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40 ENGLISH STREET - BUILDING JACKET 40. ENGLISH STREET r tF• � .:ffi R,C1X 1 '#T' �,;., sx./�1`P ;.� * - e] y k ``3 Il+Ll, vp EPT,�-.'; ! y �' f �' .c. A•M* ] rk�r "fir SALEM FIRE DEPARTMENT , • " • Fire Prevention Bureau a x fie:,I r° <='i °Y* •"' ,, •acs � xRECOMMENDATION_ i .Name. Mr..Nei� Tr0.ulx * w' r:Date l Lt �9l il'ISS rtG' Ne,rch ..117. . . ..19.. .._'s . 10 Turner St Salem Massr.."" Address-----------------........._.............................................................. ................. RE: 40 English St 'Salem Mess. 5 As a result of an inspection this date of the premises owned and/or occupied by you, the following recommendations are submitted which should receive serious consideration. These recommendations are made in ,• + the interest of fire prevention and to correct conditions that are or may become dangerous as a fire hazard; may be required for legal occupancy of the premises or otherwise are in violation of the law. Condition... buildup nf..rubbish due .rempde.ling.-of. .building ha` ...inarea.sed^ '. !•r ,to__point---ipf .a...svr..i.oua...fire. c*_hazard ........ . -----:rr . ...... , . r This is in violation of FPR #9 Rule 12 Also no Building Permit viaible:5 ' e.. ... ... ... •Reinspection date F.. .03 10-77 , 00 $uilding Insp. Raymond T Danereau ' Fmro]58FPB (Rev. 7/75) . . Jnspeetor:,� 'i+ � q } a w r .f ] " ^4T d +a AA .jx .i •+�'Y X4 ' A Yew �. M F s`k�,'� r Ac $" tet .ML •q�� $�,�4yr15,� ay �,., * n ,� "'r > . + .;� J ,y +' ai �i0'4 6 Xt w2 •�',d ' 'A a �"� '," j'y - r d1l _ •f r l a. i r1-4 .Y &. �ts��, ,✓ rr."` s � . �„ i.• +�: �l toY�'' a st,� �, t r<„ , .a"]..] b �" 9':8.� '� �e+x'.. � '�” int T� x J] AM at r,t '�Y}�f b ♦x Y A � S' Ai,` � { k a4 4 {r • { t x� f 'Y`a 9,�•rw'�4 i ^5 d ��• i � . r: s a? . it ��" r � tr � .� ' ,Y 't�'S, R y aYe 5w v � r�'J h fi;°�." t ��.._.lZ'..:€�:1"i U .`i. - !l•. sge •{� ♦Y.'.+�r "t:' _ .Sar�v s w;ylb}{v� 'w. L�:a�� l�' �� 11i 527! u s, l {y� ''�-;;I ,., // yy y[ + y.. �U�ys Y Se,;f','� 4'% i 6ry01�+t t� h�t J�� SS° '•,�+'�'o� A(p _ N i a+ fraz,a,, �wrSALEM FIRE DEPARTMENTp;, 't' " tp„ktafr �'i� t. 'f, `'FayeA. Prevention BUreauJ�y n' -! a �`rr g it:r” 'S. '' kr F .}� A ''eN°kw wv7r" ^YY w f FY T t 1 4 e t M 9 �} ,i5 I y, `$aRECOMMENDATION�' 'r� [e rattamn. a Yl-u Sr X Y. n w iai,• 1 , ',{"�d�vAt w i'y '' 'Y, t r d ,t,F " 9 1 r ((' ,�7�77✓L *'%- t to , r r. P-' v + �' k'• x a t t•,/ X .+ Grs P 4r t, x j.. u 3"� 4+.. a`L!'Mt �S,y..,,q° y, rfd.'tX d� Name`............. Mr:.STeil.,.Pro _.:. Dated March 9A1977'� `' 19` ""' c xx 3, 7 qi t Jf rjN^7 d Address '10 Turner St Salem Mesa y *, ; .RE, x4o'English St`t$sierri'% s'' t1 t * 1 � `-...t t §p ° • Y ,,. ............ „r d r • -+ p ce,.e < r°r k, k54ya.'i"5if .. As 'a result` of. an inspection, this ,date of ,the r premise ' owned and/or` occupied A by,you, the followang•at recommendations'are submitted which'should .receive serious consideration:'These recommendations arc made rn',< ,*• the interest of fire prevention and,to correct conditions that are or may become dangerous is.a fire hazard, maytbe'} 1 required for'eg 1 occupancy,of the premises or otherwise are in-violation of Tile lew. t 'k- �, aRr,t5>s1. ,,w °, tA .. " .. 'r a ° 'Gondition«nf..buildup of....rubbiah due�ramndeling of building'has ,ixsareaaed , ` to point of ar .sariaua fila kiaZard." ......n s M This is in violation of PPR'#9 Rule 12 Also no Building Permit visible. g Y x.•. , �+{, Yb« t•h d " b ! r ; S i X Reinspection date. .....'V3.7.1.°:t1 0 77 " F `+ . s j ty r J , au ng Tnap. Ragmond ,T Dansreaut P $" > ^ da aprmasanra (Rev 7/75) e . .� , . orf. ' ubwx Inspector =« d • 4 d•h i. 4 f P}xM r� k in �,. '+ , k �p(f"t..0 Yr i C,-.�.' r`-.»,.; a', - r µw r ! r l '}Sr t ! y f { *sa 4h '1�'7j7' y a a 'Y� +d�y � � �iM1R' '� ,t}{ T w�l 9Ar< 'k � t • K' qe� * tr '� �� � r � � s C�'�n ,�#.RT�i'�� # *44'4 eC,,* .k'T ,}rZ � e,+ � Y ��� ni: ' ♦ ".* ( �,�V .tf+ ���}� '1yd rE ,*� aI a '. J w, r�" 4a9� �, rte.,,'J f t! Q .t k^� fi 4n , 1 F F•AFB dY "Ar" FW >r° a y f d A V Y G^�" T y'q, �, �,r r �y. Yk r k4 + ,7y ✓NE TS i ,',A�{rp y� « y v0j°Jid�/}. °'y ��a{°r �kv Y5► i� . ° , + ya�.�, } 1'��k �"kM ,. j��1 5 a� y t' � �''�r� t qfE •( .,,, �-' � q BUILDING DEPT MAR 11 9 45 RK'ii RECEIVED CITY OF SALEM.MASS. $ 2(8 cK y i `13 The Commonwealth of Massachusetts RECDN E7 ' Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR ff15PECTV)i ++ •Revised - � sed Mar 201 Building Permit Application To Construct,Repair,Renovate Or��neUtie, ttu Q j: 52 One-or Two-Family Dwelling tia0 This Section For Official Uw Only 1 Building Permit Number: Date A ied: In i � 1 hll Building Official(Print Name) Signature Date L SECTION 1:SITE INFORMATION I 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 40 English Sl 41-0103-0 L la Is this an accepted street?yes x no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: R2 .086 AC Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public ❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yesO SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Alicia Dio=i Salem MA 01970 Name(Print) City,State,ZIP 40 English St 978-766-1103 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other El Specify: PV Solar System Brief Description of Proposed Work2: Roof mounted grid tied PV Solar System 18 modules @ 285 watts/18 micro inverters 5.13 KWDC SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 10000.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 11 Standard City/Town Application Fee 19655.00 ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 29655.00 11 Paid in Full 0 Outstanding Balance Due: A11 Vke 14 i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-108214 4/2/2018 Eric Chartrand License Number Expiration Date Name of CSL Holder List CSL Type(see below) ll 27 Sanborn St. No.and Street Type Description Fitchburg, MA 01420 U Unrestricted(Buildings u to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 978-652-2680 ericchartrand@endlessmtnsolar.com i I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 174479 1/28/2017 Endless Mountains Solar Services HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 288 Kidder Street jimlaskowski@endlessmtnsolar.com No.and Street Email address Wilkes Barre PA 18702 570-820-5990 Ci /Town,State,ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... N No.___..❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Endless Mountains Solar Service to act on my behalf, in all matters relative to work authorized by this building permit application. W� GI L, M , dF 17_/515 PrintOwner's Name(Electronic Signature) V Lp b Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. ),kzfr Ro/S PnVwwner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.¢ov/dos 2. When substantial work is planned,provide the information below: Total-floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" SECTION 5: CONSTRUCTION SERVICES 5.1 Construcilon Supervisor License(CSL) 4018 .. CS-108214 Ede Chaarand License Number Expiration Dale Name of CSL 11older U list CSL Type(sec below) 27 Sanborn SI No.tmd StWa t _ Type Description U Unrestricted(Buildings tip to 35,000 cu.R. Fitchburg MAO 1420 R Restricted 1&2 Family Dwelling Clyfrown,State,ZIP M Masonry RC Roofing Covering ._.__ WS Window and Siding SI' Solid Fuel Burning Appliances _928.652:2680_ ertcchadrnnd endtessminsolaccom I _ Insulation Tele houe Email address D Demolition 5,2 Registered home Improvement Contractor(I1IC) 174479 1128/17 Endless Mountains Solar Services HIC Registration Number Expiration Date RIC Company Name or RIC Registrant Name �2811-H(ddaLSt limlaskowski@endlessminsclar.com No.and Street Email address Wilkes Barre PA 18702 570.820-5990 Ci lfown State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(h4.