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HomeMy WebLinkAboutBuilding Permit # 11/23/2016 �1 .......... BUILDINGPERMIT TOWN OF NORTH ,ANDOVER APPLICATION FOR PLAN EXAMINATION d * K Date Receive Permit C1: 4 Date Issued: i ­_2_L_ ;2_o d IMPORTANT: A2plicant must complete all items on this page LOCATION "t f, PROPERTY W � A tfy Prim ^ MAP NO: �. " PARCEL: ONIIO C TRICT: Historic District'' yes no Machine Shop Village yesn -------- -- —- TYPE OF IMPROVEMENT PROPOSED USE _ Residential Non- Residential - _ __--- Carte family Addition New Building 1 Two or more family Industrial Alteration No. of units: Commercial--_- Repair, ommercial ___Repair, replacement Assessory Bldg Others: Demolition Other 10 Septic Well :.i Floodplain C.1,Wetlands ::i Watershed District 0Water/Sewer Identification Please Type or Print Clearly) OWNER: fume: Address: 1" 4-��A) U0 dJ U CONTRACTOR Na e- ,.hc n � m \T%" bik_ R, vy) L) I_Sa/,��, Supervisor's Construction License: "„ p. Date: Home Improvement License: � � � Exp. Date: ARCHITECT/ENGINEER Phone: . Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER&F. FEE: . Total Project Cast: $ � � � Check No.: Receipt No.: NOTE: Persons corrtrcxctira p r"tf; regitel a c« tltors yx crry ac ce to t1earcaral2ty fu�acl Signature of Agent/Owns i u 6 contractor Town of ndover ® x.. - •y`. y•� Mr . . No. C; h ver, Mass, LOC MIC�+lWrc 1K 1' U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR has permission to erect .......................... buildings on ... „ ..... ..,. � .................... Foundation . .. . .. ........... ...... � Rough to be 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS l ELECTRICAL INSPECTOR UNLESS C®NSTRUCTX-T TS Rough ........... ...,.. .,...®..... ............................ Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to ®ccu_gy Buildine 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. Nov 21 2016 08:01PM HP FaxHeritage Green 19786850521 page 2 L. E. MORGAN CONSTRUCTION INC. 86 BILLERICA AVE., N. BILLERICA, MA 01862 PH: 978-670-4747 / Fax: 978-670-6477 PROPOSAL Submitted To: Affinity Realty Management Date: 10-28-16 Address: 39 Rear Farrwood Rd., (Clubhouse N.Andover, MA 01845 Cell/Fax: 978-376-9687 f 978-685-0521 Job Site: Heritage Green Condominiums 5-7 Fernview Rd.,N.Andover, MA,Approx. 5,279 SQ FT WE HEREBY submit our proposal for the following scope of work; 1. Remove the existing shingles down to the wood deck and dispose of off-site. 2. Install V of ice&water shield at the leading edges and 3' In all valleys. 3. Install RHINO SHIELD Synthetic Underlayment to the remainder of the wood deck. 4. Install 8"'white aluminum drip edge to the entire perimeter&mechanically fasten. S. Install Certainteed Swiftstart shingles as a beginning course. 6. install Certainteed Landmark Silver Birch architectural shingles&hurricane nail. 7. Install 4 new pipe flanges, 3"-4",with neoprene collars. S. Install new Attic Slant Vents to replace the existing on rear of the building. 9. Install new ridge Trent and snatching cap shingles. 10. Remove the metal siding on dormers,&install 10D% ice&water shield on the walls. 11. Install now white vinyl siding on all 3 dormers with white vinyl comers. WE propose hereby to furnish materials&labor,complete In accordance with the above specifications,for sum of; Elghtee ousand Eight Hundred Twenty Dollars: $18,820.00 AUTHORIZED SIGNATURE Lawrence E. Morgan Jr President ACCEPTANCE of PROPOSAL.The above prices,specifications&conditi s are satisfactory and are hereby accepted.You area orized to do the work as sp Otter � ► 4k---wj" AUTHORIZED BUYR SIGNATURE DATE THANK YOU FOR CHOOSING MORGAN STRUCTION Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or G.S.L. Licenses ❑ Copy of Contract © Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (if Applicable) • Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc.INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 S—N The Commonwealth of Massachusetts Department of Intlusti-lafAceident.9 I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/tlia Workers'Compensation Insurance Affidavit:Bijildet,s/Cojiti,actoi-s/.f?,Iecti-icians/PIumbers. TO BE FILED WITHT111r,PERMITTING AUT1101017Y. Al)plicant Information Please Print Legibly Name (Bt isitiess/Oigaiiization/Iiidivi(itial): ni att rlllndi�i Address: City/State/Zip:N Are yoplin employer?Che Ile appropriate box' Type of project(required): 1.1 z(l am a employer with__employees(full and/or 7. EINew construction 2,0 1 am a sole proprietor or partnership and have no employees working for me in 8, Remodeling any capacity.