The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 6/7/2016 ,. ,,. _. BUILDING PERMIT ,_. a ° TOWN OF NORTH ANDOVER R . APPLICATION FOR PLAN EXAMINATION Permit NO: �� Date Received ,��° .-�� "� � Py g5 q3°roAre. , , °- npP (`9 Date Issued: r �cwus� IMPORTANT: A.2plicant must complete all items on this 2age LO CATION -51 V11111111"I 44�' ' PROPERTY OWNER Print MAP NO _ N AF CE, If fO DISTRIOT: Histc►r"r l lstri t yep no Machine Shop Village yes no- TYPE o TYPE OF IMPROVEMENT PROPOSED USE Restial Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: Cl Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ 'loodplsin", o Wetlands ❑ Watershed District ❑'Water/Sewer 1 4 C3, Identification Please Type or Print Clearly) OWNER: Name: Lie Phone:(1041111 �41` � n Address: CONTR "PI ", - -1 1, 11 M , I 1 4 W'USA Address. 4"'a, upervisbr' Con tructio'6 License* Exp Date; ,, Home lmprnvernr License Exp: DateWb ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PER lT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project CostA, FEE: $ Check No.: t Receipt No.; . g g guaranty u d 'I'I+r° l'e�°sorts contracting with unregistered contractors do not have acres �"o the uara � Signature of Agent/Owner L9- ,Msignature of cQntrac i, F %AORTH Town ofr 2 I,. ndover ® ti•: ® F2biT ZhJ; j97- O �a.cs ver, ��9 COC NI CNl WICK y1. x.95 4ATE9:) U BOARD OF HEALTH Food/Kitchen ERMIT 1[ LD Septic System At THIS CERTIFIES THAT . ~. .1A4 ® BUILDING INSPECTOR .. ....... .. ..... .... ..... .. .... ..... ... .. ................... Foundation has permission to erect .............. ...... . buildings on ....:::. ....... .:�. . � ... ..... ..... Ar M Rough to be occupied as ....IrTf4r... .. y provided that the person accepting thi per 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST ON S Rough Service .... .... ...... ....... ... ... .. ...........7CT'7R4 FinaBUILDING I GAS INSPECTOR Occupancy Permit Required t® Occupy BLlzldznRough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall o Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. PROPOSAL L.E. MOPg8Y1 C®11St)CllCtl011 COriil.p8riy We Accept: 86 Billerica Avenue,Unit#1 V13� t N. Billerica,MA 01862 Office: (978)6704747/Fax: (978)670-6477 gBOPOSA'11-1'7'71 118M1 ED T DATE.' ST ET- r j rrt t JOBNAME - — - ` C sTATE AND ZI CODE '-�� }:t• "t t ,y, JOB LOCATION _ 4 ,f :i,+ i{!} i� r� F - t 9 // f CONTACT CEL PHONE n -it i i� OjTy}{EyR _ j y p F q@� i =�OBP�ONFTI it t ' ..` Strip down to the wood deck, r_L layers of shT{ingles, dispose of debris to a licensed recycling facility. +�'� Install - ice and water shield at the gutters 3 feet of ice and crater shield in valleys. Install synthetic underlayment on the remainder of the wood decking. Install 8"'aluminum drip edge on•all perimeters, color choices: ❑ White, ❑ Mill, ❑ Brown, ❑ Copper. Install•6" year architectural asphalt shingles, and hurricane nail: Install ridge vent manufactured by r== f `r to all ridges and dormers. Install t` 1 new skylight flashing kits manufactured by Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing r 'j chimneys and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. SS WE.PROPOSE hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: X11 i,. i.c__ f� r ftltJ.CrY-�[fti: i.11 jtelr .._... i � dollars($ 1. All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices. Signature: ces.Any alteration or deviation.from above , specifications involving extra costs will be executed only upon written orders,and will t~ become an extra charge over and above the estimate.Our workers are fully covered Note:This'proposal maybe withdrawn by Workmen's Compensation Insurance and Liability Insurance. by us if not accepted within days. E AS A CONTRACT-The above prices, �,' Date of acceptance: q- : .67 and conditions are satisfactory and areAuthorized signature:-LA2eL `�1Lted.You are authorized to do the work as ' V''ment will be made as outlined above. Authorized signature: Additional Remarks: SHINGLE COLOR=_ t. ; THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth of Mass(tchusetts Department ofIndustfialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 wim.mass.govvifia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THF,PERMITTING AUTHORITY. Applicant Information 4 Please Print LegibI Name (Business/Organization/Indivi(lual): 4410 U16 Od 11 Address: J(ri c V1 City/State/Zip: `7 f,12 11 It, Y7 V__ A� employer?che I Type of project(required): '�re�,yoi emp c(I propriate box: I am, -time).* I am a employer with jr employees(full and/or part 7. 0 New construction 2.F]I am a sole proprietor or partnership and have no employees working for me in 8, E]Remodeling any capacity.[No workers'corup.insurance required.] 9. El Demolition 3.