The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 6/22/2016 OORTil BUILDING PERMIT 0��Y��D TOWN OF NORTH ANDOVER o i APPLICATION FOR PLAN EXAMINATION - Permit NO: Date Received . ,. DpATfD PPN'�.�� Date Issued: ,, &„ aCH 5 IMPORTANT: Ap2licant must complete all items on this page LOCATION w PROP RTY'gWNER Print MAP'N(7 " y� F!ARCEL; C IIN+ I `T I T Hi toric bistrict y no Machin S,hap`VilJsge yes tic TYPE OF IMPROVEMENT PROPOSED USE Resig#ntial Non- Residential EI New Building Nobne family E Addition ❑ Two or more family E Industrial E Alteration No. of units: E Commercial E Repair, replacement ❑Assessory Bldg Others: E Demolition E Other E Septic ❑Well o Floodplain El Wetlands ❑ Watershed District EJWater/Sewer a Identilication PIease Type or Print Clearly) PIN OWNER: Name: ro J 'd ron Phone: w Address: z ;. . CONTRACTOR,,,Nam w ` J Ph wane: - Address: i Superui or's Construction,License Exp. pate. Hearne Improu n 01 L,a en e. xp.' D�to:' : ARCHITECT/ENGINEER Ap Phone: Address: Reg. No. SED ON$925.00 PER S.F. C FEE SCHEDULE:E(/LD�G PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED OST BASED Total Project Cost: ; C; FEE: $ Check No.: �� Receipt No.: ',""'5 6 " ... NOTE: Persons contracting with unregistered contractors do not have acce 'o the guaranty fund Signature of Agent/Owner „m. y of contra N®RTF Town of Andover No. -MOM $C, Ok ver, Mass, 0LMXa COC HIC"EWICK y�• ,q o�A4E® S 11 BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System ® BUILDING INSPECTOR THIS CERTIFIES THAT ............. ... .. ..............................................,... .................................. ... . .. ...... .... Foundation has permission to erect .......................... buildingson .. .. .. . . .... .... . Rough tobe occupied as ......... . .. ... .......... .... .. .. .. . .................................................................. Chimney provided that the person accepting 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 PERMIT ELECTRICAL INSPECTOR UNLESS CONS TIORough Service R%1=4a .... ....... ......... Final INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinz4 Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. L.E. Morgan Construction Company weaccept: 86 Billerica Avenue,Unit#1 r t/1SA N. Billerica, MA 01862 - Office: (978)670-4747/Fax: (978) 670-6477 " S� T D TO T .) `.y q f+ D E .per .� /®� eVY I IV'I JOB NAME W T,ST( Z CODE(_ ',; JOB LOCATION TACrT f � CELL PHONE OTHER JOB PHONE - Strip d n to the wood deck, layers of shingles, dispose of debris to a licensed recycling facility: Install lo ice and water shield at the gutters 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: 0 White, Q Mill, ❑ Brown, ❑ Copper. Installer yearh 1� c'i � architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured byto all ridges and dormers. Install new skylight flashing kits manufactured by ' Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing / /� 1-"c'4,0 chimneys and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. WE PROPOSE hereby o furnish material and labor-complete in accordance with above specifications,for the sum of: `3d � nz o haw �a yiv t�� `r dollars($ y 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 Signature: 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) ACCEPTED AS A CONTRACT-The above prices, Date of acceptance: [hereby cifications and conditions are satisfactory and are Authorized signature: '" "maxis/ accepted.You are authorized to do the work ascified.Payment will e a o Authorized signature: 4 Additional Rema s: SHINGLE COLO — THANK VOLT FOR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth of Massachusetts r Department oflndustrialAccidents I Congress Street,Suite 100 Boston,MA 02.114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WI'111 THE PERMITTING AUTHORITY. Applicant Informations Please Print Legibly Name (Business/OrganizatioMndividual): l CL t w° Address. - City/State/Zip: l a e#: Are yo r errrployer7 Cher tf appropriate box: Type of project(required): L . I am a employer with employees(fiill and/or part-time).* 7. ❑New construction 2.n I am a sole proprietor or partnership and have no employees working for me in $. [:]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself[No workers'comp,insurance required.]t 10 FI Building addition <11 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.Q Plumbing repairs or additions S.Q I am a general contractor and Dave hired the sub-contractors listed on the attached sheet. 