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HomeMy WebLinkAboutBuilding Permit # 9/29/2016 ------------------...............----------- BUILDING PERMIT ttORTA'1' 16 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#.- C Date Received 20, Arev C FBU5c Date Issued: IM PO S page LOCATION )e_W�US . ........ JPrint PROPERTY OWNER 11 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no ---—---------- TYPE OF IMPROVEMENT PROPOSED USE . Resi tial Non- Residential Li New Building One family El Addition ri Two or more family Li Industrial 11 Alteration No. of units: 1] Commercial D Repair, replacement F]Assessory Bldg El Others: F) Demolition 0 Other t .b"w [2] Floodplain ClWet I a hds Watershed h "Distribt/''.,�,",::/// W we S6 r, ORIPTION OF WORK TO BE PERFORMED: D E� -------—---—---- Ide fificaflo - Please llypeor.Print Clearly OWNER: Nam fP- Phone Address: 9;bc Rd =�iLs e 4) Contra for Name- 1)AA)i'P?1fJ Phone: Email: ne-4- Address:.IbPJ7 1 'ron Supervisor's Construction License: Exp. Date: 3. D Home Improvement License: S-19). Exp. Date: ARCH ITECT/ENGINEERA 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: $ FEE: Check No.: Receipt No,.- ''I z NOTE: PPersons contractin ith nregistered contractors do not have acces the guaranty.fund ature- 8.�6n 0 G ,., eAORT# Town of 2 _ ��' b ndover -. O M Y No. 7 r� �KK, h ver, Mass �'Q COEN[[NC W1[fl �. o� b U BOARD OF HEALTH PERMIT T DFood/Kitchen Septic System THIS CERTIFIES THAT ....... .; ) e. ... ... m0 rl A,. 13UILDING INSPECTOR has permission to erect ................ . ....... buildings on ..., ,..,,, „�,�,!# L„ R s, + !fie Foundation Rough to be occupied as ................... it .................................... _ .................................................. .....:.... Chimney provided that the person accepting this permit shall in every respect conform to the terms of thea lication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 CONSTRU ON ST Rough Service .......... ............ BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occuy Building .. ". .. Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wali To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building inspector. Burner Street No. Smoke Det. PROPOSAL L.E. l�Qrgan Consimeli 3n company We.Accept: 86 Billerica Avenize,Unit1 N.Billerica,Mik 41863 I� Office.(978)6703-4747/Fax.(978)i570-64,77 PFioPOS S➢9iM]—EOJTO PHONE _ paTE t GIT>r:5T0.7E 0.N'➢ZIP GO➢. r. Joe Zvc0.TION i� r�{nrl P7,77�r rn ACqCTga7Hea Ice PHONE Z Strip down to the wood deck, -L layers of shingles, dispose of debris to a licensed recycling facility: Install 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 8"aluminum drip edge ori'all perimeters, color choices: Cr White, M Mill, 0 Brown, G° Copper. Install.C6 year � �lc Gam tt�..�'=� architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by c to all ridges and dormers. Install N new skylight =lashing kits manufactured by IVIS Flash all cheek,walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing chimneys and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. WE PROPOSE hereby to furnish materiel aid labor-complete in accordance with above specifications,for the sum o€: ( ra dollars(s �- AEI material is guaranteed to be as specified.Alt work:a be completed in aworkmantike rnanner according io standard practices.Any alteration or deviation from above At:therized SignaY specifications involving extra costs W,II be executedonly upon written ordais,and will become an extra charge over and aheve the estimate.Our workers are fully covered Note:This AroposaI maybe withdrawn by workmen's compensation Insurance and Liability Insurance. by its if not accepted within � � days. ACCEPTED A AS COti''rRACT-"l'he above prices, �Aatr of acceptance: �• `1 f"'-� y"c 1 specifications and conditions are satisfactory and are k + Authorized Si nature: + j hereby accepted.You are authorized to do the work as --`-' �^ specified.Payment will be made as outLvned above. .authorized sicnatare: Additional Remarks: s - L a r 0 ��r l..