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19 GREENLAWN AVE - BUILDING INSPECTION (2) - 14 - �12� g2 _ 320� The Commonwealth of Massachusetts RECEIVED Board of Building Regulations and StatECTIONAL SERV ICESCITY OF Massachusetts State Building Code,780 CMR SALEM l�e�ised Mar 2011 Building Permit Application To Construct,Repair,Renom(Kael2lis r� One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1..1 Property Address: 1.2 Assessors Map&Parcel Numbers 0 1,r4414),atam % 7 Lla I an accepted street?yes ✓ no Map Number Parcel Number 13 Zoning Information: 1A 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? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner,of Re rd: to I JAB ye M h214 �Is�yYl I'�l (9)! jw Name(Print) City,State,ZIP 1-� n134 l4 Alhr ' Y No.an treet Telephone LEmail Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check ail that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other W'Specify: Brief Description of Proposed Work': ) wa )e D Y Oki +/t% I'w 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: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑ Outstanding Balance Due: MAIt,(� S �ZZ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 101 ' I-LZ* vy 1/1- License Number Expiration Date Name of CSL Holder Lis[CSL Type(see below) No.and Street Type Description R Unrestricted(Buildings s u el ing cu.ft. /µ_.(��pQ" R Restricted 1&2 Family Dwelling Cr o State,ZIP 0 M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances GJ I Insulation Telephone Email address D Demolition 5.2 Registered.Home Improvement Contractor(HIC) rf'1�Y'1 l y HI Registration trationn NCuumbeCJ r Expira' tiO1 Bate HiC Company Name or HIC Registr t Name �+�, to +-4 �rLyl n]A . � h�V�J�� - 6Cy1-I No.and Stree )�n^ � �— Email address Cit /Towh,State,ZIP (" r 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 .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize to act on my behalf, in Cn all matters rrelative to work authorized by this building permit application. � Print Owner's Name(ElectronicSignature) � Date SECTION 7b:OWNERS 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 or Authorized Ager......,..... ) 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.gov/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.R) 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" 1�t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen icor 1 &2 Family License: CSFA-101264 -' BRUCE D DI[ E 677 TEMPLE STREET' i", IF DUXBURY MA 62332 I�F Expiration Commissioner 05/23/2014 fee sum r Affairs& o�✓L��id>a laden la Office of Consumer Affairs&Business Regulation W1HOME IMPROVEMENT CONTRACTOR Registration: 4160450 Type: Expiration __7/29/2014 DBA F..: BRUCE DIKE ALTERNATIVE ENERGY BRUCE DIKE Y # ! 677 TEMPLE ST ( DUXBURY,MA 02332,�);,--:r�sr' Undcrsccretary New ENGLAND Status: active Date: 2/25/2014 S LAR QUOTE:B121 hotwater HOME I SCHOOL I BUSINESS TO Mike Pannenton huskvdiver(o)aol.com 19 Greenlawn Ave Salem MA 01970 Salespen;on r Job Delivery Date ;: Paymem terms Bruce I Solar domestic hot water system TBD 50%down,balanceupon completion �. Description _ G1ty. f Un�tt PneI Install solar domestic hot water collectors, Storage and all associated controls and hardware. III I i Included; I j (3)Kingspan FPW30 flat plate collectors and racking Kingspan Tribune 119 gallon stainless steel solar hot water tank w/electric element Copper or stainless steel solar line set with 18mm UV proof insulation and sensor wire I Resol 'BS Plus'solar controller j Wilo Star 32F primary pump j Zilmet drain back tank I Propylene glycol heat exchange loop C Potable anti scald valve Not included; Electric element wiring $10,130 50%of engineering costs(if any)above$275 I 1 This system will generate a$4 052 MassCEC rebate that is payable to the customer (MassCEC home value adder assumed; <$400K) (NESHW can take rebate check directly from MassCEC if required. to reduce customer's immediate out of pocket'expense) 7 ! 