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HomeMy WebLinkAboutBuilding Permit #759 - 28 FERNVIEW AVENUE 5/26/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PROPERTY OWNER 'fir 1 MAP 210 Tt P.ARCEL Date Received applicant must complete all items on this page A TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic `` Welt, Floodplain Wetlands1�vatershed District W" at _ DESCRIPTION OF WORK TO BE PREF RMED: 5 r'eu i'(/tP.� tS i e Identification Please Type or Print Clearly) OWNER: Name: rs I .2 Phone: Address: COAITRACTOR Naive' Y nPr?�nn t�rt�n C`i �J`%� I � ,A Phnno7qf ARCHITECT/ENGINEER Address: Phone: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST P f�ON $125.00 PER S.F. Total Project -Cost: $ Jam, 060 FEE: $ Check No.: Receipt Receipt No.: TE: Persons contracting wit unregistered contractors do not have access to the guaranty fund Signature o gen Owner Signature of :contractor Location d ',.�(C� No. Jr; T� e n 1 Date �aRTM TOWN OF NORTH ANDOVER Oi ••,o_ ,,'y00 � t 9 Certificate of Occupancy $ MU,E<�' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23'V; Building Inspector 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 Reviewed on Siqnature COMMENTS HEALTH Reviewed on Sianature 1 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes _ Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/Sii nature & Date Drivewav Permit DPW Town Engineer: Signature; 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU 1 t, and UA 1 A — (tor department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 No 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 U. Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ 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) o 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: Building Permit Revised 2008 —r — r-� Ti w 0 w m c 0 w x. a O � OO a O y w u� o° w Cf)w o c� o o a: v :c U co x �, � o ci' c is. V a w o w � v) C7 o c a �' v d 2 v Q E a M N s VN c O CDm 12 cm c m 0 cm S c N CD 0 Z O O z 0 w P-4 W Vj CD O CD L O Z CD 0. O CO) p c � c cm CO) p '� y O O �E m m CD 0 CD CL ~ *. CD O:lift O �CD CD 0 0 cc o a Z—L cmcc y C c � c CcCc V _J .O •d OCD CO2, C Z CD CL C.� V2 O C C ice+ � C _c CL 0 LLI U) C9 W W W U) m c O � O y VO C5 Tom: O. l0 O r.+ O � N � Ea ..: oc co, 0 D C2 0 u cm m c CL m c H 3 cm m E 4D CL C.) L: a m m t 0 cm's 1: :mom COD co 0 t coao CD fq c = m CL p H COD W !ij LL �N C EL 21, .y W�E C3 .0 C K y y H t J.-O.y m E a M N s VN c O CDm 12 cm c m 0 cm S c N CD 0 Z O O z 0 w P-4 W Vj CD O CD L O Z CD 0. O CO) p c � c cm CO) p '� y O O �E m m CD 0 CD CL ~ *. CD O:lift O �CD CD 0 0 cc o a Z—L cmcc y C c � c CcCc V _J .O •d OCD CO2, C Z CD CL C.� V2 O C C ice+ � C _c CL 0 LLI U) C9 W W W U) 05/18/2010 11: 19 9786_85441'J t+ri .11.. . .,-.._. ►-Aar fJi 95/1V_2010 0;,:17 97CGU7774 L.E. MORGAN CONSTRUCTION CO. po. Box 75, 66 sweriea Aventle, Unit #1 N. Billerica, MA 01862 Office, 978.670-4747 + Fax: 978.670-6477 Submitted To., 11tritage Gree$ Condominiums AdArtm, 39 Ftirrwood Road N. Asadover, MA 10 Copy Phone 1 Paz: 97g- 4W4434197"85.0521 Date: A,psil 12, 2010 Job lte: Building 28-30, Feraview Rd. JW RE10V subntit our proposal for the following scope of work,, AYIP�a 4,7'52 1. Remove of the existing asplmIt shingles on the various roof planes dowca iv the W004 fleck, silos o1 ds age or rotting and report results. 2. gRA*ct the wood decltlog for any 3. Install b' of Wewater shield at the pestling awes and 3' in the valley. s, 4. ltastr#lp 151b. aspbalt saturatcd fl�lt papor over the remaining woc;d. deck. Rnstal9 g" 'whine tionlinum dripedge to the entire pev�ixaertec & dc►rntr�sa. 6. Instill 2r,, -yr. Certainteed I.0white asphalt shingles, eplor to he as close as pOzs6b�. 