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HomeMy WebLinkAboutBuilding Permit # 11/14/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 'rep C Date Issued: - 01 -__._-----.-_-.__--------------.__..m.__ IMPORTANT: Applicant must complete all items on this page 'IAOi,'ATION 4o cL e- V1- AIA Cie y" del Print A PROPERTY OWNER C,/ t-L22 I"-,-If e- .4 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop'Village yes no TYPE OF IMPROVEMENT PROP SED USE Resi E ntial Non- Residential 11 New Building VOne family Ll Addition 0 Two or more family F1 Industrial EJ Alteration No. of units: ri Commercial F] Repair, replacement 1,71 Assessory Bldg El Others: D Demolition 1_J Other FloodplaNn J Wetlarlds''/', L1Wate`rsh' d:,Dist'rictl,'',,,,,,,,,,,�,", , Mat ewe' DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Llorfq Phone: q J Address-: ....................... Contr ctorWarne: Ph PhQnd)S/ L_]DqJ4_) Email: WY)WA I wy�o�' klv\ -Mffi Address: �"rw �&" W t)-iNk Supervisor's Construction License: UX71?�D� _Exp. Date: 6.3, 0 V2 ,d) Home Improvement License: 0 Exp. Date: ,7 ARCHITECT/ENGINEERN Phone: Address: Req. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125. ER S.F. Total Project Cost: $ 920 FEE: Check No.: Receipt No.: NOTE: Persons contracting� Vith U gistered contractors do not have acces d the guaranty a " act oLAgenfl-Owner --- - -------- Signature.of. contra r F Town of. ndover tor No. _ oh , ver, Mass, Coc"Mt WIC y �S R'STED A4¢�.�5 U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT . A.R►. PA04 II �V � 6UILDING INSPECTOR has permission to erect .......................... buildings on .44, .....1.y ,...A. ....... ........... , Foundation ..1� .,..P.... ./. KIER oRough tobe occupied as .,......I. .. .,. ..... ............................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT TA Rough ......................... .. Service ......... ... ..... ..�. .. .. ... BUILDING INSPECTOR Final GAS INSPECTOR OecuBancy Permit Required to Occupy Buildin Rough 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 Al We Accept: 86 Billerica Avenue 1'nit#1 i Visa -_7 iX. Billerica,IW 01862 -4747, /liar: (978)670-6477 Office: (978) 670 — & A -L(0 UKE P"ONE 11, fs VIDN "T' bA Mj2 in q, d -9f GWI.UTATE AND ZIP Wrv- Joncnrrpt IZ. V e I JOB PHCIIE 160-- hg/q.,am Strip down to the wood deck, ,,— layers of shingles, dispos ' of dt-bl-iq to licensed recycling facility. Install -kL ice and water shield at the gutters 3 feet of ice and water shield in valleys. Install synthetic underlayment on the remainder of the Nvood decking. Install 8" aluminum chip edge on'all perimeters, color choices: 0 White, D D&U, 0 Brown, U Copper. Install,-5'p year L-, . d ---k architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by A , -,- to all ridges and dormers. Install new skylight flashing kits manufactured by 4`/,4 Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing 11111;11 Z� chimneys and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. WF PROPOSE hereby to fitrnish material and labor-complete in accordance with above specifications,for the sum of.- T� dollars($-J,���—0 �)- All material is guaranteed to be as specified.All work to be completed in nworl(manlike A utho riz e d S isr-,�. manner according to standard practices.Any alteration or deviation from above 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, 4 7i- ACCEPTED AS A CONTRACT—The above prices, Date of acceptance: 'EP' C C specifications and conditions are satisfactory and are Authorized Signature:p cl 1cation 8 f [he�re,�by accepted.You are authorized to do the work as spec d -it will be!p��� ahoye. Authorized signature:P. I specified.Paymei FAdditional IRIenuarks:,jS�NE E COLO 4X bEF TX I F T- - ------------------------------------------ ------------------- - -------------- Mr--tAT.TTr -VA11FT -ROIR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth ofWassachusetis x Department ofbidustrialAccidents " 1 Congress street,suite 100 's Boston,M102114-2,017 rvww.mass.gov1d1a Workers'Compensation.Insurance Affidavit:Builders/Contractors/.11Xectriciansfflumbers. ApplicantInforma.tion Please Print Le lbl Name(Business/Organi7ationLCxi.dividrtat cre City/State/Zip: I #: ' Arepi an employer?Check rpproprlafe box; Type Qf project(yec�uired}: it I am a employer with�... ! employees(full and/or part thnc).