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building pemnit. Signed Affidavit Attached? Yes ..........M No...........0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Endless Mountains Solar Service to act on my behalf,in all matters relative to work authorized by this building permit application. > 2 !` enne{Akeeroesnatuea} Ci$Co�p Date s 'r' auk •x SE ON7b ,QWNER`40R AUTHORIZED AG1 NT.DECLARATION x , s>r d tt of►,k�mfomnation i t � �s .4-T- ' �sS ,Date 1 h 1,e' an"uttr'i:gistered contractor r _ in 1 cc �(b the arbitration t to ! fogIam call be found at n iw i inss 0i s tut decks;or porch) h0 }ix. ti lilt, om.: tt *5 b tt The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgmization/Individuaq: 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.Q I am a employer with 10 4. ❑ I am a general contractor and I employees(full and/or part-time)." have hired the sub-contractors 6. E] New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y a tY 9. E] Building addition [No workers' comp. insurance comp. insurance? required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152,§1(4),and we have no Solar employees. [No workers' 13A Other comp. insurance required.] *My applicant that checks box#1 must also 611 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 anew 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 Inc Co. Policy#or Self-ins. Lie. #:000087615 Expiration Date:5/9/16 Job Site Address: 40 English St City/State/Zip:Salem MA 01970 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 under the pains and penalties of perjury that the information provided above is true and correct. SSi nature: Date: 14-5,711r-1— Phone d J9f,1-Phone#: 708205990 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#: ENDLESS MOUNTAINS SOLAR SERVICES, LLC 184 CEDAR HILL ST,\LIRLDOIt00011,MA 017521 OFFICE(508)357-2354 FAX(508)532-3562 WORK ORDER HIC#174479 Reg:BBB of Central NE Demo Date&Time: Referred B C#1IIa-Il � 3a P^ Y� C ^C-�-E ^ - /Ballasted Bu Type of Installation Roo /Ground yens Name.�f i.C,L, I a 77 Roof Type. Shingle Metal/Rubber/Other._-- -Address: 4 O � � ° n $� • ° ° ° 45 Other: — 3 Roof Pitch- 0° 10 15 20 25 30°35 40 City: �G^'4+"'-+ State:MA zip: � i X17' p � 1-- � House Type• Ranch/Modular/ e/Other: �IB+')ti� Phon • - e. �7� 766-Ilo3 Work: J House Stories- Single/Two!Thre /Other.�.- -- Email: jr')5 1 v O, GO ice Panel- Fuse/60A/`00 /200A/Other.—� d _Z; h a r"T Sery ,l� Notes: 1 Znclt-r �S p_eo A .e�t �•}Y'/cad �,,�g,^aZe Tree Tri-e%- ,5 COMPLETE SYSTEM PACKAGE System Description: �, 13 kw soh- ArrA bey I g sev?tit- Iwv.- I ag S PA a-Fy le° � n}��+�i� e /1n:era V. 1- Terms:Payment Plans Based On Current Interest Rate COST OF SYSTEM: ar•I�q c) C- please note the payment schedule: S;ti^ JISIo N^ 7 40%-To start permitting 50"/0-To start the installation l ? 6 S(7- 10%- 10%-Ager final inspection by your municipality CASH,CHECK or CREDIT CARD(mcNISA/AMEX/DISCOVER) L ^P+c Sub Total............................................... $ J1 6 q-sti— ....................................................... s SELF FINANCE Total..................................................... S Deposit Received .......................................I E ,MSS FINANCEOPTION gqGraddt�ptt sy •...•....... 5 O'1 Q Balance Due ................. .................. ,L�_ (.! q� v relo�Yt%Yo�r�aGk f?er4 Comp y P Buyers Signal ure• IMPORTANT CUSTOMER INFORMATION r "L �Yrlyms,drscoimkf ssstNm prmtdsn made w otheimw offend dining a"sales Date: fation mart be in w+itiag on this Work Order in otda to be valid.AWitiotullY.MY By usai^B Wolk Otda,l hereby fWly ulmwledge fad agsce b the tomo or this Osdes p smoresiBLod Vmirtwtioas ofthe savices to be performed or aMdons to those F.ss.,a u rhes Tema and C°Midaae oo the c ow.ideofthts Work ONer aotheswix .Po6li esdom by Btrya mast be apptmed by EMSS and may htem additlooal ehatga. coached tw to.andfonher soft W pay as 4=u:sa due m&vo,&ct withthie Work ONa. Scanned by CamScanner ASA Engineering Shrewsbury ,Ma December 6, 2015 To: John Pitcavage Endless Mountains Solar Services Re: Solar Array installation 40 English Street Salem, Ma. Per your request, I have performed a site visit at the above referenced project location to evaluated the existing roof structure framing system. This evaluation was conducted to determine if the existing roof structural framing system has the load carrying capacity to support the additional proposed loading for the solar array system(see attached). Loading Criteria: • L.L.— 20 psf • D.L.=15psf • Pg = 40 psf • Solar Panel=4 psf(including hardware) Evaluation: Main house Structure The roof framing for this structure(built in 1820), in the areas designated for the installation of the solar panels, consist of 6 %2 in. x 6 '/2 in.(Avg. dimension)rafters, spanning 22 feet from the outside wall to the ridge and an average spacing of 8.5 feet and a maximum unsupported length of 9.5 feet. Additionally there are 3x3 inches intermediate support beams in between rafters at 30 inch spacing. The support for the rafters (3`d floor level) is provided, utilizing 5 x8 inch beams, placed on a bearing wall below , or directly placed bearing wall under. The bearing walls on the 3`d floor transfers the roof load to the foundation with a continuous path below through the structure (2°d& I"floors) utilizing bearing walls or support beam headers beams (8in. x8in. , max. un-supported length of 11 feet). Based on the above framing configuration, the existing roof system will be able to carry the additional load of the panels, without any modification. The above evaluation is my best professional opinion, based on the available information. Please note that during the installation of the panels, discovery of any changes from the findings stated in this report would prompt further load analysis of the roof support system. Please also note that this review is intended solely for analyzing the structural capacity of the roof framing system due to the additional loading of the solar panels and it is not intended as a complete structural analysis or code compliance review of the entire structure or its framing system. The roof connection system for the solar panel shall be in conformance with the system installation manual, in order to resist the uplift forces due to basic wind speed as determined by the current building code. I also recommend staggering the attachment of the rail to the roof at alternating roof rafters between the upper and lower rail, to avoid concentrating loads on a single rafter. Each lag screw must also be centered on and fully penetrate the rafters (min 2" embedment). In particular the installation is designed to confirm with ASCE-70 wind limitations and Endless Mountains Solar Services shall confirm that the system designed will be installed accordingly. Please contact me at 978-377-5084 if you have further question regarding this report. Sincerely 410F AHM000 AZIZI MAood Aziz- 4141E �ONA4E ►Vw 2 r_S-10821: RIC CLtART-P-A D 39' ?LM STREET Gardner h1A 01=;40 - 04102/2015 -_ :./ 1'7.r� (J��iii/! ?Zfi?�;:`. ^3��..�f,E2, (;.. _ �,/if r/✓iv{`C.1':,�.h.{��✓.