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HomeMy WebLinkAboutBuilding Permit #506-2017 - 31 LYMAN ROAD 11/14/2016r BUILDING PERMIT I� �IyA44 v V TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 50V— a01-7 Date Received - 0( 6 Date Issued: / I ` / L( - 0 b IMPORTANT: \ILOCATION PROPERTY OWNE Print MAP 1( PARCEL-09tZONING DISTRICT: Wq must complete all items on this Print 100 Year Structure yes no Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROP SED USE Res' ential Non- Residential ❑ New Building Vbne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Q Septic p Well ❑ Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Lo,rru Fele Phone: q9B�– Address: Contractor Name: PhGine: 1 V `'( 1 Email Address: fid \` V\A VM �1 X-121% ( . Yn Supervisor's Construction License: Uz�-N Exp. Date: Home Improvement License: I t Ilk 1 `:) Exp. Date: I. d 1 1 I ARCH ITECT/ENGI NEER_N Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED O�A"" S.F. Total Project Cost: $�nt�� FEE: $_ Check No.: Receipt No.: NOTE: Persons contracting_2vith unKgistered contractors do not have accessIth the guaranty fqd 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 C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 0 ap Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products IOTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products TE: 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 recordg must be submitted with the building application Doe: Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ; ❑ Taming/Massage/Body Art ❑ SwuzmmRg Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑. Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN - F - PLANNING & DEVELOPMENT Reviewed On _ Signature COMMENTS CONSERVATION Reviewed on Signature P 'COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town ]Engineer: Signature: FIRED ,- - Located Y384 Osgood Street h EP�IRTMEIVT Temp ®urnpstergntsite° ►yes .. o ,Located at`24Main�treet FretD'epartmentsgnature/date :, Dimension 0 Number of Stories: t ries. 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.$1oo-$1000 fine Doc.Building Permit Revised 2014 M Location -S/ / �M.41r � b No. sod Po ! -7 Tj Check #� 31175 Date //— 1 ''/ -d 0/ lv TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ (� ! Building Inspector 0 C � 0 0 CD Q �• y � cc -v 00 , 0 vCD o Q� = cr CD m 0 000 Io CD y• c0•O cCDD I � v O "a z CD 0CD0 CD Z! '3 O r O Z O_ CD N O _O O� to O Q cc. CD cc c 2. o='ao a) z < (o N N � �.0 0 m 0 0 Q- C.) m N O 0•.F Q 0 m -„ y W 0 t0/► p CD CD 2 7 C O C7 co CL O '� ? O p� O < CQ o,=� :z CD♦ O 0' c D CD U)CL 0 Q :O C O Q = <N� OCD CD O CD CL CD � rt0 SO NOW o :1'Rib cc s o� CD �- N cD N o' a 0 ft 2)o C O 1 J Lo p 77 rD Mm rD rD * Z o C z m m zQ Z :io C- Do S G) H VZ 0 T v N rD X C DQ S �� T 07 .o C Da rte„ c W m T N (') S m .Z7 C Da S T C Q v r+ O p c'. G Z m 0 N 'O to (D T O a S CD 3 O O T m D i nm O� z 0 cn �m C Cl) Z ic .00 —.� n� cn v z 0 0 O r O Z O_ CD N O _O O� to O Q cc. CD cc c 2. o='ao a) z < (o N N � �.0 0 m 0 0 Q- C.) m N O 0•.F Q 0 m -„ y W 0 t0/► p CD CD 2 7 C O C7 co CL O '� ? O p� O < CQ o,=� :z CD♦ O 0' c D CD U)CL 0 Q :O C O Q = <N� OCD CD O CD CL CD � rt0 SO NOW o :1'Rib cc s o� CD �- N cD N o' a 0 ft 2)o C O 1 J Lo p 77 rD Mm rD rD * Z o C z m m zQ T N :io C- Do S G) H VZ 0 T v N rD X C DQ S r n c1 'mv -� 0 T 07 .o C Da rte„ c W m T N (') S m .Z7 C Da S T C Q v r+ O p c'. G Z m 0 N 'O to (D T O a S CD 3 O O T m D i Aft MW C 1� L.E. Morgan Cmnstruaio' n Comp ill We Accept 86 Billerica Avenue. Unit #1 4 iN. Billerica, .-i1A 01862 Office: (978) 670-4747 /Fax: (478) 670.6477' ice Strip down to the wood deck, layers of shingles, disposA' of debris to h licensed recycling facility: Install .b` ice and water shield at the gutters _3 feet of ice and water shield in valleys. Install synthetic underlayment on the remainder of the mood decking. Install 8" aluminum drip edge on'all perimeters, color choices: White, 0 ME, 0 Brown, 0 Copper. Installvro year architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by 6 v` ti to all ridges and dormers. Install new -skylight flashing kits manufactured by /-'/,a Flash all cheek walls, pipes, Skylights, and penetrations to manufactures specifications. Remove existing lead flashing ;/41 /0 chimneys and install.. new lead flashing. Install matching cap shingles to all ridges, hips and dormers. WE PROPOSE hereby to.furnish.material and labor - complete in accordance with above specifications, for the sum of tA-S� dollars All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized Sips ' / �— ! manner according to standard practices. Any alteration or deviation from above -��— specifications involving extra costs will be executed only upon written orders, and will ro become an extra chNote. This proposal may arge over and above the estimate. Our workers are fully covered p p S be'vithdrawn by Workmen's compensation Insurance and Liability Insurance. by us if not accepted within flays. ACCEPTED AS. A CONTRACT -The above prices, � Date of acceptance: IV A' specifications and conditions are satisfactory and are J` _authorized Signature: hereby accepted. You are authorized to do the work as T specified. Payment will be ma ve, Authorized signature: Additional Remarks: . 1rXT A xrrrvrt>iT VnR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth ofidassachusetts Department ofIndustrialAccidents ' = _ X Congress Street, Suite 100 Boston, MA 02114-2017 - F s� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Ele etricians/Plumbers. TO BE FRED WITH THE PERMITTING AUTHORITY. Naille (Bu1siness/Organizatiton/1'zidividual :1,_.L - Address: 1r . , Address: `1� () 1 To i1 C4_' City/State/Zip: Are an employer? Checker ppropnate pox: Type of project ()required): 1. I am a employer with • UY � employees (full and/or part-time).* 7. Q New construction 2. Q I 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. Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] 4. Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition ensure that all contractors either have workers' compensation insurance or are sole 11. Q Electrical repairs or additions proprietors with no employees. 12• V'br bing repairs or additions 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp, ins urance.t 13. re r 6. ❑ We area corporation and ifs officers have exercised their right of exemption perMG1, c. 14. 152, § 1(4), and we have no a rtployees. [No workers' comp, insurance required.] *Any applicant that checks b6x41 must also fill out the section below showing their workers' compensation policy information. Homeowners who suiimit this affidavit indicating they are doing all work and then hire outside contractors niust submit a new affidavit indicating such- TContractors that check this box must•aitached an additional sheet showing the name of the sub -contractors and state whether or not those entities wave . employees. If the •sub- co' n`u-actors have empIoyee' s' ,' iey must provide their workers' comp..poficy number: -: { Tai'' an employer that is pi•ovidlhg worriers' compensation insurancefil my employees ' Below is•the policy and job site information. Insurance Company Name: VV1 Y l W Policy # or Self -ins, Lic. #: b6 iration Date: 1 .� `� • W Job Site Address: �� City/State/Zip: 0\.nd Attach a copy of the worr,' compensation policy declaration page (showing the policy number and expiration a Failure to secure coverage a equired under MGL c. 152, §25A is a criminal violation punishable by a fine 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 ofup to $250.00 a day against thelator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance Y do the ( information provided a pbve is rue and correct. tiatP• / � only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense # Issuing Authority (circle one): i 1. Boar. of Health 2. Building Department 3. City/'Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: CE LEMORGA-01 BBOYER CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDfYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 4PON THE CERTIFICATE HO /14/2016 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR L TER RIGHTS 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 CONTACT Welsh & Parker Insurance Agency, Inc. / Hudson Office NAME: 131 Coolidge Street, Suite 100 PHONE FAX Hudson, MA 01749 (AIC, No E'�): (978) 562-5652 (AJC, Na). (978) 562-7120 INSURER(S) AFFORDING COVERAGE NAIC # JNSURED INSURERA: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 E: COVERAGES INSURER F CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN rico TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE n OCCUR I GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JET n LOC a OTHER: AUTOMOBILE LIABILITY B ANYAUTO ALL OWNED kX SCHEDULED AUTOS AUTOS XHIREDAUTOSNON-OWNED UMBRELLA LIAB X OCCUR C X EXCESS LIAB CLAIMS MADE DED RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y f N OFFICERIMEMBER EXCLUDED? ❑ N / A (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NPP8381520 6230688 XLS0099346 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Rem