[No workers'comp.insurance required,] 9. Demolition 3,[:]I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10 r] Building addition 4,E]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 sole 1 LF]Electrical repairs or additions proprietors with no employees. 12.n Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F-J.Rf, 'Of rel airs ti These sub-contractors have employees and have workers'comp.jusurance.t 6.n We are a corporation and its officers have exercised their right ofexemption per MGL 0, 14,Q Wo 4'�" — 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 111 must also fill out tire section below showing their workers'compensation policy infonnation. V t Homeowners who submit this affidavit indicating they are doing all work and their hire outside contractors must submit a new 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. lama art ei)il)loyei,that i.vpi-oiliditigipol-lft,l.s'conipellsatioiiillslll'aticefor iiiyeiiiplojpec,s. Beim v Is the policy an djob site hijbi-matron. Insurance Company Name:_Qftl Policy#or Self-ins.Lie,IkExpiration Date:A City/State/Zip: 0�Idtw(l Job Site Address Attach a copy of the workers' compensation policy declaration page(Showing the policy nut -,xpiration date). Failure to secure coverage as required under MGL c, 152,§25A is a criminal violation punishable by a fine lip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK 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 vq4fication. I do lie eb er^tify_raider,, , thepain'a and;rp!�W' S o�fPe1jii y that the information providers bove true and correct. Si nattttDate: A ------- Phon OfAijal ise only. Do not sprite In this area,to be completed by city or town official City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6,Other—_____ Contact Person: Phone LEMORGA-01 BBOYER CERTIFICATE OF LIABIL117Y INSURANCE DATE(MMIDDNYYY) 411 4/2016 016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AN CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEP ID OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A ONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy iesj must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorser ient, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTAC NAME: Welsh&Parker Insurance Agency,Inc,1 Hudson Office PHONE ��-FAx 131 Coolidge Street,Suite 100 {Arc,Nn, <t}: 978)562-5652 I(P C,No). (978)562-7120 Hudson,MA 01748 E-MAIL ADDRES INSURER(S)AFFORDING COVERAGE NAIC# — -- INSURER :Western World Insurance Company INSURED - ---- INSURERB:SAFETY IND INS CO 33618 LE Morgan Construction Inc INSURER :Scottsdale Insurance PO BOX 75 INSURER Billerica,MA 01821 INSURER_ INSURER - 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 AN CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY HE 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 LTR TYPE OF INSURANCE ADgL SUB OLICY EFF POLE'WVD POLICY NUMBER MJODIYYYY MMIDDNYYY LIMITS A X COMMERCIAL.GENERAL LIABILITY � EACH OCCURRENCE 5 1,000,000 CLAIMS-MADE I ' I OCCUR NPPS381520 0411312016 04/13/2017 DAMAGE TO RENTED — PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) 5 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LiMiT APPLIES PER: GENERAL AGGREGATES 2,000,000 POLICY JET E LOC PRODUCTS-GOAiPlOPAGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANYAuio 6230688 - (Eaaccident) S 1,000,000 1 /13/2015 1011312016 