* 7. New construction 2.[]I am a sole proprietor or partnership and have no employees Workiag for me,in $, r]R.eixrodolirig any capacity.[No workers'comp,immanco required.] 9. Demolition 3. T a n a homeowner doing all work myself.[No workers'comp..fusurarace rerlufred.l t � 10 (]Building addition 4.E]I am a homeowner and wilt 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.n LlectrLeal relmiis or additions pxopraetoaswith noeariployecs. 1�.Q1'1 Bingr`epair'soradditions 5. I am,a general contractor and I have hired the sub-contractors listed on the attached sheet. ��These sub-contractors Bayo oinployces and havo workers'comp,insuranco.t 13. oofxe 6.[j We are acorporat{rn pndita offzcera,havc exercisedtheu eight o£exemptionperMG c. 14' Other 7.52,§1(4),and we have rga,,ezriployoes.[too workers'comp,itrsuranco rerluiced,l a.. _ t��j `'Any applicant that checks b6x##1 must also fill out the section below showing theirworkers'oomponsation policy iniornlation. Homeowners who s6riiif 11da affidavit indicating they are doing all work and then hire outside contractors must s4bm#t anew affidavit indicating such. tContracters 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. Iftho sub.coritra(irs have'amployees,.Yliey must provide their workeis'comp.policy number. ., I a/n an efnpioyer Mat is piovidiiig ivorlcers'compensation insurance fo y my emplriyees.'73elow is'tlie policy and joh site infer^rriation. k Insurance Company Name: __..__ Policy#1 or Self ins,Lie. : Expiration Date:. Yob Site Address: �' _....� µ City/Stato/Zip: M d Attach a copy of the wor w 'c'onapetisation.policy declaration page(showing the policy number and expiration e`a Failure to secure coverage,as equii ed tinder MGL c. 152,§25.x.is a exirninal violation punishable by a flue up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a flue of up to$2.50.00 a day against thqqolator..A copy of This statement may be forwarded to the Office oflnvestigations ofthe DIA for insurance coverage vers: e ion. _Ydo-here y unde'the ai zs i .Il i s filer,jrrry tha thlinformationprovidedaT ve it rue and correct{ Sinatux "_._..._ Date: Offi is zise only. Do not`write in tTiis area,to e completed by city or toren official. City or Town; PermitTLicense� Issuing Authority(circle one): 1.I3oar� of health 2,Building Department- 3.City/Town Clerk 4.Electrical Inspector r,Plumbing Inspector 6.Other Contact-Pex'son: _...__ ^ Phone LEMORGA-01 BBOYER CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 411412016 THIS CERTIFICATE 1S 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: 1f the certificate holder is an ADDITIONAL INSURED,the p0licy(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 Welsh&Parker Insurance Agency,Inc.!Hudson Office NAME. 131 Coolidge Street,Suite 100 PHONE __ Hudson,MA 01749 (A1C,No,Ext):{978}562-5652 {AIC,No 978 562»7120 E-MAIL j; } ADDRESS: INSURER(S)AFFORDING COVERAGE NAtC A INSURED - INSURER A:Western World Insurance Company INSURER B:SAFETY IND INS CO 33618 LE Morgan Construction Inc INSURER C:Scottsdale Insurance PO Box 75 Billerica,MA 01821 INSURER D: INSURER 5: CpVERAGESINSURER F: 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. !NSR DLSUBR LTR TYPE OF INSURANCE IN WVD POLICY NUMBER POLICY EFF POLICY EXP MWDDIYYYY MMrDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY fI EACH OCCURRENCE S 1,000,000 CLAIMS-MADE f XI OCCUR NPP838152o 04/13/2016 04/13/2017 4pREM ES RENTED ---- PREMS 100,000 - MED EXP(Anyone person) $ 5,000 _ GEN'L AGGREGA_T_E LIMIT APPLIES PER. PERSONAL&ADV INJURY S 1,000,000 