Loading...
HomeMy WebLinkAboutBuilding Permit #354-2017 - 387 MASSACHUSETTS AVENUE 10/3/2016 i/ 0y ewL BUILDING PERMIT o� NORTF� q • A TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION H [O r O OPermitNoM all- R/7 Date Received 16 ` `3 - 9ot �SSACHus�( Date Issued: IMPORTANT: Applicant must complete all items on this page. LOCATION . `J 1M &S Print PROPERTY OWNER ,� Print 100 Year Structure yes no MAP PARCEL: vb ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building q One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others- ❑ Demolition 0 Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer �D .T TION OF WORK TO BE PERFORMED: O �} Identification, Pleas >Type or Print Clearly )) OWNER: Name: 3�jn e. V; Phone Address: Contractor Name-.Je 64 )Q 1Y 0 ffltVYJ11PhoM: 010 4�/bjt) q� Email: l Address: ` ( G' Supervisor's Construction Licenser:�c uiq q:3 L_Exp. Date: e- 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 S.F. O Total Project Cost: $ Q FEE: Check No.: SYO Receipt No.: 30 8 NOTE: Persons contracting with unregistered contractors do not have access 11111the guaranty u Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming Pools ❑ O Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 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 Wafter& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE:,DEPARfWM Ffd - TempiDu_mpster on }yes Located,at 1241Main%Street Fire,Departnient!ihnafure/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, rust or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA- (For department ease) �J ® Notified for pickup Call Email Date Time Contact Name -......... ----- — -- --- Doc.Building Pennit Revised 2014 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 O 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 OTE: 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 Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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 OTE: 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 recordin6 must be submitted with the building application ! Doc:Building Permit Revised 2014 I i Location 397 t'N M SS 4 V E No. ?SLI 20l'7 Date /0' 3 • A0A, w • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#S-yo y hc A V Building inspector i c10RTy Town of Andover o No. Z4i h ti � ver, Mass, CO[NIc"ICNl WK.f "�SDR'4TED NPR�.�S V BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT ............................: ....................................................... BUILDING INSPECTOR ........................................ has permission to erect .......................... buildings on ............................................................................. Foundation to be occupied asRough ................................ provided that the person accepting this permit shall in every respect conform to the terms of the application ......... ........... .................................................. Chimney on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR 1 Rough Service ...................... BUILDING.INSPECTOR. Final O cungnry Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises - D Rough o Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. [Burner PROPOSAL L.E. Morgan Construction Company We Accept: P.O. Box 75, 100 Iron Horse Park f Ills S4 r• * •� I N. Billerica,MA 01862 ------- : ast;;vs�c: Office: (978)670-4747/Fax: (978)670-6477 PROP ,SAL SjJ TTED TO •- PH9% 0 DATE <, f I/j1 ! t ,f C7 0 SS Y 6 JOB NAME Y,sill AND IP CODE JOB LOCATION ` . 0 • 5 CO TACT CELL PHONE OT ,1 • 3 P- CLwd)V, ON � 1 � Strip down to the wood deck, .2 layers of shingles, dispose of debris to a licensed recycling facility: Install IL ice and water shield at the gutters J feet of ice and water shield in valleys. Install synthetic underlayment on the remainder of the wood decking. Install 8" aluminum drip edge on'all perimeters color choices: kf White, Ll Mill, ❑ Brown, ❑ Copper. Install--f-,t> year he-K,%1 architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by to all ridges and dormers. Install new skylight flashing kits manufactured by /J-/A- Flash all cheek walls, pipes, skylights, 4nd penetrations to manufactures specifications. Remove existing lead flashing /c a /0, chimneys and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. WE PROP hereby to fur sh material and labor-com lete in`laccorda c with above specifications,for the sum of: rssz � y dollars($ � All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above Authorized Signature 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. ACCEPTED AS A CONTRACT-The above prices, Date of acceptanc - ' specifications and conditions are satisfactory and are ��'— •�''�� hereby accepted.You are authorized to do the work as Authorized Signature: specified.Payment w be tuned above. Authorized Signature: Additional Re rks: SHINGLE COLOR= THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION i The Commonwealth of lY.Massachusetts z. Department ofgndustrlalAcczdents I Congress Street,Suite 100 Boston,MA 02114-2017 ,R .... ,y.�. www.mass.gov/dia workers'Compensation Insurance Affidavit:Builders/Contractors/1llectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization&ftdividual): /rot, nc . .Address: n �fo,n fSe kj�� City/State/Zip: �� M� n. ane, —qq (,/ P�7_ Are a employer?Chec b ppropriate box; Type of project(required): 1. I am a employerwith t employees(full and/or parttime)i. 7. 0 New construction 2. I am a sole proprietor or partnership and have no employees working for me in 8. Remo delilig any capacity.(No workers'comp.insurance required.] 3.FJ I am a homeowner doing all work myself[No workers'comp..insurance required.]t 9. ❑Demolition 4.F1 am a homeowner and will be hiring contractors to conduct all work on my property- I will 10 F1 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing 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 einployee's and have workers'comp.insurance. 