BOOILYINJURY(Perperson) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) S UMBRELLA LIAR X OCCUR C X EXCESS LIAB CLAIMS-MADE XLS0099346 0 /13/2016 04/13/2017 EACH OCCURRENCE s 5,000,000 AGGREGATE $ 5,000,000 DEO RETENTION S S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER _ ANY PROPRIETORIPARTNERfEXECUi1VE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N!A If to and E.L.DISEASE-EA EMPLOYE $ If yes,describe under �._ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES (ACORD 101,Additionat Remarks schedule,maybe att Ichad it more space is required) WORKERS COMPENSATION CERTIFICATE OF LIABILITY WILL BE SENT DIRECTLY BY T E CARRIER. CERTIFICATE HOLDER CANCEL ATION 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 ACCORE ANC WITH THE POLICY PROVISIONS, 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 CERTIFICATE OF LIABILIT( INSURANCEDATE(MMIDDIYYYYI T19M 71201_r, MIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFE S NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR LTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETW EN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE R PRODUCER AND THE CERTIFICAT HOLD R. PORTANT:If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)ME St be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorserne t. A statement on this certificate does not confer rights to the certificate balder in lieu of such endorsement(s). PRODUCER CONTAC NAME: BALDW1NIWELSH PARKER IDIS PHONE FAX 131 COOLIDGE ST,SUITE#100 (A1C,No, xt): (A1C,No): HUDSON,MA 01749 E-MAIL ADORES 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER P013OX 75 INSURER NORTH BILLERICA,MA 01862 INSURER ENSURER ; 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% HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CDN ]TIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR ADD SUB POLICY EFF DA I POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) {MMIDDIYYYY} LIMITS GENERAL LIABILITY ACH OCCURRENCE COMMERCIAL GENERAL LIABILITY .. $ CLAIMS MADE E]OCCUR, DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER; PERSONAL&ADV INJURY $ POLICY 0 PROJECT❑LOC GENERAL AGGREGATE $ PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Peraccident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR []OCCUR EACH OCCURRENCE IT EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-15 12/1412015 12/14/2016 x` LIMITS ANY PROPERITORWARTNERIENECUTIVE NNIA E.L,EACH ACCIDENT OFFICERIMEMSEREXCLUDED? $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERAT€ONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORK RS COMP COVEItAGE. ERTIFICATE HOLDER CANCEL TION TOWN OF NORTH ANDOVER SHOULD AIY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1 b00 OSGOOT3 STREET,BLDG 20,SUITE 2035 BEFORE T E EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCOR `NCE WITH THE POLICY PROVISIONS. AUTHORIZE REPRF�SEt(TAVE _ NORTH ANDOVER,MA 01845 ff\\���1 r�'' ACORD 25(2010!05) The ACORD name and logo are registered marks of ACORD 198E-2010 ACORD CORPORATION. All rights reserved. Massachusetts Department of Public Safety Board of Building Regulations and Standards �/e Y110rsr.»zowaeaff/r.of'�/((«rrrrc/rrre \ Office of Cansufner Affairs&Business Regulation License: CS-079476 Construction Supervisor HOME IMPROVEMENT CONTRACTOR Registration:, 137913 Type: ,Expiration:;._--1l2Q1>7 Individual LAWRENCE E MORGAN,JR 1• 900 iI2ON WORSE PARK LAWRENCE E-MORATV'!R NORTH BILLERICA MA 01882 LAWRENCE MORGAd1t 100 IRON HORSE PARK - ^ (!1� BILLERICA, MA 01862•-�-n V� Expiration: Undersecretary Commissioner 06/03/2017 ��,t.L'1 lyntldflvaFth - � - - LL9A...111LLL This mid acknOwfedges tFlatth.e raciplofiF llasstilcoessfulfycornplEterla ii.s.[;:,a to �#_a �, — �� _� _ Sp=flour Qdbupalional Safety and Health Training Course in C0i1*U0ti0n Saiety and Heailh LARRY A Y . ., teas successfuu�eom�lelEd a Sr7 r�;,ur iaz+.c}pa:igsial Safei_v End Health Construction Safety a I feaitft reP (Trainer name=prTnt ar bfpe} (GOUrse and daie) .._ - - - _ -_� , - . �-- _• r - Kale# I