Loading...
HomeMy WebLinkAboutBuilding Permit # 6/30/2016 %AORTI-I BUILDING PERMIT ,,ED TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION *L ro Permit No#: Date Received rE D CHUS Date Issued: WPORTANT: Applicant must complete all items on this page " k�1111--61S Lcliclf A , , d , r Print LOCATION "��> A o\g PROPERTY OWNER 100 Year Structure yes no `7 STRICT: no MAP PARCEL: ZONING4int Historic District yes Machine Shop Village yes (� no TYPE OF IMPROVEMENT PROP SED USE R Non- Residential F1 New Building _l One family El Addition El Two or more family 0 Industrial [I Alteration No. of units: El Commercial Ll Repair, replacement E Assessory Bldg 11 Others: F-1 Demolition F1 Other " S6p,tic ❑Well 17,1 Flobdpl0:in Ei Wetlands ''. Watershed District I DESCRIPTION OF WORK TO BE PERFORMED: I nti Mop Please Type or Print Clearly OWNER: Name: IYAA Phone: ar Address: L,,, b4 � A Q q,-A Contra for Nan e: Aj�cev 10 one:, "0 Email 2,71/`cLQ1 L '��c n c 4)a e V Y7 r4 51 eLZ--�F— Address: ('5 Supervisor's Construction License. (42 Exp. Date: Home Improvement License: Exp. Date:. ARCHITECT/ENGINEER At Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $!J I kt) FEE: $ (-,-I 5-1 o Check No.: Receipt No.: /1111 NOTE: Persons contracting with unregistered contractors do not have acre s the guarantyfund --SJ-g-n-aW-re Qf-fte-nMWIIEI��z a affi ...i tkORTH Town of !, Andover ® 4( � ® LAK9 very Mass, JtAjt to coc"Ic"2 WICK °'?ATE® AP�`��.��s BOARD OF HEALTH Food/Kitchen PEK��, mlT T LD Septic System A4 THIS CERTIFIES THAT .. .. ...... .. .............. .................. ......... BUILDING INSPECTOR Foundation has permission to erect ................... buildin s on ... ..... ...... ...... . . . . . ..... ... . AM .� Rough g tobe occupied as ....... . .... ............. ..................................:........................................................... Chimney ever provided that the person accepting this permit shall iny 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 CONS I I Rough S Service . .. r.... ...... . .......���. .......... ...�........... Final UILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in aons icuous Place on the Premises — ®o Not Remove Final No Lathing in or Dry Wall T® Be ®one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. PROPOSAL L.E. Morgan Consirneflon Company We Accept: 36 Billerica Avenue; Unit#1 f TNT. Billerica,IVLA 01862 Office: (978) 670-4747/Fax: (97 8)670-6477 .tAOPOSAL SNBIAITTf,q;'FQf PHONE DATA z A, tt e STFIEET �. r g ➢ �.. I`- Job NAME - .'IFY STATF AND IP CODEt - JOB LOCATION c COyTPC7T E DELL P€-IOtIE , ;- 'y'3,rHER JOB PHONE 3 f S till P l Strip clown to the wood deck, �—- layers of shingles, dispose of debris to a licensed recycling facility: Install <jM 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 c," aluminum drip edge on'all Perimeters, color choices: Q mite,•` bill, Q Brown, 0 Copper. Install_. year 4 - architectural asphalt shingles, and hurricane nail. Install ridge vent,'- manufactured by `�E g I r �'_= �°,��� - to all ridges and dormers. Install new skylight flashing Its -manufactured by Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. ao ve eA sting lead _ a.s'nit,g fl'— C1hiYY3ney5 and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. �f v T:� 1,11noPo-SE hereby to furnish material and labor-complete in accordance with above specifications,for the sum of- I 3 d +: i _ '-., j s kl „ ,.• L f 3,-;y - dollars($ e ) I All material is guaranteed to be as specified.All work to be completed in a workmanlike ✓ f st manner according to standard practices.Any alteration or deviation from above Authorized Signature. t t specifications involving extra costs will be executed only upon written orders,and will ly become an extra charge over and above the estimate.Our workNote:This proposal may be withdrawn workers are fully covered _- Eby bVorkmen's Compensation Insurance and Liability Insurance. by us if not accepted withinF• days. j AccE,,P TIED AS A CONTRACT--The above prices, Date of acceptance: specs ications and conditions are Satisfactory and are -- uthorized Signature: '_hereby accepted.You are authorized to do the work as '!`•a specified.Payment will be made as outlined above. Authorized signage: i Additional Remarks: 9 �[GLE QQLQR-, ---- I THIANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION I f 1 s € i The Commonwealth ofMassgchusetts Department o0'Intlusiria1-ecrdents � , = X Congress Street,Su to 100 d Boston,M9.02114,2 017 ,'.•sy,� www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electi•icians[Plnmbers. TO BE Fffi D WITH TIM PER WTTMG AUTHORITY. Applicant Information A ]Please Print Legibly (B g ion/Sridividual ' ,. �alJtl.e ztsznesslOr anzzat ) Address: ci /state/Zi : tY p Aareyou„aaa employer?Chee apliiopriate box: Type of project(xequir ed): 1. 1 am a employer with employees(full and/or part-time).* 7. Q New construction 2,[.]1 am a sole proprietor or partnership and have no employees working for me in 8. E]Remodolitig any capacity.(No workers'comp,insurance required.] 3_E]1 am a homeowner doing all work myself.[No workers'comp..insurance required.]t Demolition 10 C]Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. f will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. ' 12.FlPlumbing repairs or additions 5. 