•. 'k-FLA-NK YOU FOR CHOOSING L.E. MORGAN CO3NSTRUMON Yhe commonvealth of'MussorOusefis Depoolment qf IndustridAeddents I Congress Street,Suite 100 Boston,MA 02,11,4,,2017 vvw.mass.gov1W!a Workers,Compensation Insurance Affidavit-:Builders/Contractors/E k0ricianshplumbers. TO BE FjffiED N"Yff THE' PF-,RWCTf NG AUTHORITV- Applicant Information.-, Please Print Le NaM V 0 (Business/orgarrizationfibW idual)Y: Addxessj.(_)0 city/'State/zip:Lill t ri* Areyouanemployer?'ChecTkVo pproprIatebox; Type of project(T4uired)' Lj�rIamaemployer with.. . employers(full and/or part-fine)." 7. New construction 2.0 f ana'a sole proprietor or partnership and have no employees worldug; for me,in 8. Romodelffig any capacity.[No workers'comp.insurance requirrd'i E]Demolition IL]I am ahomeowner doingalt work myself.[No workers,corrip.Jusuranoo required.]t 10 n'Building addition 4.F_]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 solo 11.0 Electrical repairs or additions pr6VxJetors with no ei4loyces. li Fj)?Jumbing repairs or additions 5. Ilam a general contractor and I have hired the sub-contractors listed on the attached sheet, 14. R06f r irs eso si'1b­contrac'tor�hav"p'ch�plqyllle's and have workers'comp.insumuceJ 6.E]We are a corporation and its office.is have exeyoised their right oVexemption PorMCIL 0. 14 . Other 152,§1(4),and NY 1'a- jffoworkors comp,insurance requiled.] haye oy�es . . '. " ofloy information. "Any applicaritthat checks,15601 must also U out the section bclow.hc��w�j their oikers"componsationp Homeowners who snbiii1f this Adavit indicating they are doing all work and then hire outside conti-aPtols Must submit anew a ff-idavitindicatIng such. tcontractPra that check this box must'attacbed an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. ff tha'suh­c6ri6dors]cavo emploYces".'V64 zimit provide their workois'comp.policy number. J'arij,all einpioyer that isp'iovidihg iporfrpsi compensation insurancefor iny emp1byeeN.'Pe/01V Is thepOiiey and)ob site in ,formation. hisurance Company Namo:_O&�_ Policy#or Self ins,Me.#: _ Fixpirationl)atojJ- I lob Site Address: 4 AP 6 Atta6h a copy of the Workers'compensation policy dtclaration page,(showing the policy number n expiration elate). Failure to secure cov6rago as required under MOL c. 152,§25A is a criminal violation punishable by a line lip to$1,500.00 and/or one-year imprisonment,as Well 88 civil penalties in the form of a STOP WORK 01WER.-and aflue of UP to$250.00 a (lay against the violator.A copy of this statement may be for to the Office of Investigations of the DfA fbr insurance op, coverage verifl, ation. lon _�ei�Zfles 0 p,��i 1�that, I do hereby c r uizdiei-tliepaiiisandpeiiattlesofpei,* jy that the Infortnaflonprovided above is true and correet. n Y IM 1. , Si ta r Date: Phone 72 L Offs use use only. Do not write,In this area,to he completed by city oil town Official. City or Town: Permit/License it Issuing Authority(circle one): 1.Boar.of Health 2.BuildingDepartulent 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#:__ boy? CERTIFICATE OF LIABILITY INSURANCE DATE{MMlDD1YYYY1 1'1HIS 12/1712 TIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. THISERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE 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: BALDWINIWELSH PARKER INS PHONE Fax 131 COOLIDGE ST,SUITE it 100 (A/C,No,Ext): (A/C,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27ICLD 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: NORTT-I 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 DAMAGE TO RENTED $ CLAIMS MADE F-JOCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY ❑PROJECT E]LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ i SCHEDULE AUTOS (Perperson) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ ( (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-58738312-15 12/102016 12/14/2016 x LIMITS ANY PROPECER/ME BERIPARTNDRlEXECUTIVf . NIA E.L.EACH ACCIDENT $ 1,000,000 OFFiCERfMEMBfR 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 DESCRIPTION OF OPERATIONS/LOCATION$fVEHICLESIRESTRICTiONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. ERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD STREET,III DG 20,SUITE 203$ BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TA VE 3 NORTH ANDOVER,MA 01845 ACORD 25(2010!05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. �.� LEMORGA-01 13130YER CERTIFICATE OF LIABILITY INSURANCE DAT114/2DlYYYY) 414r201s 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 he 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.1 Hudson Office PHONE g7$ 562-5652 PAx 978 562-7120 131 Coolidge Street,Suite 100 A!C No,Ext}:{ {Arc,No); ( ) -MAIL Hudson,MA 01749 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 766 INSURER O: 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 TYPE OF INSURANCE ODL SUSR _- POLICY EFF POLICY EXP LIMITS LTR wsD WVD POLICY NUMBER MMIDDrYYYY MMIDDlYYYY A X fE COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 -----`----- AGE CLAWSMADE n OccuR N PP8381520 04!13!2016 04/13/2017 PREDAMMisETO REN S(Ea occuD rrence) S 100,000 MED EXP(Any one person) S 5,000 PERSONAL a ADV INJURY $ 1,000,000 OEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO- LOC PRODUCTS-COMPIOP AGG $ 2,000,000 JECT S OTHER: AUTOMOBILE LIABILITY (°accident)INGLE LIMIT S 1,000,000 B ANY AUTO 6230688 10/13/2015 1011312016 BODILY INJURY(Per person) S ALL OWNED _X_SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S X HIRED AUTOS X AUTOS _(Per accident S UMBRELLALfAB X OCCUR EACH OCCURRENCE 5 5,000,000 C X EXCESS LIAB CLAIMS-MADE XLS0099346 04/1312016 04/13/2017 AGGREGATE 5 5,000,000 DED RETENTION S S WORKERS COMPENSATION SiE'pSTATUTE ER AND EMPLOYERS'LIABILITY Y f N _ ANY PRA PRIETORfPARTNERIEXECUTIVE ❑ N f A E.L.EACH ACCIDENT S OFFICEMMEMSER EXCLUDED? E.L.DISEASE-EA EMPLOYE S (Mandatory In NH) _ - If yes,describe under E.L.DISEASE-POLICY 41MIT $ DESCRIPTION OF OPERATIONS below 9 I DESCRIPTION OF OPERATIONS I LOCATIONS r 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 ACCORDANCE WITH THE POLICY PROVISIONS. 1640 Osgood Street,Bldg 20,Suite 2035 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 i'. Massachusetts Department of Public Safety _ Board of Building Regulations and Standards C//r.� n�,r.�,zn�ruer��t/of'G/l�ua:facrue/ Office of Consumer Affairs&Business Regulation License: CS-079476 - HOME IMPROVEMENT CONTRACTOR Construction Supervisor [ Registration: 137913 Type: LAWRENCE E MORGAN,JR F;7 Expiration----_A&712017 Individual 100 IRON HORSE PARK LAWRENCE E. MORGAN;JR - NORTH BILLERICA MA 01862 LAWRENCE MORGAN JIB 100 IRON HORSE PARK /n1 , BILLERICA, MA 01862 —' �.r�n l� EXpira#lOn: Undersecretary Commissioner 06/03/2017 �11"!i trliutoryandHvaRi, _ ��- _ - 1L r p 09;' . t fftis card acknowledges tharthrz racipioill ttassuo ssfully GoMp€cWd a :r.:=.t'„Qnr.ler;o!_at a, �- r 30-Dour OeWpaiional Safety and Health Trafr:ingoutse in �Jer:��sianat s;efe;•3;,r,Hry;,r, a, ;n;,•,•; Construction Safety and Health I ' 1 R&A ! 3 -•-� - � -*.,:J/�. , - � t,as scaac�ssf�ttj cor,pleted a.101,0� uc:;up<'tsi0ri�1 Salettar3J N�allft - consiructio�Safety a PeeFd l # 1c3 ' .— _ met (Tra[n2r Hama Lea prTntar tyke} {course end dale) - _ iv9[QJ