„ Office of Consumer Affairs and Business Regulation - -_7,1 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Howe Improvement Contractor Registration Registration: 174479 Type: LLC Expiration: 1/28/2017 Tr4 261910 ENDLESS MOUNTAINS SOLAR SERVICES, MICHAEL PITCAVAGE 288 KIDDER STREET - WILKES BARRE, PA 18702 Update Address and return card. Mark reason for change. .Address Renewal _ Employment 1 Lost Card I Yal"K Yiaza - 3uim; j t u Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 174479 Type: PP Supplement Card Expiration: 1/28/2017 ENDLESS MOUNTAINS SOLAR SERVICES, -- JAMES LASKOWSKI 288 KIDDER STREET - WILKES BARRE, PA 18702 Update Address and return card. Mark reason for change. Address ! Renewal '_1 Employment 1 Lost Card I U Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement. Contractor Registration Registration: 174479 Type: Supplement Card Expiration: 1/2 812 01 7 ENDLESS MOUNTAINS SOLAR SERVICES,, ERIC CHARTRAND 288 KIDDER STREET WILKES BARRE, PA 18702 - Update Address and return card. Mark reason for change. I-] Address [__I Renewal LI Employment [] Lost Card SYSTEM SPECUTACEIONS Endless Mountains ENPHASE M250-60-240V LINE DIAGRAM KWDC 5,13 KW SOLAR SERVICES KWAC:4.5 KW AC VOLTAGE:240V AC AMPS:I8A AC DISCONNECT SIZE:30A MODULES/QTY:SolarWorld 285 Watt/18 FNPHASE CABLE BLACK-LI RED-L2 WHITE-NEUTRAL GREEN-GROUND JUNCTION BOX 2POLE 20 AMP E3 CIRCUIT BREAKER En - --__ r PER BRANCH CIRCUIT I— 9Modules/ 9Micro Inverters 6AWG WIRE I� JA WIRE(FROM SOLAR ARMY TO COMBINER) (FROM COMBINER TO µY INTERCONNECTION) 1n 0 PVC Conduit I"SCh 80 PVC Conduit AE6ue6AWG 06AWGIR _ ��TERMINATORCAP �� • INSTALLED ON 9Modules/ 9Micro Inverters PUP ERTO 16 BRAM250'sPER BRANCH CIRCUIT [ND OF CABLE TOMETEROR AC DISTRIBUTION PANEL REC METER 6AWG WIREPOLE 30AMP (FROM COMBINER TO AC DISOONNECT INTERCONNECTION) CIRCUIT BREAKER NONFUSEDrOuwnnuwwarxEn I"S&80 PVC Conduit _ AWAY FROM MAIN OR REP ENVOY COMMUNICATIONS GATEWAY –' lef enphaGse \ Existing service panel location 1 —_ COMPANY:ENDLESS MOUNTAINS SOLAR SERVICES N11NAL GROUND130 Vac POWER CABLE ETHERNET CONNECTION ZB8 KIDDER ST AC DISIRIBUIION PANEL 'A,A,G TO BROADBAND ROUTER WILKES BARRE PA 18702 (570)820-5990 O05UR�PANEL DRAWN BY:Shawn Corbley Proposed upgrade to 200A Siemens CUSTOMER: Alicia Di02Zi service panel with __ _ 40 English St. 200A main breaker Salem,MA 01970 978-766-1103 SYSTEM SPECITIACTIONS Endless Mountains Existing Utility Meter KWDC 5.13 KW SOLAR SERYIGES Proposed Upgrade to 200A Service KWAC 4.5 KW Proposed Net Meter AC VOLTAGE:240V AC AMPS:IBA AC DISCONNECT SIZE:30A Proposed AC Disco MODULESI QTY:SolarWorld 285 Watt/18 Proposed REC Meter O 2120 Azimuth 350 Pitch ❑ 3 Mods Portrait Front of 5 Mods 5 Mods 5 Mods House Portrait Portrait Portrait COMPANY:ENDLESS MOUNTAINS SOLAR SERVICES 288 KIDDER ST WILKES BARRE PA 18702 (570)820-5990 DRAWN BY:Shawn Corhley CUSTOMER: Alicia Now v' 40 English St. Salem,MA 01970 978-766-1103 Chi,oddly SW 2851MONO'(33mmlframe) p - ' ' � REALVALUEI TUV Power controlled: ,OvRndxm�a Lowest measuring tolerance in industry3 I i _ I i Every component is tested to meet 3 times IEC requirements I�J I� Designed to withstand heavy accumulations of snow and ice i Sunmodule Plus: Positive performance tolerance Will/ j 'PR.4 .I� 25-year linear performance warranty P and 10-year product warranty .r. Glass with anti-reflective coating o�,�m<tl.mcfims World-loss quality S�� V •Blewln nntl,olsOna.IEC 60068-?6e rJ Fully-automated production lines and seamless monitoring of the process and mate- o e :R'mc ILrnl.W ie•�EC fi:nfi p'm It IEC 61101 rial ensurethe qualitythatthe company sets as its benchmark for its sites worldwide. - <,tl;i�,aP«no. c us ; UL 1703 5olarWorld Plus-Sorting Po" ew Plus-Sorting guarantees highest system efficiency.SolarWorld only delivers modules that have greater than or equal to the nameplate rated power. C C ❑ H�m:E.��E:�.e � 25-year linear performance guarantee and extension of product warranty to 10 years i SolarWorld guarantees a maximum performance digression of 0.7%p.a.in the course ovE of 25 years, a significant added value compared to the two-phase warranties com- Mcs,: mon in the industry,along with our industry-first 10-year product warranty.' ss�� In accordance with the applicable solarWorld Limited Warranty at purchase. www.scla rworld.com/warranty i MADE IN USA OF US solarworld.com ANDIMMIFTEDPARTS i Sunmodule% Pl u s ® ° SW 285 MONO (33mm frame) REALVALUE PERFORMANCE UNDER STANDARD TEST CONDITIONS(STC)- PERFORMANCE AT 800 W/m2,NOCT,AM 1.5 Maximumpower pm,y 285 Wp Maximumpower Pm„ 213.1 Wp Open circuit voltage V. 39.7V Open circuit voltage V. 36.4V Maximum powerpoint voltage Vmn, 31.3V Maximum power point voltage Vmpp 28JV Short circuit current Iu 9.84A Short circuit current 1„ 7.96 A Maximum powerpoint current Impp 9.20A Maximum powerpoint current Impp 7.43A Module efficiency rim 17.0% Minor red a ction in efficiency under pa rtial load conditions at 25•C:at 200 W/m',100% (+/-2%)ofthe STC efficiency(1000 W/mr)is achieved. •5TG 1000 W/m;25°C,AM 1.5 1)Measuring tolerence(P„)traceable to TUV Rhein land:+/-2%(TUV cower Controlled). COMPONENT MATERIALS THERMAL CHARACTERISTICS Cells permodule 60 Cell type Mono crystalline NOCT 46°C Cell dimensions 6.17 in x 6.77 in(156.75 x 156.75 mm) TC I„ 0.04%/°C Front Tempered glass(EN 12150) TC wr -0.30%/°C Frame Clear anodized aluminum TCP,,, -041%/°C weight 39.7 Its(18.0 kg) Operating temperature -40T to 85'C SYSTEM INTEGRATION PARAMETERS IJ 1000 W/m° Maximum system voltage SC 11/NEC 1000V Maximum reverse current 25A - 800 W/m4 Number of bypass diodes 3 Design Loads' Two roil system 113 psf downward 600 W/m' 64 psf upward psf downward 400 w/mr Design Loads' Three roil system 178 64 psf upward Design Loads' Edge mounting 178 psf downward 200 W/m' 41 psf upward — ��00W/m -- • lease refer_to_theSunmoduleinstallaton'nstruct'ons forthe details associated with _ these load cases. V. ADDITIONAL DATA Module,tltzgeM Power sorting' -0 Wp/+5 W p 37.0(961) 1-Box IP65 4.20 — Module leads PV wire pe r U L4703 with H4 con hectors (106.65)4 i — �® 4x--L Module type(UL 7703) 1 712 0026(6.6) Glass Low iron tempered with ARC .__(100.85) • 00.3s(g) C, 0 $ 0,43(n) Compatible with hath°Tap-Down” and"Bottom"mounting methods o •LGrounding Locations: —4locations along the length of the 0 module in the extended flange. a 130(33) e • 00.35(9) �— 1.14(29)--� 1132 (2132 F• 39.4(1001) 1.30(33) I All units provided are imperial.51 units provided in parentheses. SOIarWorld AG reserves the right to make specification changes without notice. SW-01-7102U512-2014 r Enphase®Microinverters Enphase° M250 w. A The Enphase M250 Microinverter delivers increased energy harvest and reduces design and installation complexity with its all-AC approach. With the M250, the DC circuit is isolated and insulated from ground, so no Ground Electrode Conductor (GEC) is required for the microinverter. This further simplifies installation, enhances safety, and saves on labor and materials costs. The Enphase M250 integrates seamlessly with the Engage®Cable, the Envoy Communications Gateway'', and Enlighten®, Enphase's monitoring and analysis software. PRODUCTIVE SIMPLE RELIABLE -Optimized for higher-power - No GEC needed for microinverter -4th-generation product modules - No DC design or string calculation - More than 1 million hours of testing - Maximizes energy production required and 3 million units shipped - Minimizes impact of shading, - Easy installation with Engage - Industry-leading warranty, up to 25 dust, and debris Cable years [e] enphase® $�® E N E R G Y C US S Enphase®M250 Microinverter//DATA INPUT DATA(DC) M250-60-2LL-S22/S23/S24 Recommended input power(STC) 210-300 W Maximum input DC voltage 48 V Peak power tracking voltage 27 V-39 V Operating range 16 V-48 V Min/Max start voltage 22 V/48 V Max DC short circuit current 15A Max input current 9.8 A OUTPUT DATA (AC) @208 VAC @240 VAC Peak output power 250 W 250 W Rated(continuous)output power 240 W 240 W Nominal output current 1.15 A(A rms at nominal duration) 1.0 A(A rms at nominal duration) Nominal voltage/range 208 V/183-229 V 240 V/211-264 V Nominal frequency/range 60.0/57-61 Hz 60.0/57-61 Hz Extended frequency range` 57-62.5 Hz 57-62.5 Hz Power factor >0.95 >0.95 Maximum units per 20 A branch circuit 24(three phase) 16(single phase) Maximum output fault current 850 mA rms for 6 cycles 850 mA rms for 6 cycles EFFICIENCY CEC weighted efficiency,240 VAC 96.5% CEC weighted efficiency,208 VAC 96.0% Peak inverter efficiency 96.5% Static MPPT efficiency(weighted, reference EN50530) 99.4 % Night time power consumption 65 mW max MECHANICAL DATA