NORKERS COMPENSATION CERTFICATE OF LIABILITY WILL BE SEI C Town of North Andover 1600 Osgood Street, Bldg 20, Suite 2035 North Andover, MA 01845 REVISION NUMBER: PERIODS CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOLWHICH AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT THIICY TO ALL MAY HAVE BEEN REDUCED BY PAID CLAIMS, THE TERMS, NUMBERMIONffDDDYJYYYY MOMfLDIDEXP LIMITS EACH OCCURRENCE $ 1,000,000 04!13/2016 04/13/2017 AM GE TO NTED PREMISES (Ea occurrence) 5 100,000 MED EXP (Any one person) S 5,000 S 1,000,000 PERSONAL 8 ADV INJURY GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG S 2,000,000 S COMBINED SINGLE LIMIT (Ea accident) S 1,000,000 10/13/2015 10/13/2016 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident S S EACH OCCURRENCE $ 5,000,000 04/13/2016 04/13/2017 AGGREGATE $ 5,000,000 S PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE S S E.L. DISEASE -POLICY LIMIT irks Schedule, may be attached If more space Is required) IT DIRECTLY BY THE CARRIER. vr.,�va-VL,/1 I IVtV 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ® CERTIFICATE OF LI TNA -CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, E THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTF . PRODUCER. AND THE CERTIFICATE HOLDER ,_,PORTANT: If the certificate holder is an ADDITIONAL INSURED, the p the terms and conditions of the policy, certain policies may require and the certificate holder in lieu of sur_h PRODUCER BALDWIMWELSH PARKER INS 131 COOLIDGE ST, SUITE #100 HUDSON, MA 01749 27KLD INSURED L E MORGAN CONSTRUCTION INC PO BOX 75 NORTH BILLERICA, MA 01862 COVERAGES CERTIFICATE NUMBER: ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTL"' ICU bt:LUW HAVE BEEN ISSUE1 RACT OR OTHER DOCUMENT WITH AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUS PAID CLAIMS. LTR I TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE 0 OCCUR. GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY M PROJECT ❑ LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULE AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB OCCUR EXCESS LIAB M CLAIMS -MADE DEDUCTIBLE RETENTION $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY Y/N ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? M N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below POLICY NUMBER UB -5B738312-15 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITI THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFE HOLDER I V W N OF NORTH ANDOVER 1600 OSGOOD STREET, BLDG 20, SUITE 2035 NORTH ANDOVER MA 01845 26 name and logo are registered marks of A ABILITY INSURANCE1 DATE (MMIDD/YYYY) 19/171201 IS AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS XTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE olicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to endorsement A statement on this certificate does not confer rights to CONTACT NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E-MAIL ADDRESS: SURERS) AFFORDING COVERAGE NAIC # MERICAN ZURICH INSURANCE COMPANY F REVISION NUMBER: TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE ONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY OLICY EFF DATE POLICY EXP DATE (MMIDMYYYY) (MrMDDIYYYY) LIMITS EACH OCCURRENCE $ DAMAGE TO RENTED $ REMISES (Ea occurrence) MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ ENERALAGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE $ LIMIT (Ea accident) BODILY INJURY $ (Per person) BODILY INJURY $ (Per accident) $ PROPERTY DAMAGE (Per accident) EACH OCCURRENCE $ $ AGGREGATE 12/14/2015 12/14/2016 X LIMITSATUTORY OTHER E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 1,000,000 fMS `TING WORKERS COMP COVERAGE. CANCELLATION 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 REPR TA %Y! ;� - rnRn --- -- • - --jr— 1 rvn. AH rlgnts reserved. V. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -079476 Construction Supervisor LAWRENCE E MORGAN, JR 100 IRON HORSE PARK NORTH BILLERICA MA 01862 �zzx- &'-- Expiration: Commissioner 0610312017 Plis card aknowfed ges thatthd re-tipidrif hot taddds!#dy dbffipjd*ff 3M - 0 0c- con*p t-'ruotion Safety and Health (lralnarnarne-.Printar'bMe) CF211 Office of Consumer Affairs& Business Regulation OHOME IMPROVEMENT CONTRACTOR Registration:,,�`)37913 Type: Zi. Expirations.-� �-17 Individual LAWRENCE E. MORGANMR LAWRENCE MORGANW—t' 100 IRON HORSE PARK BILLERICA, MA 01862 Undersecretary OS -HA LARRY MORN has E;uCcLSVfU111,' cornphNed,-. onatSafej%, Trp.infng ('Our --e m Cbnb-tMGU0'11 Safety api�&. LAJI V5 0SAU&69