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HomeMy WebLinkAboutBuilding Permit #472-13 - 196 MAIN STREET 12/18/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 7 % ,� zf Date Received Date Issued: /a- W 11 IMPORTANT: Applicant must complete all items on this page LOCA 01 r 4. Print 1UU Year Ula Structure yes MAP NO: —30 PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes no no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition 0 Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial KIRepair, replacement ❑ Assessory Bldg J)eOthers: C4.Vrt1, ❑ Demolition Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands 0 Watershed District 0 Water/Sewer Cs OWNER: Name: -5 Address: DESCRIPTION OF WORK TO BE PERFORMED: or PrY Clearly) w/m CONTRACTOR Name: L. E•- Phone: '7 76 Address: - IA/I i�[Cr 'Okm Supervisor's Construction License: `l ' K7(e Exp. Date: _ 3 Home Improvement License: 1 37q1_3 Exp. Date: f 1.3 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 S.F. Total Project Cost: $ (020 OO FEE: $ Check No.: -7 G Receipt No.: %Z,9 6 �1.2- NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund Signature of Agent/Owner Signature of.contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow Engineer: Signature: LOcatea 3M FIRE DEPARTMENT - Temp Dumpster on site yes no Located at124 Maiq Street Fire Department-signature/date COMMENTS ooa Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA —(For department use B Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract u Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan u Workers Comp Affidavit E3 Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 La i fon / �a A4~ oc No. 7 / d —/ J Date �Z �'Z-- Check #� 26042 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ l/ Building Inspector <_ 0 0 0 --I y =F <iF. � N p c�•CDCL 0 CD m o CLN• =�= N. Z O -'O y C 5 o,o �a m N � W �° y o N =• cP 0 m _ 0 0 to n n CL `3 N O CD CD CD Z N A C �° CD It m Cl) CL c N CDZ C �Q m Er 3 rt 01� Z .� O O 0 o �a\ p c0 Cl) o CL C ""� r y O. : Ce Q C Cl) rn a \ :h ,•,� Cr 0 CD c 0 = �_ cD CD o O Z U)rt :c WCDc� O ; o WF_ ;Z Q Op CD rt k► Cl) 0o CO CD Z cn CD v o NCD • .a Z q U' O Z'p 3: G) y m CD Z �� - < n o' CD --1 = p m o CL V1 (n 03 T .Z7 T (n :;p T7o T (7 7p T N T 9 O (D ID -- (D K Z O c O �' 61 O C S 7 (D ¢1 zC }• r) O S 7 61 O C S �' N s 7 K O C S O C O_ p' (D "OO r) O O \ n ry T m D m -� D N N m A O �. m m A Z Vf n 0 M c 3 W Z H n 0 7 co C 2 Z M m 0 S (D D x OT m x O 4L NO K) C 41 OLC s L.E. Morgan Construction Co. P.O. Box 75, 86 Billerica Ave, Unit # 1 N. Billerica MA 01862 Office: 978-6704747 Fax: 978-670-6477 Submitted To: Saint Michael's Parish Address: 190 Main St. North Andover, MA 01845 Date: 11/19/12 Phone: 978-686-4050 Job Site: North Andover, MA WE HEREBY submit our proposal for the following scope of work; 1. Remove existing shingle roofing on New Church roof, Old Church/Hall roof, and Pastoral entrance roof. 2. Install 6 feet Grace Ice and Water Shield at eaves. 3. Install 3 feet of Grace Ice and Water Shield at roof all rakes, ridges, and valleys. 4. Install 15# felt paper on remainder of roof. 5. Install new 16oz. lead coated copper drip edge at all eaves and rakes. 6. Install new 18" wide 16 oz. lead coated copper flashing at all valleys. 7. Install new 16oz. lead coated copper step -flashings at all cheek walls and chimneys. 8. Install new GAF starter shingles on all eaves and rakes. 9. Install new 50 year Timberline asphalt architectural shingles by GAF. 10. Shingles will be hand nailed with 6 nails per shingle. 11. Install new premade aluminum pipe flashings with rubber gaskets on all pipe penetrations. 12. Install new Shingle Vent H ridge vent at all ridges. 13. Install new Timbertex hip and ridge cap shingles on all hips and ridges. 14. Clean and remove all job related debris. We propose hereby to furnish materials and labor, complete in accordance with the above specifications, for the sum of: Sixty seven thousand six hundred twenty dollars $67,620.00 Note: Morgan Construction will provide all Insurance Certificates & upon award of contract. Morgan Construction will warranty all labor for a period of 2 - years. AUTHORIZED SIGNATURE: Tho as Beaudoin Estimator ACCEPTANCE of PROPOSAL: The above prices, specifications and conditions are satisfactory And are hereby accepted. You are authorized to do the work as specified. Payment is due 30 days from completion. Authorized Buyer �e v . 1`�eu i N - e I Signature Date O'J I a 1- Sfi./J��G�.�el Pet•fk Ahs Thank you For Choosing L.E. Morgan Construction. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): E Me Address: 5?ln City/State/Zip: Af, 6a t (9,CQ Ig— Phone #: `� `� �-r & 70 — y 7 � fz Are on an employer? Check the appropriate box: S 1. I am a employer with 4. ❑ I am a general contractor and I _ employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their 3. E] I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other ),ny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. tsurance Company Name:_ ZU {r' l CA olicy # or Self -ins. Lie. #: !�A D . Expiration Date: lb Site Address:_ MaL� 5 f City/State/Zip: ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ae 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 fine up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. to hereby cert' y tinder the pains and penalties of perjury that the information provided above is trate and correct. ,.2 00- Official atse only. Do not write 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 5. Plumbing Inspector 6. Other Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE evised 5-26-05 Fax # 617-727-7749 www.m a es. QOv/d i a A . � v CERTIFICATE OF LIABILITY INSURANCE' DATE (MMIDDNYM LTR ILTR 12/17/2012 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 02 CONT C NAME: NORTH ANDOVER INSURANCE AGENCY, INC. M.J. FOSTER INSURANCE SERVICES 163 MAIN STREET (978) 686-2266 110): (978) 686-6410 E-MADDRESS cfernandez@nafins.com CCUUSSTTOMER ID Morgan Construction NORTH ANDOVER MA 01845-2508 INSURERS) AFFORDING COVERAGE NAIC d INSURED - Morgan Construction INSURER A :S. H. SMITH & COMPANY I INC. INSURER a :SAFETY INSURANCE PO Box 75 INSURER c :ZURICH INSURANCE INSURER D :SCOTTSDALE INSURANCE INSURER E North Billerica MA 01862- INSURER F 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. LTR ILTR TYPE OF INSURANCE INSR yyvo POLICY NUMBER POLICY EFF (MMIDDNYYY) POUCY EXP (MWDDIYYYY) LIMITS A GENERAL LIABILITY Y CBC10000241200 4/13/2012 4/13/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [K] OCCUR / / / / / /-D—Am--AGE / / TO RENTE07— PREMISES Ea oC a rrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPIOPAGG $ 2,000,000 / / / / X POLICY PEO LOC / / / / $ B AUTOMOBILE UABUJTY ANY AUTO 6215111 0/13/2012 / / 0/13/2013 / / COMBINED SINGLE LIMIT (ED accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS / / BODILY INJURY (Per acddent) $ X SCHEDULED AUTOS / / / / PROPERTY DAMAGE (Per accident) $ X HIRED AUTOS / / / / X NON -OWNED AUTOS / / / / $ $ D X UMBRELLA LAB X OCCUR KWO081465 4/13/2012 4/13/2013 EACH OCCURRENCE $ 5,000,000 EXCESS aAB CLAIMS -MADE / / / / AGGREGATE $ 5,000,000 DEDUCTIBLE $ RETENTION $ /. / / / $ `. WORKERS coMPENsgnm ANDEMPLOYIRS LIABtL1TY Y / N ANY PRO PRIETORIPARTN OFFICERiMEM8Q2EXCLUDFSERIEXEY/CUTIVE� (Mandatory in NH) U es, describe under DESCRIPTION OF OPERATIONS below NTA BE DETEFMdIN D 2/14/2012 / / 2/14/2013 / / WC STATU- OTH- RY I T ER _ EL EACH ACCIDENT 1000, $ 000 � _ EL DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AttwA ACORD 101, Additional Remarks Schedule, H more space is requited) vr_� r rrrve� r � r Iv�v�r� VlY17l+CLLN I IVIV TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER MA 01845— ACORD 25 (2009109) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. I mauAa (ZUU9U9) I NIC NiV6JRU name arra IUBU are re9151UTC10 marKS Or AUUKU - Massachusetts - Dei tr-tment of Public Sant% B -rd of Building Zcrmiations and St and ar(Is Construction Sdpervisor tic License: CS 79476 LAWRENCE E MORGAN JR s 86 BILLERICA AVE UNIT 1 .N BILLERICA, MA 01862 Expiration: 6/3/2013 Commissioner Tr#: 16354 MOBILE EQUIPMENT __ _-- - a-• OPERATOR CERTIFICATE THIS CERTIFICATE CONFIRMS THAT has srczesdul'y fi"` 1&-d all the Ox-elcd o :cu' tchiN and emluanon reGlrrerrrsts listed iD ledz;d and r t r 1phorts and is hreby autivized b opreh 6he typejs) d mobile eaDiplce-d list -don the r7erse. 1 1 1i rE bDNF � i I: L OSHA 002329991 U.S. Department of Labor OccupationarSafety and Health Administration LARRY MDR&AtIiJ y is has successfully completed a 10 -hour Occupational Safety and Health Training Course in Construction Safety & Health LDu� S Rot jPS*'4j R 'AU&A6 (Trainer) {Date) >�x..::.......::............. ..:....... .........,.......,..:............._..,:...•.............. __........ ...... ._. ........ . f� o I , Office; Co sumer A aia sines�atr HOME IMPROVEMENT CONTRACTOR Registration 137913 Type Expiration: Individual �/1fRENCE E. MORGAN; -J12:`; f LAWRENCE MORGAN JR ` 86 BILLERICA AVE UMT-.+' i BILLERICA, MA 0 (862 ) i Undersecretary ,