Ambient temperature range -40°C to+65°C Operating temperature range(internal) -40°C to+85°C Dimensions(WxHxD) 171 mm x 173 mm x 30 mm(without mounting bracket) Weight 2.0 kg Cooling Natural convection-No fans Enclosure environmental rating Outdoor-NEMA 6 FEATURES Compatibility Compatible with 60-cell PV modules. Communication Power line Integrated ground - The DC circuit meets the requirements for ungrounded PV arrays in NEC 690.35.Equipment ground is provided in the Engage Cable.No additional GEC or ground is required. Monitoring Free lifetime monitoring via Enlighten software Compliance UL1741/IEEE1547, FCC Part 15 Class B,CAN/CSA-C22.2 NO.0-M91, 0.4-04,and 107.1-01 'Frequency ranges can be extended beyond nominal if required by the utility To learn more about Enphase Microinverter technology, r enphase® visit enpha8e.com E N E R G Y 0 2013 Enphase Energy.All rights reserved.NI trademarks or brands in this document are registered by their respective owner. Greenfasten" GF1 — Product Guide Installation Instructions R; 9L rn itt ¢IYf u pj • �-'rfi 3 4 ItC'i '' k 1. Locate the rafters and snap horizontal and vertical lines to mark the installation {t t position for each GreenFasten flashing. 2. Drill a pilot hole(114"diameter)for the lag bolt.Backfill with sealant.* 3. Insert the flashing so the top part is under the next row of shingles and pushed far al _ enough up slope to prevent water infiltration through vertical joint in shingles. Ae v M�tR. 4. (Line up pilot hole with GreenFasten hole. t} #ktp 5. Insert the lag bolt through the EPDM washer,the top compression component v- ! +. :, (L-Bracket pictured)and the Basketed hole in the flashing and into the rafter. 6. Torque to 140 inch-pounds Consult an engineer or go to www.ecofastensolar.com for engineering data. , x l EcoFasten recommends an EPDM mastic. F wf� J 6 ` F I r t � 877-859-3947 Committed to the Support of Renewable Energy ©EcoFasten Solan All content protected under copyright.All rights resented.05/29/2012 2.1 GreenFasten{" GF1 — Product Guide Installation Instructions Use for vertical adjustment when leading edge of flashing hits nails in upper shingle courses h' A s Slide flashing up under shingles until leading edge engages 2. Remove flashing and cut"V" notch at marks where nail shafts engaged nails.Measure remaining distance to adjust upslope. leading edge of flashing the distance desired in Step 1.Notch depth not i to exceed 2" length by 1/2"width. h 1 I Nails beneath shingle 41 Placement of-V"notch rr l*� - C ' r ,: • ).'.' 8 �i.✓ . zr. r.i. �f �l (( f rr I ti\ tp i t• +.. 3. Reinstall flashing with notched area upslope. 4. Position notched leading edge underneath nail heads as shown. r e y h' Nails beneath shingle Nails beneath shingle 0 / ; f . r v. ` 1 s7 N R 877-859-3947 committed to the Support of Renewable Energy ©Ecolasten Solar®AII content protected under copyright.Al rights reseNed.07/122012 2.2 V N RAC° SOLARMOUNTm 1-6 (Patent Pending) i �J SolorMountr"'shown flush mounted i in landscape(horizontal) mode r � f SoLARMouws are the easiest, fastest, and safest way to install a PV array on the roof of virtually any building: Universal –Any 64 Watt or larger, framed PV module Bi-Directional Mounting – Mount your modules in sold in North America can be mounted using landscape (horizontal) mode, as shown above, or in SolarMount. (See PV Module Compatibility List on the portrait (vertical) mode. If you have limited roof back page.) space, you can even use both orientations in a single installation. Roof Top Assembly– Because of its "top down" clamps, SolarMounts are ideal for use with the new Meets Building Code Requirements–Whether the "plug 'n play" PV modules. An entire array can be roof is pitched or flat, and regardless of the roofing fully assembled and wired where they'll be installed— material, SolarMount will securely attach your PV array on the roof. This eliminates the awkward hazard of to your roof in compliance with U.S Building Codes. lifting partially assembled arrays to the roof, and then (See "Building Code Compliance" on the back page.) mounting and adjusting them on their footings. Quick and Easy Installation –Continuous, dual slotted (See inside for details)a SolarMount rails provide the ultimate in adjustability. No more re-drilling holes, or repositioning footings. UNIRAC° N SolarMount is a "patent pending"mounting system designed for easy, safe and fast on-the-roof installation of PV modules. No more lifting cumbersome, pre-assembled arrays from the ground to the roof. > SolarMou ntTm Dual Slotted Rails SolarMount rails have a Footing Bolt Slot that provides infinite flexibility for positioning SolarMount footings. Module You can always lag directly into a roof member for maxi- Bolt Slot mum structural integrity. The Module Bolt Slot provides equal flexibility for mount- ing your modules. The result is that SolarMount can ?_ >- mount any module on virtually any roof. Footing Bolt Slot SoiarMount "Top-Down" Module le Clarilaps Modules attach to the rails from the top with unique I I i SolarMount clamps. l, First, attach the footings to the roof, and the rails to the footings..—Theni-use-the SolarMount clamps to --� - - - ----- - -j - - attach the modules to the rails from the top - one ' module at a time. l 1 I SolarMounts can easily be mounted in either landscape ly (horizontal array) or portrait (vertical array) mode without Portrait ,r, , any special added parts. -f ,, „ $. Mode �+ „ A variety of SolarMounts are available for mounting from two to as many as nine modules, depending on module andscape> ,> size. And, SolarMounts can be set end to end to create a e}` extended length arrays. (See Splice Kits on the facing page) \�v ® RM®V 1 b 1 Tnw 'L:' Footings = The standard SolarMount "L" shaped foot is designed to - bolt through existing roofing material to the rafter, and to be sealed with an appropriate roofing sealant undereach footing. Two vertical mounting holes provide for adjustment of the height of the SolarMount rail. " ' o � aic9 Yd S90P'd� Round standoffs (3" and 6" tall) are also available. ° They are installed under the roofing material, and are Sy compatible with Oatey 1'/4" diameter elastomer collared flashings and other non-collared flashings. (Visit www.oatey.com for details of Oatey flashings) TA U_ags Standard SolarMount are designed to be flush mounted on a pitched roof. If the roof is flat, or if the roof pitch is too low, tilt legs are available to lift your array to the desired angle to the sun. The maximum angle can vary from 25 to 45 degrees from horizontal depending on the size and 9 � p 9 ori- entation of the SolarMount and your PV modules. SolarMounts can be mounted end to end in order to create continuous rows of modules. Simply splice as a7= many SolarMounts together as required. PV Moduile CornpatibiNty Usk ASE ASE100, ASE300 AstroPower AP-65/75, APX-90, AP-110/120, AP-150, AP-6105/7105, AP-1106/1206 BP Solar BP270/275, BP585/590, BP2150, MSX-120, SX-75/80/85, SX-110/120 Evergreen EV-94/102 Kyocera KC-70/80/120 Photowatt PW750, PWX1000 Siemens SP65/70/75, SR90/100, SM100/110, SP1 30/140/150 Uni-Solar US-64 Call UniRac or your PV dealer for any PV module not shown. SolarMount7" Component SIpet;fications 10 Year Uniited Warranty o SolarMount Rails and Mounting Clamps, Tilt Legs UniRac, Inc. warrants to the original owner at the original installation site and "L" Shaped_Footings- 6061-T6 Aluminum _ that SolarMounts shall be free from defects in material and workmanship Extrusion -- fora pefod-bf-ten-(TO)years from the"earlier bf"1)"the tl5te -"e installation is complete, or 2) 30 days after the purchase of the SolarMounts by the © 3" and 6" Standoffs —Grade 5 Zinc Plated, original owner. This warranty does not cover damage to SolarMounts that Welded Steel occur during shipment,or prior to installation. N