13. R f r s. , 6.Q We are a corporation and itq officers have exercised their right of exemption per MGL c. 14.. Other I 152,§i(4),and we have nq eglayees.[No workers'comp.insurance required.] , C'.Anyappl• icantthat checks box#!must also fill outthe section below showing theirworkers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such (Contractors 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-con actors have employees,they must provide their workers'comp..policy numbEr. i T am an employer that is piovz ' g workers'compensation insurance for my employees'Below is the policy and job site information. 2� Insurance Company Name: (It Policy#or Self-ins.Lic.#: S( KS Expiration Date- / lob Site Address- F � � L �w City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required 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 da a amst th 'olato .A y g A copy py of tlns statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ve ' tion- X do Hereby tify under thepains and per ties o�rjuty that e information provided above is true and correct. r( 1 -17 Si atur . r Date: lo. d:2) 2 Phone : C Of ci use only. Do not write in this area,to be completed by city or town official. Ci or Town: Peimit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Flectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CE LEMORGA-01 BBOYER RTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.1 HIS 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 CONTACT Welsh&Parker Insurance Agency,Inc./Hudson Office NAME: 131 Coofldga Street,Suite 100 PHONE FAX Hudson,MA 01749 (A/C,No,Ext):(978)562-5652 ArC,No):(978)562-7120 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 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 E: COVERAGESINSURER 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. INSR ADDLSUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY MM/DDIYYYY MMIDD/WYY LIMITS CLAIMS MADE n EACH OCCURRENCE S 1,000,000 OCCUR NPP8381520 04/13/2016 04/13/2017 PREM SES Ea occurrence) S 100,000 M ED EXP(Any one person) S 5,000 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ 1,000,00 POLICY PRO- F]LDC GENERAL AGGREGATE S 2,000,000 JECTOTHER: PRODUCTS-COMP/OP AGG S 2,000,000 AUTOMOBILE LIABILITY S COMBINED SINGLE LIMIT B ANY AUTO 6230688 (Ea accident) —j---1,000,000 ALL OWNED X SCHEDULED 10/13/2015 10/13/2016 BODILY INJURY(Per person) 5 AUTOS AUTOSNON-OWNED BODILY INJURY(Per accident) S X HIREDAUTOS X NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB XS OCCUR C X EXCESS LIAB EACH OCCURRENCE S 5,000,000 DED CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 AGGREGATE S 5,000,000 RETENTION$ WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY PER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N STATUTE ERH OFFICERWEMBER EXCLUDED? ❑ N/A E.L EACH ACCIDENT (Mandatory in NH) S If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below ' E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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 2035ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 7 AUTHORIZED REPRESENTATIVE ACORD 25(2014101) The ACORD name and logo are registered marks ACORD ACORD CORPORATION. All rights reserved. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1) rTHIS ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE O UCE D THE CERTIFICATE HOLDER .PORTANT: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 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 INS NAME: 131 COOLIDGE ST,SUITE#100 PHONE TFAX(A/C,No,Ext): No): HUDSON,MA 01749 E-MAIL 27KLD ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED L E MORGAN CONSTRUCTION INC INSURER A: AMERICAN ZURICH INSURANCE COMPANY INSURER B: INSURER C: PO BOX 75 INSURER D: NORTH BILLERICA,MA 01862 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATEDNUMBER:SION . 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. INSR ADD SUB LTR TYPE OF INSURANCEPOLICY EFF DATE POLICY EXP DATE L R POLICY NUMBER (MMIDDIYYYY) (MWDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ACH OCCURRENCE $ CLAIMS MADE M OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ POLICY F]PROJECT❑LOC ENERAL AGGREGATE 1$ AUTOMOBILE LIABILITY PRODUCTS-COMP/OP AGG Is ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT(Ea accident) SCHEDULE AUTOS BODILY INJURY $ (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EXCESS LIABCLAIMS-MADE EACH OCCURRENCE $ DEDUCTIBLE AGGREGATE $ RETENTION $ $ A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY Y/N UB-5B738312-15 12/14/2015 12/14/2016 X LIMITSATUTORY OTHER ANY PROPERITOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) It yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/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 rA ACORD 25(2010!05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts Department of Public Safety --- Board of Building Regulations and Standards a ��io�Oooy�nartcuecr�l/r.a�C/t%ja�s�cclu�e C L\ Office of Consumer Affairs&Business Regulation License: CS-079476 ('HOME IMPROVEMENT CONTRACTOR Construction Supervisor Re istration:;- - 9 >-137913 Type: o ,� Ex LAWRENCE Individual LAWRENCE E MORGAN,JR ` 100 IRON HORSE PARKi-=—= LAWRENCE E-MOkd-- lft. NORTH BILLERICA MA 01862 -__ J •_, `` t ; LAWRENCE MORGW =�; 100 IRON HORSE PARK. BILLERICA,MA 01862 Expiration: Undersecretary Commissioner 06/03/2017 ' SHA -5rsfoh'aint}tvYkfi _ --- :1 J1.t 3L/idakUsltaUoe" - _ =6 1 ------------------- Phis yard acknowledges that"fhe recipiei has'sifcaessfu(ly compld a l tS.rG,,3nn; �i",�, 30=Hour..OiiZvpational Safety and Health-rialningcoursein Occ;�acicnatSate anGHeat;! a„ C Gori*uotion Safe€y and Health LARRY MO has success(utty completed a t}F��r Oc:-iu -e-iprial i t r - - R�• Safeti and Health rtinmg Course n '• t 1 E Consn•uction Safety a N.awal ILI A. l 1 ramer name rfnt ar e 1 i�e ltrtfiJi . � P ) (Course enddate) 0SA Maher) } .Date} !