar DESCRIPTION E.LDISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS DBIOW DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(AIIaCh ACOR0101,A00i ional Remarks Schedule,it more space fa required) Refer to polioy for exclusionary endorsements and apecial provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN T04m Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 2600 Osgood Street North Andover, NA 01845 AUTHORIZED REPRESENTATIVE qtl Q .r,4jy-,y' —-7s-. 7 "1/� Laura Perrin/asc L j O �y6�^ •. ACORD 25(20010/05) 01988-2010 ACORD CORPORATION. All rights reserved- INCn7.r,ofwnat n, Tho ernAn name and Innn arc raniAtarAd markt of arnRn ConsPera4CONTRACTOR WORK ORDER Conser anon , r Services Group 64141 �o� Z- 50 Washington St.Suite 3000 / Printed: 5/28/2014 Westborough,MA 01581 Work Order Id: S19071 P24442C332 Contractor Information Customer/Site Details Energy Saver Enablers LLC Marlene Mitchell Email: marlene03l2@gmaii.com 52 Fitzgerald Dr 700 Sharpners Pond Rd Phone(Eve): 978-687-2062 Phone(Day): Jaffrey,NH 03452 North Andover,MA 01845-3338 Site ID: S00002219071 Total Installed Measures Location Description Quantity Unit$ Total $ Exterior Door Weather Stripping 3 $25.20 $75.60 Living Space Attic Stair Cover Thermal Barrier with carpentry 1 $237.65 $237.65 Living Space Perform Air Sealing at Estimated 62.5 CFM50 6 $77.00 - $462.00 Door Sweep 3 $21.17 $63.51 Attic Propavent 2'or 4' 60 $3.50 $210.00 Living Space Attic Floor Open Blow Cellulose 7" 794 $1.40 $1,111.60 Damming 76 $2.00 $152.00 Installed Measures Total $2,312.36 WorkOrder Notes Payments Incentive Payments Air Sealing Incentive $838.76 Weatherization Incentive $1,105.20 Total Incentive Payments $1,943.96 Customer Share Total Customer Share $368.40 Less Deposit Of $121.57 Customer Share Balance(Due Contractor) $246.83 Conservation Services Group-50 Washington Street Suite 3000-Westborough, MA 01581 -(508)836-9500 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-072316 , CALEB AHO 482 JARNLANYHII. s SHARON NH 03U58 Expiration Commissioner 12/19/2015 Office of Consumer Affairs and ausiness Regulation 10 Park Plaza - Suite 5170 r Boston, Massachusetts 02116 Home Improvement Co{ntrActor Registration Registration: 161406 _ /n Type: Individual z '�fr1r Expiration: 10/20/2014 Tr# 231955 CALEB AHO w' CALEB AHO f �� 482 JARMANY HILL RD. SHARON, NH 03458 4 Update Address and return card.Mark reason for change. Address ❑ Renewal r-� Employment Lost Card DPS-CAI 0 50M-04/04-G101216 Officeo�ons & us3in as as l n License or registration valid for individul use only of, HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 161406 Type: Office of Consumer Affairs and Business Regulation Expiration: 10120/2014 Individual 10 Park Plaza-Suite 5170 Boston;MA 02116 CAI AH _t 11 CALEB AHO '<< tylf 482 JARMANY HILL°RD,' ' SHARON,NH 03458 Undersecretary alid without signature RCS PLANVIEW DIAGRAM Customer: 1" 1(, Home Phone: - Address: 76o J�pi p'Nez 'Pc+•'t Q Work Phone: ( )- Town: NU t -'e'e /! Cell Phone: Any limitations for access by large truck? No V Yes If.yes,describe: Any specific directions or landmarks? Noyl Yes If yes,describe: Site ID: ZZ 1 III - ( Energy Specialist: ` op i Zoe Reviewed by: Q � � aiS CeA -7 "Yr,,s . t \� Dc'V"1161 -76 i LoJej 1 2� 3 aN For Office Use Only Existing Conditions X=Access ❑=Vents Note Inside Square R=Roof V S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T=Triangle Install O=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise =Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access Rev 01/13 • tea", A e mass save CONTRACTOR PERMIT AUTHORIZATION FORM i, Marlene Mitchell ,owner of the property located at: (Owners Name,printed) 700 Sharpners Pond Rd North Andover (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. x Y1��`� Owners signature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participatineclintractor Date For Office Use Only Rev.12132011 The Comrnonweatth of Massachuseft Department of Industrial Accidents O,f,ftce of Inmdgadons 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass govhUa Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Energy Saver Enablers LLC Address: 52 Fitzgerald Dr Ci /Stategi : Jaffrey, NH 03452 Phone M 603-532-6346 Are you an employer?Check the appropriate box: Type of project(required): 1.[]■ I am a employer with 6 4. 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors b 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 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y p tY• 4. [] Building addition [No workers' comp. insurance comp.insurance.$ required.) 5. 0 We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.Q Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGI. 12.❑Roof repairs insurance required.)t c. 152,§1(4),and we have no Insulation employees. [No workers' 13.Q Other comp. insurance required.] "Any applicant that checks box#1 mast 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. tConttactors 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. 1f the sub-contactors 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: American Alternative insurance Company Policy#or Self-ins.Lic.#: W2A2WC0000371-02 Expiration Date: 3/8/2015 Job Site Address: 7bQ Ka(f-5 tar)j ei City/State/Zip: A44A Qh-�66-1,/, A44 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 der the pawns an enalties of perjury that the information provided above is true and correct. &ggature: ate: 61Z Id Phone#• 603-532-6346 Offtial use only. Do not write in this area,to be completed by tidy 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#: Location No. �/ 7r / Date 4 . - TOWN OF NORTH ANDOVER' Certificate of Occupancy $ y Building/Frame Permit Fee $-:?2�2-- Foundation Permit Fee $—Ole " Other Permit Fee $ TOTAL $ Check# 27664 ` Building4nspector