Fasteners — 304 Stainless Steel If within such period the SolarMounts shall be reasonably proven to be defective,then UniRac shall repair or replace the defective SolarMounts,or part thereof,at UniRac's sole option.Such repair or replacement shall fulfill �i°U79)4)3932] Code Q:®PT@�Jlhdt3G'� all UniRac's liability with respect to this warranty. SolarMounts are designed to comply with the This warranty shall be void if installation of the SolarMounts are not per- Uniform Building Code, 1997, Chapter 16. See formed in accordance with UniRac's SolarMount Installation Guidelines,or 9 the solarMounts have been modified,repaired or reworked in a manner Installation Guidelines for details regarding specific not authorized by UniRac in writing,or if the SolarMounts are installed in modules and loading. an environment for which they were not designed. UniRac shall not be liable for consequential, contingent, or incidental damages arising out of use of the SolarMounts. VNORAC 0. HAYMNIMMORMOMMIROMM UniRac, Inc. 2300 Buena Vista, SE, Suite 134 Albuquerque NM 87106 USA Phone: 505.242.6411 Fax: 505.242.6412 e-mail: info@unirac.com wvvw.unirac.com s/oi DATE: s �itp ]of a���El7Y, A �LtlEtt PLANS MUST BE FILED AND APPROVED BY THE NSPECTOR PRIOR TO A PERMT BEING GRANTED (( LocationofBuilding '/o &)CyI1,3h S'fYee7L Building Permit Application For: '(Circle whichever applies) Roof,Reroof, Install S�id�ng,_Constrvuct Deck, Shed,Pool Addition, Alteratio ]tepau/Replace, oundation Only, Wrecking Other. PLEASE FILL OUT LEGIBLY & COMPLETELY TO AVOID DELAYS IN PROCESSING To the Inspector of Buildings: The undersigned hereby applies for a permit to build according to the following specifications:Owners Name:ALhatQ b10 Contractor. A A Se_rvic 5/Chn5 r7,LA Street qQ ll<SA Street city S Ilelkl Street A 15 M nr+h s♦. City, l�m State f !� Phone (�J'f 8i �J�/N-l'I(00 State Mfl Phone N7$) Architect: City of Salem Lich V J D 5 Street city state Li( b H1P K I D I(0 09 State Phone ( ) Homeowners Exempt Form_yes, ,/no Structure:(please circle) Single Famil Multi Fami Other Estimated Cost of job S M 9a , DC) Will building confine to law? yes no Asbestos?_yes_,.,:�no Description of work to be done: �e�lcrc� Ohe / i ) Pi rfi�a �aDr�r lff� /�Pir PJ�fYI> A&A SERVICES, INC. Drawing b itted:_yes no Mail Permit to: 1 SALEM MA 01970 $�(Q'7f1.1741-042d•` ' X WWW.A-A Signature of Appli ation,SIGNED UNDER THE PENALTY OF PERJURY CONSTRUCTION TO BE COMPLETED WITHIN SIX(6)MONTHS OF PERMIT ISSUED DATE i Department use only: Permit# Zoning Map/Lot !' Permit fee S cOmams: Y 1 M i i I '� qS!+ Y l _ 9t • 'fir ..Plc . .., 5 . .. • 1 . .. ...3 . - + .:• f(I #! (eft` tn LU ELU Z. cm _ C7. , . ? O.. F e , The Commonwealth of Massachusetts 6 Department of Industrial Accidents" [� •.+ r Office of Investigations N f 600 Washington Street Boston, MA 02111 r www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ Please Print Leetbly Name(Business/organization/Individual): _A Q A Cjor Vl cs Tr)0— Address: [ 15 IJ O r-4-h Sre e± City/State/Zip: •5aL,P,rA P•[la 019•70 Phone#: I 91$� rl/ II -OH aN [2.0 ee an employer?Check the appropriate box: J I amaemployerwith 4. I am a general contractor and 1 Type of project{required): employees(full and/or part-time).' have hired the sub-contractors6 ❑New construction I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working forme in any capacity. workers' comp.insurance. g, Building addition [No workers' comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp, c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13 tLl Other •Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Ilomcowners who submit this affidavit indicating they are doing all work and then hire outside:Contractors that check this box must attached an additional sheet showing the name of the subc contractors must submit a new afidavit indicating such. ontractors and their workers'comp.policy information. !am an employer that is providing workers'compensation insurance for my employee:.Below is the policy and Job site information. —r i" Insurance Company Name:_ t r te_ Tro V0 l p rS Policy#or Self-ins//11 .Lic. #:_ C �{�,Q X I of ti (n Expiration Date: Q 1-5 O'7 Job Site Address:-?� Er,� �lsh Cj� ypP { ty p: leW t M� �1970 + Ci /State/Zi Attach a copy of the workers'ucompensation 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 ofa 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do aereoy ccert _u der the pains and penahies ofperlury that the information provided above is true and correct - Sianature: l Date �Jq�a7 Phone#: - (61-1$) "PA 1 — D"A a I-{ 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 Persian: Phone#• r � Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.": MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any . applicant who has not produced acceptable evidence or compliance with the Insurance coverage required." . Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers` compensation policy,please call the Department at the number listed below..Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the- applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,': ` please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia ,� t; DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M. G. L. c. 40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed facility as defined by M. G. L. c. 111, Sec. 150a. The debris will be disposed at: Salem Transfer Station ,. owned by Northside Cardna Signature of ennit Applicant JJ9/ D7 . Date Christopher Zorzy Name of Permit Applicant A &A Services, Inc. Firm Name 115 North Street Salem MA 01970 Address, City, State, Zip Code -7k B ���� uv OARD OF BUILDIN REGULATIONS '"'i. License: CONSTRUCTION SUPERVISOR _ d A '7 Number:'CS 057733 i� Bttthdate 05/2671958 E>tptttis OS/ZB/2607 Tr.no: 12633 k Rel�iYy1��t�tl Db CHRISTOPHERY �. 115 NORTH ST ` C—ll. . SALEM, MA 01970� Commissloner i ;sue ✓�.e �a�iunmunea%/� �f�./�iara��rae� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR _ Registration: 101609 Expiration: 6/26/2008 - Type: Private Corporation A&A SERVICES,INC - Christopher Zorzy 115 North Street - C;�^. Salem,MA 01970 Deputy Administrator Commonwealth of Massachusetts Division of Occupational Safety Robert J.Prezioso,Commissioner > Deleader-Contractor CHRISTOPHER ZORZY Eft.Date 02/09/06 Exp.Date 02I08/07 0 - DC000440 h4m*rof C.O.RE.S.T. . 7 BO11W1W1,,I11 t'I'IfltfI IIpII II„I�III�IIIII IIIII IIIIIIIIII IIIII IIIII III IIII IIII BOSTON-RENEW KtUtIVLU The Commonwealth of MassachuseidNPECTIONAL SERVICES UlfBoard of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM ZDIb ���� A 1l:. mvisedMar2011 Building Permit Application To Construct, Repair, Rendvate r e'llish a _ One-or Two-Family Dwelling n This Section For Official Use Only U J Building Permit Number: Date Applied: GL 9 ". ..._ r4, I ..,cam I•IJ'j(O _ Building Official(Print Name) Signature Date_ SECTION 1: SITE INFORMATION 1.1 Property{address: 1.2 Assessors Map &Parcel Numbers �rC7 �rY�LI of S� I.l a is this a accepted street. es no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' , 2.1 CM'of Record: (A -� ��� � Cb /(1t�72 ( MA Nat (Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2 check all that apply) ( PP Y) ._ New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteratiioon(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ff Specify: /Z+OC Brief Description of Proposed Work 2: SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $ �� 1: Building Permit Fee: $ Indicate how fee is determined; 2. Electrical $ ❑ Standard City(Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees $ s 4. Mechanical (HVAC) $ List 5. Mechanical (Fire Suppression) Total All Fees: $ . Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ - S �� ❑Paid in Full ❑ outstanding Balance Due."r 5210 IIDCO0T, �' SECTION 5: CONSTRUCTION SERVICES 5.j1�Coon,.strucltiQ1n-Supervis1or License(CSL) ) 4- - �-b lOpr-0 License Number Expitiation Date Name of CSL Holder Jam+ List CSL Type(see below) No. and Street tMd C ,.Type I);-Description �LGldWw���Cti„M w� 1 �Z U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town, State,Z R Restricted 1&2 FamilyDwelling M Masonry RC Roofing Covering WS Window and Siding t,�C SF Solid Fuel Burning Appliances 1 Insulation Tele hoe Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1 5�a�� �� `6 I to R9 rn ' HIC Registration Number Expiration Date HIC Company Name or MC istran[Name i Lam, and Street Email address City/Town, State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.'§ 25C(6))" Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issua ce of the building permit. Signed Affidavit Attached? Yes ..........Nd No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TORE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT" 1,as Owner of the subject property,hereby authorize / L'b(lG NO S-D(a-y- to act on my behalf,, in all matters relative to work authorized by this building permit application. ot; c, c, 1 iozzt 1 / /S/l6 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. . /04-�;, 5� zcv i J/S //6 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.<rov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage, finished basemenUattics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" f CITY OF S�UEL I NLkSSACHUSETTS BUILI)NG DEPARTNIENT ` 120 WASHINGTON STREET, 310 FLOOR TEL (978) 745-9595 FAX(978) 740-99" KIN fBERLEY DRISCOLL MAYOR THoNw ST.PtERRB DIRECTOR OF PUBLIC PROPERTY/BUILDLIIG CONLNQSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) Tn accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: l✓• Z. �Ue�, �� � � 6� �� DPI h,ey)� Mp (name of hauler) The debris will be disposed of in (name of facility) (address of facility)— , OY, c���Gyno signature of permit applicant Date a�br�wtr.ax CITY OF SOU E.i,I, 2AXSSACHUSETTS BUILDLNG DEP\R"rNMNT 120 WASHINGTON STREET, Yo FLOOR TEL. (979) 745-9595 FAX(978)740-9846 KimBERLEY DRISCOLL MAYOR T HOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDLNG co%m ISStioNER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusingssOrganimtiovindiviiddual): E R Y2 Address: AACA-fQ Sr \ City/State/Zipk Y`00 014o,t Phone Are you an employer?Check the appropriate box: Type of project(requireft 1.0 1 am a employer with 4. 0 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet.: 7. 0 Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. ,�,/4rkers-comp.insurance. [No workers'comp. insurance 5. ILJi We are a corporation and its 9' ❑ Building addition required.) officers have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL I t.0 Plumbing repairs or additions myself. [No workers'comp. C. 152,§1(4),and we have no 12.0 Roof repairs insurance required.)t employees.[No workers' comp. insurance require 13.❑Other d.) •Any applicant that cluxits box 91 must also[ill out the section below slowing their worker'tomptmsatton policy information. 11 in t own s who submit this affidavit indicating they me doing all work ami then hire ourido commetma must submit a new affidavit indicating such. Conuxon that cheek this box must attached an mianiorel sheet showing the more of the sub nnacor and their worker'comp,policy information. I am an employer that Is providing workers'compensadon insurance for ray employees. Below Is the policy and job sire information. ((�� Insurance Company Name:.L d kf( � Co Policy#ur Self-ins.L�ic.ft:_ NN C,V hl7�l C� �� Expiration Date: ,, ••o2S ` Job Site ) Address: �(0 �'�C„� Sl Ciry/State/2ip:�_'�l.frn •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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a firm 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 under ))the pains and penaties ofperjury that the information provided above Is true and correct Date Phone#: C(' Cam{. )3( - (-( 3 � A O)rcial use only. Do not write in this area,to be completed by city or town official City or Town: _ Permit/I.icease Issuing Authority(circle one): 1.Board of Ilealth 2. Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5. Plumbing inspector 6.Other Contact Person: Phone#• Massachusetts Department of Public Safety Board of Building Regulations and Standards License. CSSL-101027 Construct on. Suaerr;isor Specialty . . RONALDO SOLANO 763 WAVERLY STREET I FRAMINGHAM MA 01702 =xpiration: comrniss;oner 12/09t2017 ---------------- /,,, n r!�fr ,ni,rn,mrrcc«B(usidess Regulation Office of Consumer Affairs& ME IMPROVEMENT CONTRACTOR Type: 8/872016 gistmtion: 152206 DBA I�n'T Pimtion: H&R ROOFING RONALDO SOLANO a 763 WAVERLY ST � FRAMINGHAM,MA 01702 Undersecretary s�coRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMRIDNYYY) `� 1 0/1 512 01 5 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the forms 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 COMTA,CT- Lori Bigelow THOMAS J. WOODS INSURANCE AGENCY, INC. PHONE 508)755-5944 Ws: Ibi elow@woodsinsurence.c m 20 PARK AVENUE INSURERS AFFORDING COVERAGE NAIC 0 WORCESTER .MA 01613 INSURERA: ATLANTIC CHARTER INS CO 44326 INSURED INSURER B: H&R ROOFING &CONSTRUCTION INC INSURERC: INSURER D: 763 WAVERLY STREET INSURER E: FRAMINGHAM MA 01702 INSURER F: COVERAGES CERTIFICATE NUMBER: 5757 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. ILTR NSR ADWVn DLISUB19 MNUYEFF MUY�TYPEOFINSURANCE POLICYNUMBER M MIU LIMITS COM UI MERCLGENERALLIABILIY EACHOCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE PREMISES Ea ocamenoa $ MED EXP JAnyone arson) $ NIA PERSONALBADVIWURV $ DEVIL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO, LOC PRODUCTS-COMP/OPAGG $ OTHER: $ MTOMOBILEUIBILITY COMBINED BINGLE MIT $ LE, a Wenl ANYAUTO BODILY INJURY(Par person) $ ALL OWNED SCHEDULED AUTOS AUTOS NIA BODILY INJURY(ParettMenl) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per eoGtleni $ $ UMBRELLAMS, OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE NIA AGGREGATE It DED I I RETENTION$ it WORKERS COMPENSATION V _ ANDEMPLOYERS'UIBILITY YIN /� STATUTE ER ANWROPRIETOR/PARTNERIEXECUrIVE E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDEDT NIA NIA WA WQV00990603 02/2$/2015 02/25/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1QD,000 If 6 saoiba under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 13 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Ramarke Schedule,may be attached If more apace 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 Dan be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at w ,mass.gov/lwdtworkers-compensationfnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - Del M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA 9)1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD H&RRO-1 OF to Bc CERTIFICATE OF LIABILITY INSURANCE °1012°D7/2 01515 1012 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 ,..a..__ .. Thomas J Woods Insurance Agcy NAME: Walter M.Conlin Jr.CPCU - - P.O.BOX 2940 ac�+mo Ezm:SOS-755-59" :FAX 1 Worcester,MA 01613 ADDRE Walter M.Conlin,Jr.CPCU ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC _ INSURER A:Prnn America Iremance Co. INSURED H&R Roofing&Construction IBC INSURER B:Commerce lns��mnce Company 3g7,yq Ronaldo Selene 763 Waverly St INSURER C Framingham,MA 01702 INSURER D: !NSURER E INSURER F: I 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. NSR' LTR TYPE OF RISURAN(.E BRI IN SDI Wve PO4CY NUMBER MM!DD/YYYY mD FOLICYy I JAAnS A. I X,I COMMERCIAL GENERAL LUULLIIY ! wo EACH OCCURRENCE is 1,000,00 CLAI�.j ^ ;'OCCUR IPAV0073377 '. 