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HomeMy WebLinkAboutBuilding Permit # 4/27/2016 I %AORTF1 BUILDING PERMIT ��? TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h Permit NO: '>-2 "'7- Gate Received Date Issued: L � � $ c us�Rf o IMPORTANT Ap2licant must complete all items on this page LOCATION mw F?rint PROPERTY OWNER rant .. - MAP"NO �� = PAROL. �OI�IING aI aTRI'CT. hliatcir"(d Dit�et yes,, ',;M dhi`ne�Shop Vilfag ,/ 'y TYPE OF IMPROVEMENT PROPOSED USE ResicIgntial Non- Residential ❑ New Building One family 11 Addition ❑ Two or more family F-1 Industrial ❑ Alteration No. of units: ❑ Commercial 15 epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition Cl Other 11 Septic [],Well q Ftuodplain' ❑'Wetlands . Ll Watershed"District 11 WaterlSewer, Identification Please Type or Print Clearly) OWNER: Name: � ' Phone: Address: 7 G / ON RAC R Name � F? one. r, Address; I 1 Supervisor' ',P0 'Wuction J ense Exp.'Date ° Hcarne;Irnprauem nt I Icein e „ Czr ; tW 74, ARCHITECT/ENGINEER _ Phone: Address: Reg. No, FEE SCHEDULE:BULDIMG PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. g, Total Project Coat: $ FEE: $ Check No.: . Receipt No.: gn .-g o the guaranty fund NOTE: Persons contracting with unregistered contractors do not have acc s Signature of Agent/C?wner signature of contr ` a,f rlu-1 AM t%oRTk I Uwn Of Alluuver : _ Si;2+_1 COyas GEh1ver, K .CHIWIC offATED U BOARD OF HEALTH PERMIT r L �u Food/Kitchen Septic System �o THISCERTIFIES THAT ................. .. . ........................... .................................... ................................ BUILDING INSPECTOR has permission to erect ,,, � ., . Foundation p ........................ buildings on ..... � ... . :. ...............�.. Rough to be occupied as .. ... . .. ..®. ....... ........... . .. ............................................................................ Chimney qrk provided that the person accept) g this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final IT EXPIRESI MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service ........... .... .. .... ........ .. ............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. PROPOSAL L.E. Morgan Construction Company W Accept: 86 Billerica Avenue,Unit#1 VISA N.Billerica,MA 01862 Office: (978)670-4747/Fax: (978)670-.6477VER �� P OPOSAL UBMITT PHONE f m rJ 4 1 STREET J E -n Pot ' ,nohaj CITY,STATE AND ZIP CODE JOa CATI ',q C f : NTACT T OT R JOB PHONE Strip down to the wood deck, a layers of shingles, dispose of debris to a licensed recycling facility: Install ( ice and water shield at the gutters 3 feet of ice and water shield in valleys. Install synthetic underlayment on the remainder of the wood decking. Install 8" aluminum drip edge on'all perimeters, color choices: )4 White, U Mill, ❑ Brown, Q Copper. Install TO year /•—,j & � architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by C--05bt^cq– to all ridges and dormers. Install new skylight flashing kits manufactured by AJIA Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing /00;B chimneys and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. WE PROPOSE hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: dollars($ All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above Authorized Sign specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.Our workers are fully covered Note:This proposal may be withdrawn by Workmen's Compensation Insurance and Liability Insurance. by us if not accepted within days. A CCEPTED A5 A CONTRACT-The above prices, ate of acceptance: (yam J � 5 s and conditions are satisfactory and are Authorized Signature: �1 'Vlv'1 `�✓ 1 1 pted.You are authorized to do thework asyment will be made as outlined above. Authorized Signature: Additional Remarks: SURP=COLOR= THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.,gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITHTHEPERMITTING AUTHORITY. Applicant Information Please Print Legibl Name (Btisiness/OrganizatioMiidividual): Address: Ci /State/Zi ("1 (61 0(1 Cij� It' fione#: 4) Are yu un'employe0Check propriate box: Type of project(required): I am a employer with employees(full and/or part-time).* 7. New construction In I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity,[Na workers'comp.insurance required.] 9. ❑Demolition 3.FJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 Building addition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with no employees. 12.F]Plumbing repairs or additions S.F]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 11-ft"Roof repairs These sub-contractors have employees and have workers'comp.iDBUrance.t 14.Q Othe 6.n We area corporation and its officers have exercised their right ofexemption per MGL c. 152,§i(4),and we have no employees.[No workers'comp.insurance required.] 