[:]1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.F]I am a horricowner 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. Plumbing repairs or additions 5.F]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. P irs These sub-contractors have employees and have workers'comp.insurance.f irl ' I I 6,0 We are a corporation and its officers have exercised their right of'exemption per MGL c. I 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information." t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet allowing 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 ug"'orkers'compensation insurance for my employees. Below is the policy and jolt site information. Insurance Company Name AJ 11 L Exp Policy#or Self-ins,Lie.#: Expiration Date: CA - Job Site Address:�J,, �J City/State/Zip: Attach a copy of the workers'compensation policy decl/ration page(showing the policy number and expiration date). f16 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 fine of up to$250.00 a day against th lator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance c tion. coverage ver'?il�,�ti I ilo hereby fj ill le t 'its nilp tallies e, iq 11 1 the j i rination pi,avid d above true and correct. VVIA, 7 'yil 'y u ur ppai Sian, 7 Date. e Phone jaa Of cial use only. Do not write in this area,to be completed by city at-town official ity or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ThMIS.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 R PRODUCER AND THE CERTIFICATE HOLDER. PORTANT:if the certificate holder is an ADDITIONAL INSURED,the pol)cy(ies)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 (A/C,No,Ext): (AIC,No): HUDSON,MA 01749 EMAIL ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTT_ON INC INSURER B: INSURER C: PO BOX 75 INSURER D: NORTH BILLERICA,MA 01862 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 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) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY -•• CLAIMS MADE F__1 OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ POLICY PROJECT 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 $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB 8 CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-58738312-15 12/14/2015 12/14/2016 LIMITS ANY PROPERITOR/PARTN OFFICER/MEMBER EXCLUDED?DED? CUTIVE M NIA E.L.EACH ACCIDENT $ 1,000,000 (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 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. ERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED )600 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 REPRF,SEMXTA ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988f�\\/-220010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER CERTIFICATELIABILITY INSURANCEDATD/YYYY) 4//14121412016 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 NAME: Welsh&Parker Insurance Agency,Inc./Hudson Office PHONE FAX 131 Coolidge Street,Suite 100 (AIC,No,Ext):(978)562-5652 (AIC,No): (978)562-7120 Hudson,MA 01749 E-MAIL 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 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. IR ADDL SUER LT POLICY EFF POLICY EXP LTR! TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE n OCCUR NPP8381520 04/13/2016 04/13/2017 DAMAGETORENTED PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY JEn LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT BANY AUTO 6230688 (Ea accident) s 1,000,000 AOWNEDX SCHEDULED 1011312016 10/13/2016 BODILY INJURY(Per person) S AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) S S LJM13RELLALIA13 X OCCUR C X EXCESS LIAB EACH OCCURRENCE S 5,000,000 CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 AGGREGATE 5 5,000,000 '.. DED RETENTION S S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER '. ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory ( under If yes,describe under E.L.DISEASE-EA EMPLOYE S I 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 Town 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 Massachusetts-Department of Public Safety / — -- uoaro o -- iuiiftg R$gula-lons and VLan—da-rdsOff`Ie✓�Of//noni�sudmJ?eL7r77� TvasGitr , s�egu a4o ',t HOME IMPROVEMENT CONTRACTOR License: CS-079476 Registration: 137913 �I I:r t s Type: Expiration:Expiration: 1/2712017 Individual LAWRENCE E MftG f - LA NCE E.MORGAN JR. 86 IRMLEPJCA AVE U N BULEMCA MA 0jg-fY Y a LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 4� Expiration N.BILLERICA,MA 01862 — — Commissioner 06/0312017 Undersecretary 003 5areprantt Eeattfi - _ ; r1l - AAAA as-�c«:ron i 8 0' ,,,,, This card acknowledges that the recipient has successfully completed a !° artrna:u of wa 30-hour Occ=upational Safet`j and HealtltTra ning Course in Orct.,pationarSafety and Health ;,w-ituatu:n Construction Safety and Health i LARRY ARRY I O G-A r /� 1rie has successfully competed a i1`:our O;;upational Safety ani Health Training Course m Construction Safety 8 Health C" ( mo i_e_= i i z t Lr>tlt S lRvND 0!5AU&69 (Trainer narn e—print or type) (Course end date) — �rainer) ROOF TOP RECYCLING ENEEMEME], No= SEAN ANESTIS PREsmFwT&CEO 369 CODMAN HrLL ROAD TEL: 978-263-1899 BOXBOROUGH,MA FAX. 978-263-1879 EMAIL:R00FT0P1@VERIZ0N.NET CELL: 508-726-5341