1012612o15I 10/26/2016 ppcMiSES Es oaurrer;ce j s 50,00 l I I ! MED EXP(Ay one person) s 5,00 ! FERSONAL S ADv!wURY s 11000,00 II GEML AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE IS 2,000,00 X %POLICY L_J EC r L_J1 LLC-' - -1 ' PRODUCTS-COMPIOP AGG 5 1,000,00( Ii OTHER: I AUTJMOBILE LIABIIIrY I S ! !CEa amNtle�ntSINGLE i1MiT S B ' I,ANY AUTO '!ALIOVJNED rX1 SCHED!n Fp IBBXY33 03/01/2015 03/01/2016 i BODILY INJURY(Per person) s ;10QOO I--'AUTOS I I AUTOS I BODILY INJURY(Per 8cd )1 5 300,00 Xj HIREC AUTOS %X N �-0VvNED I PROP DAMAGE g 100,0 j s I UMBRELLA!run TOCCUR ; EACH OCCURRENCE S EZCESS 'en CIA IMS YIACE' AGGREGATE s i i DEC I REl'ENnONb I I s I WORI�RS COMPFNSATgN I 'PER OT !AND E#IPLOYERS'(L1aRrfY j ANY PROPWETOR ARTNER/EXECUTNE YIN { i ISATIfIe ER !CFRCEER0IEMBER EXCLUDED, NIAj !SEE NOTE BELOW IE.l.EACH ACCIDENT s i(Mandatory in NH) E.L.DISEASE IPYea:desvihe lndet 1 E4 EMPLOYEgS DMd PTIONOFOPERATIONSbd. E.L.DISEASE-POLICY LIMIT S ' I OESCRIPitON OF OPERATIONS 1 LOCATIONS!VEHICLES(A(bRD tot,Additions!Remarks Schedule,maY Oe ambctred h more space is repuireO) WORKERS COMPENSATION COVERAGE INFORMATION WILL BE PROVIDED UNDER SEPARATE COVER BY THE ASSIGNED RISK CARRIER. r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD ` l'ie C'onunon weal th of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CNIR SALEM 'L•-+•• Revived I htr_'Ill l Building Permit Application 'ro Construct. Repair, Renovate Or Demolish a One-or Tuu-Family Dwellhnv This Section For Official Use Onl Building Permit Number: Date lied: Building Offloal(Print N;unc) Signature Date SECTION l:SITE INFORMATION LI Property Address: 1.2 Assessors Map & Parcel Numbers U� I.la Is this an accepted street?yes no Map Nmnl+er Parcel Numlxr 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(11) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(( Gf.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal sm ❑ Check ifcs❑ P )stc SECTION2: PROPERTY OWNERSHIP' 2.1 Owner(of Record: 3 Alm ,,.. .MA None(Print) ®C'ity.State,ZIP - � I� 4N r Cy+ 5 -- / Z$7�� 1103 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction ❑ Existing Building Owner-Occupi Repairs(s) ❑ 1 Alteration(s) ❑ I Addition ❑ Denwlition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work: c., S` > UE n SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and .Materials) y I. Building S 0 o beaEa_ I. Building Permit Fee: f Indicate how fee is determined: 2. Electrical s ❑Standard City/Town Application Fee O Total� Cost(Item 6)x multiplier i. Plumbing g � F /ees: P — —..---- _. Other Fees: S 4—Mechanical ill\':\C) S List: _--,- � Suppression 11 S Total All Fees: Check No. Check Amount: Cash :\mount Total Project Co ❑ st: s -- - - ��'� Pail in Full 0 Outstanding Bal;utee Due: r- SECTION 5: ('ONSTRUCTION SERVICES 5.1 Construction Supers isor License WSW Q 6 / \ - —.. L iscense Numhcr Pxpir;uion Unlc N:une ol'CSI. I folder f I ist CSI.1)PC(see helo%0 I)PC Description No. and Street ,/ [Il Inrestricted Illuildin,s a in 35.000 cu. 11.) ® .4 �Ef,��L �!.�} Q.�_�..Q R Restricted 1 Y;2 I:amil Ihtalhu Citvi l'm%n.State.ZIP N1 %la"11111iry RC lt,xiiing Covering -- .- W'S Window and Siding SF Solid Fuel Burning Appliances I Insulation 'I cic hone Pmuil address D Demolition 5.2 Registered Ilume improvement Contractor(HIC) r�Sfw sC IIIC' Regisuation Numlx:r Expiration DateIIIC'compun) Numc or I IIC' Itcgislrani Namc Nu, and Street Email address � -•c�� r � G7g SZL�s3'"� Ci /Town. State,ZIP Tcle hone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152. 1 2SC(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ❑ No........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I.as Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below. I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's o w narircJ gars Vance I viec ronie Signature) Date NOTES: I. An Owner who obtains a building permit to do his,her own work,or an owner who hires an unregistered contractor (not registered in the Hume Improvement Contractor(HIC) Program),will ILLPJ have access to the arbitration program or guaranty fund under I.G.L. c. 1 a2A.Other important information on the HIC Program can be found at sa�aat mt.., ,% ,pro Information on the Construction Supervisor License can be found at�%ks,,.nct:: �;o\ dp,_ When substantial work is planned, provide the information below: Total floor area(sq. ft.) _ I including garage, lmished basement.attics.decks or porch) Gross living urea I sq. 11.1 ----- __- __-- - _ Habitable room count Number of lireplaces -_ Number of bedrooms Vumher of hmhroonis Number of half baths .. .. _.. . ._ . I)pe of healing system .- .. . _- _- Number of decks, porches I\peal'coalings}smnt _ _ _ _ Fncloscd .Open 1. "I otal Project Square Footage"ma) he Substituted fir-focal Project Cost' I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation 1 isurance Affidavit: Builders/Contractors/ElectriciansTluufbi:i Applicant Information IPlease Print L�ril,ls Name (Business/Organization/Individudl): A 1L a, ) Address: Are you an employer? Check the ap ropriate box: Type of project (required): I I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time. + have hired the sub-contractors I am a sole proprietor or partner listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These subcontractors have 8 ❑ Demolition working for nja in any capacity, workers' comp. insurance. 9, ❑ Building addition [No workers'.domp. insurance 5. ❑ We are a corporation and Its required.] officers have exercised their 10.❑ Electrical repairs w twdli;. ❑ I am a homeowner doing all wor right of exemption per MGL I I.❑ Plumbuig iepaus or myself. [No workers' comp. a 152, §1(4), and we have no 12 ❑ Roof repairs insurance required.] t employees. [No workers' 3,❑ Other comp, insurance required,) ---------- -- -- '.,ny applicant that checks box#1 must also till o t the secuon below showing their workers'oompensation policy information, iomeowners who submit this affidavit indicatt they are doing all work and then hire outside contractors must submit a new affidavit indicating suc'j. onuactors that check this box must attached an dditional sheet showing the name of the sub-oontraetors and their workers'comp, policy Iniotmmiuc. um an employer that Is providing wor(ers'compensation Insurance for my employees, Below is rlie policy and;oh r information. nsurance Company Name: .Z M . U ' L) Policy it or Self-ins. Lic, N: V W C (Q 0 1 n R 2 g y 1 'a n I 1 Expiration Date: on Site Address: Lk C, 0wG L;LSp%; Ste— City/State/Zip: :vitach a copy of the workers' compel.;atiori policy declaration page (showing the policy number and espir,rtiuu Failure to secure coverage as required u'.der Section 25A of MGL c. 152 can lead to the imposition of criminal penult!:s o: .. !le upLto $1,500,00 and/or one-year im-�riscarnent, as well as civil penalties in the form of a STOP WORK ORDER and up to $250.00 a day against the viola. a. Be advised that a copy of this statement may be forwarded to the Officu o t:tvestigations of the DIA for insurance overage verification. — —_— / do hereby certify under the pains and enalfies of per)ury that the information provided above is true turd correct. nanlre t�r�—� ,7 6�1� rz— Date / Z tZ. Olf7cial use only. Do not write In th s area, to be completed by olty or town official r. City or Town: Permit/License N Issuing Authority (circle one): 1. Board of Health 2, Building Del. irtment 3. City/Town Cleric 4. Electrical Inspector 5. Plumbing lnspecw 6. Other Contact Person: Phone N: __ - .,IvI Q'IIi 7(C OOY C4G4 r.L)i nvvl\V __ _ _���.• � • �• awl% a. v• aaaAl ar•r• •. • ..gww. v ..aaIA 07/28/2011 _ 97i.887.4900 FAX.976.887.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION dwi:il F. 'Sennett InsuranceApgncy, Inc. ONLY AND CONFERS NORIGNTS UPON THE CERTIFICATE 6 South Main Street HOLORR.THIS CERTIFICATE DOES NOT AMEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 0. Sox 457 opsfield, MA 01983 INSURERS AFFORDINO COVERAGE NAICp .�AED Len Gibe y ontract ng o Inc. WQURERA A.I.M. ^---- 23R Minter St. --- ^.�-................