POLICY PRO-- n LOC GENERAL AGGREGATE S 2,000,000 JECT_ OTHER: PRODUCTS-COMPIOPAGG S 2,000,000 AUTOMOBILE LIABILITY S COMBINED SINGLE LIMIT B ANYAUTO fi230688 (Fa accident) S 1,000,000 ALL OWNED X SCHEDULED 10/13/2015 10/13/2016 BODILY INJURY(Per person) S AUTOS AUTOS X HIREDAUTOS X BODILY INJURY(Per accldent) S AUOSWNED PROPERTYDAMAGE 1S _,(Peracc€dent) 1 UMBRELLA LIAR X OCCUR S C X EXCESS LIAR EACH OCCURRENCE S 5,000,000 CLAIMS-MADE XLS0099346 04/13/2016 04/1312017 mAGGREGATE s 5,000,000 DED RETENTION S WORKERS COMPENSATION S AND EMPLOYERS'LIAR€LITY PER DTH- ANY PROPRIETORIPARTNERIEXECUT€VE YIN .,,,. STATUTE ER OFFICEWMEMBEREXCLUDED? NIA E.L,EACH ACCIDENT S (Mandatory In NH} tf yesT describe under E,L.DISEASE-EA EMPLOYEE S DESCRIPTION OF OPERATIONS below --- E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES [ACORD 101,AddiNanal Remarks Schedule,maybe 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 01846 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE{MMIDDI(YYY} T�IESKCERFIFICATE IS ISSUED AS A MATT12/1712015 . ER 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($),AUTHORIZED REPRESENTATIVE R P O UCER D THE CE IFICATE OLDER. .PORTANT:If the certificate holder is an ADDITIONAL INSURED,the pol(Cy(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 BALDWINIWELSH PARKER MS NAME: 131 COOLIDGE ST,SUIT,#Igo PHONE FAX (A1C,No,Ext): c,No}: HUDSON,MA 01749 E-MAIL 27KLI3 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# rURE INSURER A: AMERICAN ZURICH INSURANCE COMPANY RGAN CONSTRUCTION INC INSURER B: INSURER c: X 75 INSURER D: NORTH BILLrRICA,MA 018f2 INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: Et THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEE N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIRCYVPE OOD�NOIICA�ED. NOTWITHSTANDING ANY REt]UIREMEN7,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 LTR TYPE OF INSURANCE POLICY EFF DATE POLICY EXP DATE L R POLICY NUMBER (MMIDDIYYYY) (MMIDMYYYY) LIMITS GENERAL LIABILI'T'Y COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE []OCCUR, DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GENT AGGREGATE LIMIT APPLIES PER: PERSONAL 8 ADV INJURY $ POLICY ❑PROJECT❑LOC ENERALAGGREGATE $ PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT(Ea accident) 5CHEDULEAUTOS BODILY INJURY $ (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE $ AGGREGATE $ DEDUCTIBLE RETENTION $ EIl WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN UB-58738312-15 12/1412015 12/14/2016 LIMETSSTATUTORY OTHER ANY PROPERITOMPARTNERIEXECUTIVE OFFICERIMEMSER EXCLUDED? NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ '1,000,000 DESCRIPTION OFOPERATIONS be(aw E.L.DISEASE-pOLICYLIMIT $ 1,000,000 DESCRIPTION OF OPERAT(ONSILOCATIONSIVEHICLESIRESTRICTIONS!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. NORTH ANDOVER,MA 01845 AUTHORIZED REPR TA VE —M ACORD 25(20101)5) The ACORD name and foga aro registered marks of ACORD 4! -2010 ACORD CORPORATION. AEI rights reserved. Massachusetts Department of Public Safety -- Board of Building Regulations and Standards \ Office of Consumer Affairs&Busies Regulation ctC� License: CS-0HOME IMPROVEMENT CONTRACTOR Construction Supervisor 4Registration: 137913 Type: t Expiratiorf_-.-j 7 Individual LAWRENCE E MORGAN,JR ;• 100 IRON HORSE PARK LAWRENCE E. MOF2�ANJR ' NORTH BILLERICA MA 01862 - _ „.' LAWRENCE MORGAN R :- 100 IRON NORSE PARK,; MA 01862 /� , ��'� �.✓�.--- Expiration: BILLERICA TJndersecrefary Commissioner 06/0312017 .�-�sfOfY andPeallh __ LCq rtSrEraUO�i" . �- This Bard acknowledges that fhe reciplorit has sUctiessfully corriplEfed a - ?� 94-dour Oct ufsatianal Safety and Health Trafning Course in 1 UT rJcr.;��alicnatSafe[y and Hnrcf;:r�;:(2;,•3i+�lr�?_� Construction 5afef f and He!alfh f ARRY MO . j h0,succassful�7 compfcted r,i 7 rt t7:,upatlar>31 5afea,And Huish � � �..___.. Consfr�ciiol�S�.fety 8:}ieafth ('Ta€ername—printort a) . LIi'z" �s— .•s uec[ae