1 I Total: $10,130 neshw.com A SOUTH SHORE SUSTAINABLE BUSINESS 677 Temple Sr.Duxbury,Ma 02332 Phone:7815368633 Fax:8153018678 bmce(?aneshwcom Ma.H/C license 160450 NEW ENGLAND LAR ho ater HOME I SCHOOL I BUSINESS BUYER'S RIGHT TO CANCEL Proposal 6121,4/1612014 If this agreement was solicited at or near your residence and you do not want the goods or services, you may cancel it by mailing a notice to the seller. If you cancel, the seller may not keep any part of your cash down payment.You must say,in the cancellation notice, that you do not want the goods or services and mail it before midnight of the 3rd business day after you signed this contract to the address at the bottom of this form. Total Amount $10,130 (includes $275 for stamped structural letter) Deposit $500 Balance upon completion $5,578 MassCEC rebate paid directly to NESHW from MassCEC $4,052 The homeowner: Agrees that he/she and has read this agreement and any addenda and the terms, specifications and conditions are satisfactory. Represents and warrants that he/she is the owner or authorized agent of the Construction Address. You are authorized to work as specified and payment will be made as outlined above.Homeowner's signature of acceptance�y� �/� � � Date k ! Contractor's signature of acceptance_ z-.i''-------Date_ ,�11�� This contract maybe withdrawn if not accepted by the Contractor within 60 days. neshw.com A SOUTH SHORE SUSTA/NABLEBUSIHESS 6771emple St Duxbury,Me 02332 Phone.7815368633 Fax.8153018678 bruce@aneshwcom Me.H1C license 160450 19 Greenlawn Ave. , Salem, MA plot plan or wn Ave, Salem, MA 1 s . a y+ 3 p 4 �. Xf V:.. �w4 q„ ! 5 x� M , • Proposed collector location (mounted 'flush' to roof Pannenton residence, (3) Kingspan FPW30 collectors Exlstlnacondltlon Sloped roof snoty load calculatlon Raft2rsize,sp2cing 1VOCIVtruss nom exposure 1 Raftersp2de5 SPF thermal 1 Rafterpitch 32 degrees importance 1 Rafterspan 13'n' ground snow load 45 Sale mground snow load 45 PIS slope factor 1 5 lope d roof s now I oad p e r ASCE,Ch 7 315 PSF Flat roof snow load(Pf)=.7'Ce'C[•1'Pg Sloped roof snow load=rs'Pf= 315 'EJOT' solar flashings w/ 3 . 5" lags, ;` z `• 8 req'd. Installer to verify that lags yt are centered on truss chord. Lags to be ; $ ' distributed over 6 trusses . :•- CITY OF SmI m, NLNSS.ICI IUSETTS • BUILDING DEPARTNiENT 130 WASHINGTON STREET, 310 FLOOR °j TEL (978) 745-9595 FAX(978) 740-98" iCI,,fBERIEY DRISCOLL MAYOR Tuol+us ST.PIERRs DIRECTOR OF PUBLIC PROPERTY/BUa DNG COMMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plwubers Antslicant Information r A -�7 Please Print LegibIX Name(Busim� s;Orgtnization/Individual)' -9),IL4 LJ�)A� Address: IIJ 7/L1T7)A City/State/Zip: e #: ffiI3 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with_10 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time)." have hired the sub-contractors 2.❑ 1 am a sale proprietor or partner. listed on the attached sheet.S 7• ❑Remodeling ship altd have ou etllpluycV3 These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers comp. insurance S. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.[No workers'comp. C. 152,§1(4),and we have no 12.❑Roof rc airs insurance required.)t employees. [No workers' 13 -,Oth r comp. insurance required.) l� Any applicant that choe-ka box nl must also tilt out the section below showing their worken'compensation policy infumnati,,, yfYl� 'l lomeuwems who submit this affidavit indicating they am doing all work and then hire outside cantmetom must submit a ler v affidavit indicating such. -ronlmcton that check this box most attached an.Mditiunal sh[el showing the name of the sub-contm workers'etom and their comp,policy information. I am an employer chat is providing>vokers'compensation insurance for my employees. Below Is the policy and Jab site information. / Insurance Company Name: I ?�i(.S{�ir7 /�/ rIVY7J-�1/I Policy Nor Self-ins.Lic.#:�(t i'J 7 l0(OI/ /J �1 ? 0 Expiration Date: 7 �� Job Site Address: [ C1 el/Ubll i, 11116 & jq j/1/j_ City/Slate/Zip: M A- Attach a copy of the wo en'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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigutiotts ul'the DIA for insurance coverage verification. l do hereby certify under the pains and oettalties olaerjury that the information provided above Is true and correct. Signature• �_ Date: Phone#: Official use only. Do not write in this array to be completed by city or town officiaL City or'ro vn: Permit/Licenge# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: nignTiax iYc—z 4/-LO/ZU14 tl :U is 3S AM TAUT; G/UUL I•aX Server CERTIFICATE OF LIABILITY INSURANCE DATE(MMmavrn) TUSZORTIFICATEIS 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 O UCER DTHE C IC HOLDER. IMPORTANT:If the Certificate holder Is an ADDITIONAL INSURED,the policypes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and Conditions of the policy,certain policies may require and endorsement A statement on this certificate does not Confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT NAME: MICHAUD,ROWE AND RUSCAK PHONE FAX P O BOX 188 (A/C,No,Ext): (A1C,No): E-MAIL NORTH ANDOVER,MA 01845 ADDRESS: 29Y5D INSURER(S)AFFORDING COVERAGE NAIL$ INSURED INSURER A: 'TRAVELERS TNDEMND'Y COMPANY OF AMERICA NEW L-NGLAND SOLAR HO WATER INC