7. farticecce nail all abingles, a m ximum of b nails per shingle, due to high wind arei.:. h. Iv4O , new pipe collars an nCW flashings an tete dormer as atcededt. last011 a Loaka>mco 750 slsca,t bas:% exiigvat vent to rcplace than e:ciWng. [:erta►aRtftd matcbjng cads Oil top of the ridges &4'd hurricane hall. It. Disp p. of all debris ata liet tl Iveyeliatlig facility. 12. Morian CoarstrGOOO will warranty all labor for a perio.4 oft! Qyeam We lPropgsee berebto `misb materials and iabor, complete ire accordance with the above POOcetiotnsF For the su :oY; Vi , fite" 'I'ptoiD�t+d IDatiarv9 S15,000.00 �if1'1'iF c 3"Qt tipper r�atr darks rtauitt be'vIeatOW Of f to prevent damage while strlppiog the 1.: 4 as well as A.11 Items on the ground in khe rear grass area. AtTI1C3RI:f,F,li Si,G-NA'I'fT.[tE;���� ACCEPTANCE of p'Rojr0$AL: The Above prices. specil";a atiOns and conditions are satisfactory Ansi are her, a by aceepted. YOU Are atutiDa4rrza*d taa da tt�rll�li..: pecifled T 9 t i$ due peon completion. _ _ y�oatur�_ __._ �' ' , -nate �ecthvraaacl '�tt:yer�. /J,,.�.---�-•--`—A.- +� MA yoFOR CHOOSING MORGAN CONSTRUCTION ? Office of Consumer Affairs & Business Regulation :i HOME IMPROVEMENT CONTRACTOR Registration 137913 Expiration -12712011 Tr# 289660 Type.1fld v1, U. t A LAWRENCE E.MC}RON LAWRENCE Mbi�6AiJiJfi 86 BILLERICAAV,UNL-T_1., N.BILLERICA, MA Ot186 Undersecretary 4 ti'lassachusetts - Department of Public Safeti Board of Building Regulations and Standards Construction Supervisor License License: CS 79476 Restricted to: 00 i LAWRENCE E MORGAN JR 86 BILLERICA AVE UNIT 1 N BILLERICA, MA 01862at I Expiration: 6/3/2011 ( unmis�i ner' Tr#: 7458 OSHA 002329991 U.S. Department of labor Occupational Safety and Health Administration LARRY MDRCs.,4J has successfully completed a 10 -hour Occupational Safety and Health Training Course in Construction Safe & Health C - Lout S RoND�py 0SAUGr69 (framer) (Date) The Commonwetzlth of Massachusetts Department of Industrial Accidents Office of rnvesizgations 600 K'ashing-Mn Street Boston, M14 02111 Workers' Compensation Insurance WWW a B orlis licant Informatio>r� ers/Contractors/Electric;ians/Plumbers Name (Business/Orymiza6,n/lndividue): - Address: ��o 8kt City/State/Zip: 4� ©— Ll Are yo an employer? Check th — e appropriate box: I. I am a employer with1_ 4. ❑ I am a employees (full and/orpart-time).* 2. ❑ I am a sole have hirede� contractor and I the sub -contractors proprietor or partner- ship and have no employees listed on attached sheet $ working for me in any capacity. These sthe sub -contractors have workers' workers' comp: insurance comp. insurance. 5. ❑ We are a corporation reeqquired] • ❑ I am a homeowner doing all and its Officers have exercised their work myself. [No workers' comp. right of exemption per MGL C. 152 1 ' (4), and insurance required.] t we have no employees. [No workers' comp Ins Type of project (required): 6. ❑ New construction 7. ❑ Remodeling g• ❑ Demolition 9. ❑ Building addition 10-11 Electrical repairs oradditions I1.❑ Plumbing repairs or additions 12•❑ Roof repairs urance required.] I I3.❑ k O - ny Iicaut that hUL 15. �,: box fil must sLso uu ect Ecc se tion beto@+ noY L•, rt� Homeowners who submit this affidavit indicatin € r, a eu woiYws' com••� �"; t g the +are dein a. wort and r- roc r-oa 'Contractors that check this box must attached .n additional sheet showingthe tnen hire outside contractors must. submit a new affidavit indicating such. name of the sub-coauactors and their wrrrtr- • T.. _r_ - �••n-� vG� u"a cs proving workers' compensation insurance for my a -r 1---.y . Unnmoa. information. 