13 R of cp "1's t These sub-contractors have employees and have workers'cornp.insurance. 6.Q We area corporation and its officers have exercised their right of'exemption per MGL c. 14 Othef. 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 informakion, f 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 errrployer•that is prov' rig tvorlfers'eoniperrsatiorr itisrrrance foe•racy employees. Below is tire policy and job site information. Insurance Company Name: >, Policy#or Self-ins.Lie•It: l Expiration Date:pr—rVit fi 1 w Jab Site Address: ) r City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration ate). 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 WORD ORDER and a fine of up to$250.00 a day against the v' lator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verc ion. I do here lify raider the pains arul rralties o y drat t/re irtforrn i t provided above is tri a mrd correct. 7 Si 3" .. Date: 1'e'ir)) one 10ficial rise only. Do not write in this area,to be completed by city or town official, City or Town: Perntit/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#: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) TWOLCERTIFICATE 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 policy(les)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): (A/C,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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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) (MWDDIYYYY) 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 0 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 $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB 8 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ A WORKER'S COMPENSATION AND XWC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-58738312-15 12/14/2015 12/14/2016 LIMITS ANY PROPERITORIPARTNER/EXECUTIVENIA E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONS/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 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1600 OSGOOD STREET,BLDG 20,SUITE 2035 IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER,MA 01845 AUTHORIZED REPRFiSEyTAT3VE ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD '198807`0 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER DATE(MMIDD/YYYY) CERTIFICATE F LIABILITY INSURANCE 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 NAME: Welsh&Parker Insurance Agency,Inc./Hudson Office PHONE 978 562-5652 FAX 978 562-7120 131 Coolidge Street,Suite 100 (IVC,No,Ext): ) (A/C,No): ) 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 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS INSD WVD POLICY NUMBER MMIDDlYYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE n OCCUR NPP8381620 04/13/2016 04/13/2017 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100 OOO MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO-JET n LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1000000 (Ea accident) > > B ANY AUTO 6230688 10/13/2015 10/13/2016 BODILY INJURY(Per person) S ALL OWNEDFXX SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per accident S UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 55,000,000 C X EXCESS LIAB CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 AGGREGATE S 5,000,000 ''..... DED RETENTIONS $ WORKERS COMPENSATION PER 0TH_ AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N!A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street,Bldg 20,Suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE /Z ©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 Board of Building Regulations and Standards Ude ,„ao�z�acc�ll/r.��Jjlcraaclr�aeCfic -�_Office of Consumer Affairs&Business Regulation Construction Supervisor License: CS-0Ir HOME IMPROVEMENT CONTRACTOR � r Registration: -137913 Type: LAWRENCE E MORGAN,JR ; Expiration -1#272€1--7 Individual 100 IRON NORSE PARKLAWRENCE E. MORGAN- NORTH BILLERICA MA 01862 LAWRENCE MORGAN Jf 100 IRON HORSE PARK r--Jz —A CA-- Expiration: BILLERICA, MA 01862 Undersecreta€y Commissioner 06/03/2017 R �i��-xu(otyaitafto-attfi - _. — 7 V lJ'-'H Al t This card acknowledges that the recipidnf has sucoessfull cornIdeda 30-hour OcBupatjonal Safetjrand HealtltT€alnirtgCourse in Cons-t•uotion Safety and Health } ' ' OP has succssslulfy completed a IG Four U::upaCio!iel Safe(t'and Neaith t T;2irung roume Construction Safety a 1Ia_'Elirepe (Trainernamr€ntarlyp6) e—p � (Course end date) (Trainer) - ! fate; 1