INSURER B: INSURER C: INSURER D: 677 TEMPLE ST INSURER E: DUXBURY,MA 02332 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUM DER: THIS fi D CERTIFY T14ATTHE POLICIES OFBISURANCE 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 MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BYTHE POLICNES DESCRIBEDHEREIN IS SUBJECt TO ALLTHETERMS,E(CLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POUCYEFFOATE POUCYEXPOATE LTR TYPE OF INSURANCE L R POLICYNUMBER IWOMYYYY) (MATnOWYYYI LIMITS GENERAL LIABILITY CH OCCURRENCE COMMERCIAL GENERAL LIABILITY AMAGETORENTED $ CLAIMS MADE a OCCUR. PREMISES(Ea occurrence) VIED EXP(Anyone Person) $ ERSONAL&ADV INJURY S GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [:]PROJECT[]LOG PRODUCTS-COMP/OP AGG $ AUTOMOBILE LABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEOULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION IS $ A WORKERS COMPENSATION AND x WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-5B756606-13 12/032013 12/03/2014 LIMITS ANY PROPERIBER EXCLUDED? CUTIVE � WA E.L EACH ACCIDENT S 500.000 OFRCER PERITOR EXCLUORnE (Mandemry In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 Ilyas.dwalbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT Is SD0,000 DESCRIPTION OF OPERA7IONSILOCA71ONWVEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TD THE CFR'fINCATHHOLDER AIFFHCPPNG WGIO(EkS COAL'COVHRAGB. CERTIFICATE HOLDER CANCELLATION CITY OF SALEM SHOULD ANY OFTHE ABOVE DESCRIBED POUCIES BE CANCELLED 93 WASHINGTON ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SALEM,MA 01970 AUTHORIZED REPRESENT VE ACOAD 25(2DT0105) The ACORD name and logo we registered marks of ACORD 1988.2010 ACORD CORPORATION. All rights reserved. I NEWEN-1 OP ID: KM CERTIFICATE OF LIABILITY INSURANCE F°A'04/24/1 YY" 04/24/14 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 endorsements. PRODUCER CONTACT Phone:978 688 8829 NAME: Michaud,Rowe And Ruscak Ins. Fax:978 557 2130 PHONE FAX P.O.Box 188 ac No Ext: A/C No): North Andover,MA Of 845 EMAIL Michaud,Rowe 8 Ruscak ADDRESS: INSURERS AFFORDING COVERAGE NAIL tl INSURER A:Harleysville Worcester Ins Co. 26182 INSURED New England Solar Hot Waterinc INSURER B:Commerce Insurance Company 34754 Bruce Dike 677 Temple St INSURER C:Travelers Insurance Company Duxbury, MA 02332 INSURER D: INSURERE: INSURER F: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE J= POLICY NUMBER MMIDDIYYYY MMMMYYY LIMITS GENERAL LIABILITY rGENEKA;LAGGREGATE RRENCE $ 1,000,00 NT A X COMMERCIALGENERALLIABILITY SPP42517H 09111113 09/11114 a occurrence $ 100,00 CLAIMS-MADE OCCUR y one person) $ 5,00 ADV INJURY $ 1,000,000 GREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: COMPIOP AGG $ 2,000,000 IIIX POLICY PIFQT RO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident B ANY AUTO BBCM55 08/21/13 08121114 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per amdenQ $ AUTOS AUTOS j HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LNB X OCCUR EACH OCCURRENCE $ 2,000,00 A EXCESS LIAR CLAIMS-MADE CMB92125K 06114/13 06114114 1 AGGREGATE $ 2,000,000 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y LIMIT ER YIN C ANY PROPRIETORIPARTNERIEXECUPVE TO BE ISSUED DIRECTLY E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) BYCARRIER E.L.DISEASE EAEMPLOYEE $ Il yes.tlescribe antler DESCRIPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Amach ACORD 101,Additional Remarks Schedule,if more space is required) Install solar hot water heater/Plumbing NO LPG CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Salem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ty of ACCORDANCE WITH THE POLICY PROVISIONS. 93 Washington Street Salem,MA 01970 AUTHORIZED REPRESENTATIVE 2 /J i��f//!G'✓� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD , . CITY OF SiuLE,LI, N'LxSSACHL'SETTS BUII.DIING DEPARTMENT p 130 WASHII IGTON STREET, 3• F.00R T EL (978) 745-9595 FAX(978) 740-98U Kl.\IBER1EY DRISCOLL MAYOR T1Hosw ST.Pwim DIRECTOR OF PLBLIC PROPEATY/sun.DINC CO%L\IIsSIovER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In 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: /0300 Y2W 21& (name of hauler) The debris will be disposed of in (name of cility) jaddress of facility) signature of permit applicant date dcbriuittdoe s/z/1a Good Day! Attached please find a building and plumbing application for 19 Greenlawn Rd Salem MA. If you have any questions or comments, please call me, Beverly Giacobbe, at 781/812-0813 or 517/827- 9033. Additionally, I have enclosed a self addressed,stamped envelope to return the permits once they are issued. Thank you! Regards, Beverly Giacobbe