61f *Any applicant that checks box r{1 must also fill out the section below showing their workers'compensation policy information, t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is pro compensation insurance for my empt S. Belolp is the policy anti job site information. Insurance Company Name: 07 7 Policy#or Self-ins,Lie.#: 3 it) rs - Expiration Date: Jab Site Address: qc�, City/State/Zip: h Attach a copy of the workers'coulpensiltion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fitic of up to$250.00 a day against the iolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ve ;lc�ion. I do hergh cellif�y under the pains mulpe a iesof1mijui, that the information provided above is hwe and correct. SI tratitr Date: hone Of�jicial use only. Do not)Prite 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 Pei-soil: Phone M LEMORGA-01 BBOYER CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 4/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Welsh&Parker Insurance Agency,Inc./Hudson Office NAME: 131 Coolidge Street,Suite 100 PHONE 978 5 FAx Hudson,MA 01749 E-MA Lo,Ext}:( ) 62-5652 (J No}:(978)562-7120 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Insurance Company -INSURED INSURER B:SAFETY IND INS CO 33618 LE Morgan Construction Inc INSURER C:Scottsdale Insurance PO BOX 75 INSURER D: Billerica,MA 01821 INSURER E: 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDYtYriY MIOVIILDI D LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 110001000 CLAIMS-MADE n OCCUR NPP8381520 04/13/2016 04/13/2017 PREM SES(Ea occurrence) $ 100,000 MED EXP(Anyone person) S 5,000 I GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY S 1,000,000 POLICY PRO- n LOC GENERAL AGGREGATE S 2,000,000 OTHER: PRODUCTS-COMP/OPAGG S 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S B (Ea accident) S 1,000,000 ANY AUTO 6230688 10/13/2015 10/13/2016 BODILY INJURY(Per person) S ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X HIREDAUTOS X NON-OWNED '.. AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB X OCCUR S C NX EXCESS LIAB CLAIMS-MADE XLS0099346 EACH OCCURRENCE $ 5,000,000 04/13/2016 04/13/2017 AGGREGATE I S 5,000,000 DED RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TgERH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N STATUTE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT S (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYE S DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) WORKERS COMPENSATION CERTFICATE OF LIABILITY WILL BE SENT DIRECTLY BY THE CARRIER. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FTown of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street,Bldg 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DE(MM/DD/YYYI� AT 1211 U2915- TkLS,GERTIFICATE 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()es)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 endorsement(s). PRODUCER CONTACT NAME: BALDWIN\WELSH PARKER INS PHONE FAX 131 COOLIDGE ST,SUITE#100 (AIC,No,Ext): (AIC,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: INSURER D: PO BOX 75 INSURER E: NORTH BILLERICA,MA 01862 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDMYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE [—]OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY E PROJECT 0 LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB 8 CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND _!J WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-15 12/14/2015 12/14/2016 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE N NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DES DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET,BLDG 20,SUITE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER,MA 01845 AUTHORIZED REPRT_TVAEY7`- ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts-Department of Public 5ar-et}r —T -- Sir ` ✓_O^rs^;—Building �eguiat,onS a;uamar S Office , '_norzr✓ c�a//7 ofe0iisumerATfBIIS uaess t:gufation = =,r�HOME IMPROVEMENT CONTRACTOR License: CS-079$_76 L 9 Registration: 137993 1 t Type: > Expiration: 1/27/2017 Individual LAWRENCE E MOlG_ _ _ 86 BILLERICA ASE _ % 1 ARENCE E.MORGAN JR. N BEUNRICA NFA 0I86� LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 Jam,.. j741� Expiration N.BILLERICA,MA 01862 Commissioner 06/03/2017 Undersecretary ••�:6�LYA 5atntY�ngliEvfth -_ 0vr.s -.• This card acknowledges that the recipient has successfully completed a i 30-hour pceupational Safety and Health tra ning Course in i 0--c.pa;onatsateiy and'reatth A,;in:,,itratto:q € Construction Safety and Health I LARRY s a M O &A tiJ r J� t:as successfully completed a it?`:aur Ocxupationzi safety and. !egi!h Training Coume in Construction Safes✓&Health Lout S R4Dr_j J 0!5AGIs69 (Trainer name—print or type)`— �� (Course end date) i (Trainer) ROOF TOP RECYCLING SFAN ANESTIS PRESIDENT&CEO 369 CODMAN HILL ROAD TEL: 978-263-1899 BO)MOROUGH,MA FAX. 978-263-1879 EMAIL:ROOFTOPI@VERIZON.NET CELL.- 508-726-5341