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Home My WebLink AboutBuilding Permit # 6/27/2016 BUILDING PERMIT, %AORTH ON TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PernnNo# Date Received Ar.0 Date Issued: y�7 " 1 IMPORTANT: Applicant must complete all items on this page LOCATION int PROPERTY OWNER Print 100 Year Structure yes 0 MAP 6 -PARCEL: IJ ZONING DISTRICT: Historic District yes no Machine Shop Village yes nod TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential D New Building One family 0 Addition Li Two or more family FJ Industrial 11 Alteration No. of units: 11 Commercial El Repair, replacement 11 Assessory Bldg 1:1 Others. [I Demolition Li Other 11 Septic,, /,,n Well 11 Floodplain, E]Wetlands [,]`Wateirshecl'District Natei/Sewer ew DESCRIPTION OF WORK TO BE PERFORMED: ld!ntifica Type 0 Ple e T r Print Clearly OWNER: Name, 7 Phone: J Add ress:h" k c6f e e", Contra ptar Name: ) (') '('(�rXP., MJ,V-(,�(I/°Phone: 2 Email: Address: Supervisor's Construction License: Exp. Date:_ Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 1Phone: Address: Reg. No. FEE SCHEDULE. BULDINGPERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ t2 , ;b J Check No.: Receipt No.: L NOTE: Persons eontractink with tinregister d contractors do not have,!dc ess o theguarantyfuln n+r qnatui6'of ASionature . a ganmuner of-m r-mr-9 01h1 t%ORTH nciover No. aim ® t % LAKE h ver, Mass, COCHICMEWICK 1' Q� `.es RATEO p' Cl U BOARD OF HEALTH rERMU LD Food/Kitchen Septic System THIS CERTIFIES THAT ................... .......... ..... ..... ............. ........ ............r .............................. BUILDING INSPECTOR .. Foundation has permission to erect ......... ................ buildings on ... ....... . ...... . . m..... .........! Rough tobe occupied as ........... .. .......... .... ... ........ .. .................................................................... Chimney provided that the person accepting t 's 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LES I Rough Service .. ....... T ... ... final 1W BUILDII0%6N ECT GAS INSPECTOR Occupancy Permit Required t® Occupy PuildinRough 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 8613BIcrica Avenue,Unit#1 IMM W. - N.Billerica,AIA 01M Office:(978)670-4747/Fax:(979)670-(.1",7 M' Y) r11111 OW/5 ...... N 7" R o J, ,ra E S ip tl�n to the wood deck, A- layers of shingles,dispose of debris to a licensed recycling facility: Inatn 6' 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 W aluminum drip edge on all perimeters,color choices:O White,X Mill,-1 Brown,O Copper. ns Itall n year ceHdrt A lir Tl�r Ct architectural asphalt shingles,and hurricane nail Install ridge vent manufactured by C-04� to all ridges and dormers. Install VIA new skylight Bashing kits manufactured by /1j1A Dash all cheek walls,pipes,skylights,and penetrations to manufactures specifications. Remove existing lead Bashing /ao 7/QtJ chimneys and install new lead flashing. Install matching cap shingles to all ridges,hips and dormers. �t1VE-hPROPOS ,£//9 by('6 tm/}%h�mfateri'Ia/nd labor/mmpl/eJe,:n/nceardetnco wit�h�ab—ovo epenficarinn.,fur thx sum nf- /ANu-t�.,-�l 1 tN_bl,--a=r`Nn.lr�/i,�c✓I'�!�.--^dollars Note:This amaa,wsparmt imse as�ece,:an aos,aea w,n+zedse ,.7-a Authorizedsignnture � r fJj-t` .mv xma,.am van.bnmfe�3mvd:.�Aa o-«n aso.e F•�/ �� Imay awn be withdr ` Erarnr an�ema.hargxorerutl Aare Nae are.O.raWers as htY warts pro1 N wuv,n�y cu.ynmv,iuvdwvvlYLr,:/ewmv.- by us:Cnotaaepte3wirhin / v days ACCEPTED AS A CONTRACT-The above prices Data of ue/eano: O -'� t specifications and conditions are satisfactory and are mu,aarra s€anv„e: � [, hereby aeeapted.Yon ore authorized to do the wortc ao /A specified.Payment will be made as4utlined above. Amnod�a s•asnwt:: - Additional R.minkC�5HINGLE COLO THANI{YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION 1 The Commonwealth of Massgehusetty N . Department afIndlustria Accidents d 1 Congress Street,Suite 100 Boston, 02X14.2017 www.mass.govldia Workers,Compensation Insurance Affidavit:Builders/Contractors/Electrieians/plumbers. TO BE FrU,D WITII THE PERMITTING AUTHORITY. Applicant Information Please Print Ledb Name (Business/Organization/liidividrlal): Address:— city/state/zip: Ai•ey an employer?Ch.ecic e npropriate box; Type Of project(x'equired): T am a employerwith r employees(fall and/or part-time),' 7. ❑Now construction 2.❑I am a sole proprietor or partnership and have no employees working forme in 8. Remoclelirig any capacity.