1 am,a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.instuanco 13• Roof e its 6.Q We are a corporation and its o£iicers have exercised their tight of exemption per lV1GI c. 14. Othet 152,§1(4),and we have no.,eraplo'yees.Wo workers'comp.insurance required.] „ I. *Any applicant that checks 156X#1 most also fill out the section below showing their workers'compensation policy information. t Homeowners who subnziti flus affidavit indicating they are doing all work and then hire outside contragtors must siibmit anew affidavit indicating such. rConfrartors that check Phis box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have , employees. rfthe'sub-coriiractorsfiave"employees;.1heymustproyide theirworkeis'comp.,policynurnbEz e X am an en2ployer that ispi•avzdlhg-worlkers'compensation insurancefor my employees.'Peloiv is thepolley and)ob site information. " Sttsurance Company T`�ama: a p °"� � ,, n Policy#or Self-ins,Lie.#: "�� )�. l" " i �".��"� � Expiration Date; ”" IJfob Site Address: �41� H f city/state/Zip: Attach a copy of the workers'compensation policy decl ration page(showing the policy number and expiration elate). Failure to secure coverage as requited under MGL c. 152,§25A is a criminal violation putusliable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORTS ORDER and a fine ofuli to$250.00 a day against:the 'olator."A copy of this statement may be forwarded to the Offtce of Ivestigations of the DM for insurance coverage vex' c ion. X do hereby er' fy under the pains and alties eij u t/at the t o r2a1ion pr ovided above is true and correct. Sian Y r Date: Phone# j i Oft f is Ilse only. Do not write in this area,to be completer]by city or town offreial: City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityffowu Clerk 4.Electrical Inspector S.Plumbinglnspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12117/20 T RTIFICATE 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(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 E-MAIL ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: PO BOX 75 INSURER D: 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. ILT R 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 F1 OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY Is POLICY []PROJECT E]LOC GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANYAUTO COMBINED SINGLE $ 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 CLAIMS-MADE AGGREGATE Is DEDUCTIBLE Is RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY TH OER EMPLOYER'S LIABILITY YIN UB-58738312-15 12/14/2015 12/14/2016 X LIMITS ANY PROPERITOR/PARTNERIEXECUTIVEFNT� NIA E.L.EACH ACCIDENT $—— OFFICER/MEMBER EXCLUDED? 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/LOCATIONSNEHICLES/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,SHITE 203$ BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TA VE ✓--� NORTH ANDOVER,MA 01845 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER DATE(MNfYY)CERTIFICATEF LIABILITY INSURANCE /10" 44!216 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.I Hudson Office PHONE 978 56 FAX 131 Coolidge Street,Suite 100 (A/C,No,Ext):( ) 2-5652 (A/C No):(978)562-7120 Hudson,MA 01749 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Insurance Company INSURED INSURER e: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. NOTWTHSTANDING 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 ADDLSUBR LTR TYPE OF INSURANCE POLICY EFF POLICY EXP !NSD WVD POLICY NUMBER MMIDD/YYYY MM/DD/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) $ 100,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY JE T n LOC PRODUCTS-COMPlOPAGG S2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT �: 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 PROPERTY DAMAGE AUTOS (Per accident) S S UMBRELLA LIAB X OCCUR C X EXCESS LIAB CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 EACH OCCURRENCE 5 S,000,OOO AGGREGATE S 5,000,000 DED RETENTION 5 '. WORKERS COMPENSATION 5PER OTH- AND EMPLOYERS'LIABILITY YIN N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERlMEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT S (Mandatory in 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 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 "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 �/t \_Office of Consumer Affairs&Business Regulation License: CS-079476 l; —0 HOME IMPROVEMENT CONTRACTOR Construction Supervisor Registration: 137913 Type: LAWRENCE E MORGAN,JR y Expiration --- Individual 100 IRON HORSE PARK _ LAWRENCE E.MORGI JR NORTH BILLERICA MA 01862 LAWRENCE MORGAN,;_: 100 IRON HORSE PARK — ��^� Expiration: BILLERICA, MA 01862 --- Undersecretary Commissioner 06/03/2017 Ada.kLSsfnUotr'- - ^�3 .Y�s . t This Bard aeknowtndges thatihe recipient has sucaessfutl`com It ted a I 30-hour Gebupationai Safety and Health Training Louise in ��r.paticnalSafett snG Heaf??;i;�:>> •yi+au,:� Gansti•uatianSafety and Health 1 has suecesslultt'completed OfzuP,"oriel sarew rind Hearth i t Training GOurSa n 1 ! ( �( ( Consiructiolr Safefv�PP—,J-,!j (Trainer name—printorhpe) (Course end date) - -- ! 116-ate) i