11 Below is the policy and, job site Insurance Company Name: 14Ce e I S A *,t_ r �. Policy # or Self -ins. Lic. #. e y� Opel j$ Expiration Date: oZ I ( 0 Job Site Address: -j 0 t �1 V� Chi Attach a copy of the workers' compensation policy declaration sae sho ' CRty/State/Zip. Failure to th secure coverage as required under Section 25A of c 152ranwing pohcy number and expiration date). fine up to $1,500.00 and/or one-year imprisonment, as well as civil to the imposition of criminal Of up to $250.00 a day against the violator. Be advised that a co pees m the form of a STOP WORK ORD allies of a Investigations of the DIA for insurance covers v ce f a fine i? coverage err ication Py of statement may forwarded to the Office of `r" pauis alto penalties ofPerJury thrzt the information provided above [s true and correct U44e ,.. r JAA Of, ficial use only. De not x7*e in this area, to be completed City or Town: Issuing Autbority (circle one): L Board of Health 2. Building Department 6. Other Contact Person: by city or toNm official Permit/License # 3. C"y/Town Clerk 4. Electrical Inspector Phone #: 5. Plumbing Inspector Information an- d 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, associaLtion, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including t1he legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association og 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 mainteMmee, 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 slates 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 tate 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' comp ration 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 stere to sign and date the affidavit. The affidavit should be r„ tm-ned to the city or town that the aglication for the -remit or License is being reaues.: d, not the .Department. of Industrial Accidents. Should you have any, questions regardira.gg the law or if you are required to obtain a worl-,err' 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 p=nit/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 p=331its 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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office ofinvestigations would Ince 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-Bombes--.. The Commonwealth- of Massachusetts Depar ent Of Industrial Accidents Office .of Investigations 600 W ashmgrton Street Boston, MA 0.2111. Tel. # 617-727-4900 ext406 or 1-977-MASSA.FE Revised 5-26-05 Fay, # 617-72.7-7749 u��n�.mass.. Dov/din ACORD,. CERTIFICATE OF LIABILITY INSURANCE 0DATE 5/2MID) 05/26/20102010 PRODUCER (978) 686-2266 NORTH ANDOVER INSURANCE AGENCY, INC. M.J. FOSTER INSURANCE SERVICES 163 MAIN STREET NORTH ANDOVER MA 01845-2508 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED LAWRENCE MORGAN L.E. MORGAN CONSTRUCTION 86 BILLERICA AVE # 1 — BX 75 NORTH BILLERICA MA 01862— INSURER A: NORTHLAND INSURANCE CO. INSURER B: HANOVER INSURANCE CO. INSURER c:ACE USA INSURER O: INSURER E: 10(91T1774N ZZI 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD POLICY EXPIRATION DATE (MM/DD/YY) LIMITS A X GENERAL LIABILITY WS061979 04/13/2010 04/13/2011 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE FKOCCUR / / / / DAMAGE TO REN ED 100 000 PREMISES a occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: XT 7 LOC POLICY JECO PRODUCTS - COMP/OP AGG $ 2,000,000 B X AUTOMOBILE LIABILITY ANY AUTO AWN6529181 10/13/2009 10/13/2010 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ALL OWNED AUTOS SCHEDULED AUTOS / / / / BODILY INJURY (Per person) $ X X HIRED AUTOS NON -OWNED AUTOS / / / / BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ AGGREGATE $ OCCUR FICLAIMS MADE DEDUCTIBLE / / / / $ $ RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 045880618 12/14/2009 12/14/2010 X I UVCSTATU- OTH- TORYLIMITS ER E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE ]$ 1 , 000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS \.AM r -LLA I IUIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT TOWN OF NORTH ANDOVER FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1600 OSGOOD STREET INSURERTS AGENTS OR REPRESENTATIVES. AUTHOURRIZED REPRESENTATIVE NORTH ANDOVER MA 01845— O ACORD CORPORATION 1988 INS025 (Dios>.os Page t of 2