-- IN6URER B' Peabody, MA 01960 INSURERC: ' INSURER D: INSURER e: ---- -- )VERAGES iE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATE[).NOTWITH$TANOING ,NY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR ,NAY PERTAIN,THE INSURANCE AFFORDED 8Y THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS,EXCLU84ONS AND CONDITIONS OF SUCH C LICIE s.AGGREGATE LIMITS SHOWN MAY HAVE BEEN.REDUCED BY PAID CLAI418. %(NSR NPE OF L43UPANCE POLICY NUMBER T 47 G�EN ERAL LAIN T Y EACH OCCURRENCE 1 MMERCIAL GENERAL L"LrTYIER 1 —^._- CLAIMS MADE OCCUR DIED EXP VVI ana parson) 6 PERSONAL 6 ADV NIJVRY 1 _ GENEMLAGOREGATE P GEN POLIGRBGATE LIMIT MPL LOC: PRODUCTS.COMP/OP AGO 11 --_-_-� POLICY PR0. LQC —_..._.__ • AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMB 1 (Ea acdaanl) ALL OWNED AVTos - OOILY INJURY 6 9CHEDULEG A1R09 Par ppsan) AWED AVT06 .....- _-- BODILYMJVRY 1 NON-OWNED AUTOS (Par eGpldeni) _... .._ _. _ PROPERTY DAMAGE —_ (Pa amidenl) 1 GARAGE LABILITY AUTO ONLY.EAACCIDENT 1 ANY AUTO — ...... .........._.. ._..._ onVA,i EAAGC 6 MIT[)ONLr: AGO s EXCESSIUYBRE"LIAB6ITY EACH OCCURRENCE 6 OCCUR n CLAWS MADE AGGREGATE DEDUCTIBLE _ RETENTION 1 S AND PiovCOUPS N"Tm YIN VWC6010979012011 08 03 2011 OS/03/2012 X T ER' ANY PROPRIETOWPMTLIDED7 CUTIVEn E.L.EACH ACCIDENT i SUO,00 OFFICERMEMBER FJtCW0ED7 LJ �NYanaNnq EI NN) E.L 018EME•PA EMPLOYEE 1 SOO,00 Y»E� IPROAASMIONS EMDw E.L DISEASE.POLICY LIMIT 7 $QQ Q oTRER <rivm DN Of OPERATKfNb.LOCATIONe/Ye6tteBT®(OLYBIONB ADDED BY E91DOR9eMmfT/a1ECNl PppV13tONs , RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIME6 BE CANCELLED BEFORE THE EXPWATION PAT&THEREOF,THE ISSUING INSURER IVILI.ENOEAVOA TO MAIL 10 DAYS WRITTCN NOTICE TO TNECEATWCILTE HOLDER NAMED TO THE LEFT,5111 FAILURE TO DO 90 SHALL . IMPOSE NOOBLIOAYION OR LMBILRY OP ANY KIND UPON THE IN4URFA,ITS AGENTS OR Evidence Of Insurance AYTMCIIRi'B tiC}IYaClITATRra Robert Sennott ORD 25(2009101) ORO CORPORATION. All rights rv6vrrvd. The ACORD n"and logo an nyletered marks of ACORO J FIN-24-2012 14:35 Sennott Insurance 978 687 2404 F'.01 Ul/24/ZO12 PCDUCER 978,887.4900 FAX 978.587.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW._ P. 0. Box 457 TOpsfield, MA 01983 INSURERS AFFORDING COVERAGE INSURED Len Gibely Contracting Co. , Inc. INSUAERA Catlin Specialty Insurance Co _ 23R Winter Street wsuafiae. 119U38 - Peabody, MA 01960 INEvaeac: .. _ - wsua6a o: T _C -- --- ...._..— --- J INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWR HSTANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDI(IONS OF SUCH PQLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IITR Nbp Type OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION - D TE MMIODITYYY DATE MM/00/YYYV LIMITS GENERAL UABILm 37DD3D1D3$ Ul/29/2012 Ol/29/2013 EACH OCCURRENCE b 1,000,00 X COMMERCIALGENEPALLMBILRV PREMISED Ea oaurrence i __1DQJ C)_ CLAIMS MADE FX OCCUR MED EXP(Any m WI99nl i 5,000 '4 PEPSONAL 8 ADV INJURY i 1 GOD,DD GENERAL AGGREGATE e 2 000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PROOUCTS•COMPIOPAGG b 2 UOO,OO POLICY j CT LOC - - v� y0�l----- AUTOMOBILE UAEHUTY ANY AUTO - (EOa e ccl a191NGLE LIMIT S - ALL OWNED AUTOS BODILY INJURY X SCHEDUUDAUTOS (Pw P91Ben) 3 B X HIREDAUTOS BODILY INJURY X NON-0WNEO AUTOS (PVI Id9N) ---••- FROPERTY DAMAGE 3 - --_-- - (Per a<699nu GARAGE LIABILITY AUTO ONLY EAACCIOENT i ANY AUTO - OTHER THAN EA ACC b AUTO ONLY. ADD b _ EXCESS/UMSREIA.A LIABWTY EACH OCCURRENCE e OCCUR U CLAIMS MADE AGGREGATE OEOUCTIBLE ^- 3 �. ..—_ P COMPENSATION AND EMPLOYERS' LI ER AND EMPLL OYERS'LIABILITY YINTORT MI�Sy. — C OFFICEANY ORIMEMB�EXCUDED?ECUTIVF� E.L.EACH ACCIDENT b (MAnEMC,Y In NMI E.L DISEASE-EA EMPLOYEE 3 Pa Not.d9C9 Gunder ECVa PROVISIONS below EL.DISEASE•POUCY LIMIT i OTHER 11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS VIDENCE OF 2012 RENEWAL COVERAGES. i I CERTIFICATE HOLDER CANCELLATION __ J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1'NE EXPIHATIONI DATE THEREOF,THE ISSUING INSURER WA.L ENDEAVOR TO MAIL l0 DAYS WRITTLN NOTICE TO THECERIIRCATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 60 SH4LL IMPOSE NO OBLIGATION OR LWUIUTY OF ANY RIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORQW REPREBENTAi1VE Sennott Ins. Agency ACORD 25('2009101) 9)1988-2009 ACORD CORPORATION. All rights moorvwd. The ACORD name and logo am registumd marks of ACORD 1•.y '• Papa No el LEN GIRELY CONTRACTING CO.,INC. > - X' ^, 23RWalterStreet , ,a 23674: ROPOSAL r PEABODY,MASSACHOSETTS 01960 �.uy+y, A " ' "' �' , +''A•�.bA�'�i I k .f An homo ttaprpblllplAtpwl4All:lom and euhaontaodton r (970)637A23pa F82(a781531.930a s „^ meased inhomp lmpmvament contracanp,unlosa r "v; NrwWdpnglbelyoMpfecling cOT 4 pppcllN&b A4 ra fnm rpplcaatlon pY Provlelon 1 n ' '• ,�`s- CMpter 1A7q of Ulp penmpt lows,mu6lbo roplale oa ' SWMllad r' p " IN Ino CommonwppRn pf MeoahcnueaAly.Innull - io ' Daut epbarredan pM piMap choula bo macro tp tno - n oneb ar'Noms ImprovpmpnLConvact Ro919Vetlon I �.-, one AabDUMOn'PNpp,RDOT'A3a1,9orten,MA 011ae Vu n bald) .b. side i Owmn,wno eeaura Anolr awn 0/C/ �lv - ronsvuctbn rW perndb'or anal with unropletorotl - {. R el ntnoas.wtll M azctud ld from bile G....M Y Fund f leavhenuf MGi.c.1<3A. SZZ IZ- .7 rmxw N0.REG.l00S1t 'oTq Npww. xpelorNw . sA•,-,e Lv i wn."nana•quuvee'.VT•w•Ms ..evemMwwrMMl.'el x r1 ,.a { .. ��iurWOA� ASdL' .r"/ �,`D)p .S/�d�: n /ilJ�/,A�/l� a.c><.�y -,,, •.l, '+ .' � -.�O/LQ^fir � 4:('� LA//q li/-G�.�i>"tiri fi, �<. �/r �• _ � Lo-S /1. ;,�,n•l�.Pr�a/k'%ia..l�/ r'!(„��.` f ��/i:A,l_.tuY,d.4 !r'�:��<,Gnln�. �F,� ,f..f:/�C�Po��'��:�5�/v�•w�'.(:cvi , sK��� r I J/. Ml GSfG Jy-Y � 4k 'cwea p 1 a - " 1 mes 'Cp ,]waM1 wtlwbmY,Wa Mn NoeN JT wbi No•Vbq s WsM .w4eaHAa Mb see Ml Man as vwX � Rb • _ ItM 1 awNpbky wa w Wvmuvn] atl ] a N•vY n wnppb q ton.)iM Qmw m ,kl a �O{'•`s.ao4'Wnu,ul am•W •Mnval tl41/bNI4.Y!• M uxµ'Amaa VA•Poq,w6 ' 1 bM f<a]mY/aa,a�b n'OwF4WMOMSMu A N 4m,aAKbM mm,bwtlw mapb 'NMod o n idl. NMiMa/adl L ` iMM•TwY ai• : w MMau giw,wtl]wn0bW w6'+myeuw MbOm•ia. raw boaaaWM �rw ba�,d,.+,kAwAaYpawn,w cwv.muw.0 ar n..,mo.w..lxrx •.w.rs+:.o.+.,.w nMW y. �nu.w,aww+•Nnn+M(rob•W9�^?.•tlb•[mAvvrouM,^r+.,wn]o,a•wnmmvnwwb•PmY�m,ua r. We PropcSe heroo,bfumGh material and labor-dampleta in l erardanb elth appvs Fppolknlbns,Io 1ho 9uT o1 1 V - Pa ream anabol dsl l'mp. CJ• 1 111 •V+q emuwl: � f AlLoonmRAaMa. 5 rc♦ "✓aev+YM1W+u y pl mnanam r i y t b JL F 1 —W eodt a _ - .,'. I,p Ybla•dtwtivra nlM. - yf.� Ap,p •NnlYa W pyapllgr,l lu �aNpmxbnl[w G q Y09=ro,S gpww ` :`'� `f Pmanot aWMCCWos1 been—dJ W blob ryXmnv m�� ) wwawwema9 am.' ],rvnarar x9mb � r 9wn.ewgr. b��aroN.amn. 'n Ya9AwY a,wean, an mme_natiemwygmplL � r � •+� I f•• : 'n .xAm ww•Imweq ap Acceptance of Prcposal 1pava as eom sNvg5l rile aoaprenl nd,[LPt Me pricat,9Pad(Icap]rn81Y1 Ma1b19 slotod.I an"betand You,the Buyer, ;.osal Eerdlws a'inainp WnYazl,You any fined, do!'•.c vroR e9 spedfpat Paymwllpill Do mpdB a6Ovdrtwtl appvC f +! You,the Buyer,,ny cancel this transaction at any time prior In n dnight of the till business day after the t, - r. dale of this r li ' coon. cpllalfon moot be tlone in writing rv. ♦ < THIS CONTRACT IFTHE�- AN ACES. NFORMATION ON 6AC)<.� I h 1 f ^+. ; tT• y°A /4. d xr M 8 Abr P M a k ,M ; aA r 'rd I t w - vatu a(, e.v✓r r tk l Yn�^ ra ,,-.ak l� Kt'•��,W'YKg � w r - �....' . .� A.&.w. Massachusetts - Department of Public Safety De�a.rt Board of Building Regulations and Standards Construction Supvi-Nisor Licerrise: CS-094763 V I'S THOMAS F-RDABINS:'19 l Cedar Hdn I Danvers 1 19 ug 0ra Expiration Commissioner 05/14/2014 �Lx Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e Istr i a jtj g on: 100811 Type: Office of Consumer Affairs and Business Regulation Xpiration: 6123/2014. Private Corporation 10 Park Plaza-Suite 5170 Boston, MA 02116 LEN GIBELY CONTRACTING' C--O.*-,.'.-.I'NC, lit 3fian Dobbins 23 R WINTER ST. FEABODY, MA 01960 Undersecretary /'- Not valid;od'utkienaturc