[No workers'comp,insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself[No workers'comp..insurance required.]i [� 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I wilt 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. r 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. i ❑ 13.F1R9ofrc 2`hcse sub-contractors have employees and have workers'comp.insurance: 6.E]We are a corporation and ifs ofgers have exercised their right of exemption per MGL c. 14. , Other 152,§1(4),and wo have nq employees.[No workers'comp.insurance required.] Any applicant that checks Sox 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who snbriiit`this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContrartors that check this box must•attached an additional sheet showing the namo of the sub-contractors and state whether or not those entities have employees. If the'sub-contractors liave:employee','i ey must provide their workeis'comp,policy number. .: X'ciiaz are employer'thatispi' i irzgivorlcers'compensation inszer^ance or'rny employees.' B'eloiy is thepoliey and)obsite information, Insurance Company Name Policy##or Self-ins Lic.#: t Expiration Date; Job Site Address: � ' � � 1 city/Stat A) rr . � Attach a copy of the workers"compensation policy deet'ration page(showing the policy number.'and expiration elate). Fail-Lire to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a fine up 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 violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veri "c `tion. 14 X do hem e ti y under tlzepat s an s o 1 y Haat tzein o ti croon provided abov is true nd correct, Si nattu � � �.� �, .� ,' �� . Data. PhoUK# r t m Ofd ial use only. Do not write in this area,to be completed by city or toren official.. ity or Town: Permit/License 0 Issuing Authority(circle one): ; 1.Boar.of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person: Phone#: LEMORGA-01 BBOYER CERTIFICATE F LIABILITY DATE(MMIDDIYYYY) INSURANCE 4/(MMIDO 6 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 562-5652 FAX 978 562-7120 978 131 Coolidge Street,Suite 100 (Arc,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 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 INSD WVD POLICY NUMBER MMIDD/YYYY MMODIYYYY LIMITS A X f COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE T OCCUR NPP8381620 04/13/2016 04113/2017 DAMAGE TO ISRENTEDr100000 PREMES(Ea occurence) S , 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- n LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea accident) BANY AUTO 6230688 10/13/2015 10/13/2016 BODILY INJURY(Per person) S ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS Per accident $ UMBRELLA LIAR X OG IUR EACH OCCURRENCE 5 5,000,000 C X EXCESS LIAB CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 AGGREGATE $ 5,000,000 DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y r N STATUTE ER ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover 1600 Osgood Street,Bldg 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE aC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) TkMLEERTIFICATE 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: BALDVWWELSH 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 (MWDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ :P CLAIMS MADE F_�OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ Ll PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY El PROJECT E]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 CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-56738312-15 12/14/2015 12/14/2016 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? i N in N/A E.L.EACH ACCIDENT $ 1,000,000 (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 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 1600 OSGOOD STREET,BLDG 20,SUITE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRFyTA VE NORTH ANDOVER,MA 01845 l/ I� ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. — Massachusetts Department of Public Safety Board of Building Regulations and Standards \_Office of Consumer Affairs&Business Regulation License: CS-079476 ! —(T HOME IMPROVEMENT CONTRACTOR Construction Supervisor � Registration:9 137913 Type: LAWRENCE E MORGAN,JR Expiration:;_-�#22#1T7 Individual y 9 s' 100 IRON HORSE PARK LAWRENCE E MORGAN JR NORTH BILLERICA MA 01862 e LAWRENCE MORGM 100 IRON HORSE PARK BILLERICA,MA 01862 Expiration: Undersecretary Commissioner 06/03/2017 -. .— �' �JJiJL�adaktztnvou- - - '_ This card acknowledges thatthe-61piont has suooessfullycQmpieteti a `- e,:anr. ;at_� ` 30•EiOur Ocbupationai Safety and Health Training Course in 6cc:pat cnarSate -ariG tear :,, Construction Safety and Health M & , has successfully completeda.1O[ ,u u..:apat;o!lat Safety end Health Training Course,n 1 Consiruction Safety_ a Hej"11 __, �_ I< 1 Lig, � t1� (Trainer name—print or b pe} (P�3 (Course encldate) _. � SAU& .--. - CrartFtl - _ _ F f0ate; f