HomeMy WebLinkAboutBuilding Permit #542-12 - 39 FARRWOOD AVENUE 1/11/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: � / 2 Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION I �C—CW Qq.D0. . A nn y
Print
PROPERTY OWNER
qe
('�7 � q (n Unit #
` f6 Print
MAP NO: `7' J PARCEL:2� ZONING DISTRICT: Historic District yes Q
Machine Shop Village yes -0
100 year-old structure yes 40
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
W00 e family
ElAddition
o or more family
❑ Industrial
❑ AI eration
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
11 Other
-- .. - . _ .. -
` DaS-eptic ❑'W.ell'
❑ Floodpl'ain. :Wetlands
�. Watershed�Distrct
El-Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
New ArdniTecn ft -a L Fk--nh-se-,
(Identification Please Type or Print Clearly)
OWNER: Name: ,� e C'��,Uyr►, ivn�. Phone: :3`?�
Address: 31 �;n tr�rsk PA d u�& ,, ,. AU A in,„�,„ h,,M,l
CONTRACTOR Name: JINg,r`c, a,,/\ �,na — c i i Phone: q ?Y—(Q20 -
�.
Address: (V,,Ar. I lltO 0 (,'(. ;t -
Supervisor's Construction License:E,)Exp. Date: 3
Home Improvement License: j3'7 11-3 Exp. Date: JA 7/13 _
ARCH ITECT/ENGINEE
Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $ (90 FEE: $ oc)
Check No.: 7Receipt No.: 2
NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund
-Sianafure.of+
&- natuaof4dent/,Owner .-: --conftantorr
Location—S,q—
No. S—�/2 - �z Date /
NORTIi TOWN OF NORTH ANDOVER
• C
•
a ; , Certificate of Occupancy $
s�cMus s� Building/Frame Permit Fee $ /��l' ao
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # e15,e7j
rj
r �
2 4 5 `; v Building Inspector
A
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer 11'
Tanning/MassageBody 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 Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Com
Conservation Decision: Co
= Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/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, mast or servicedroprequires approval of
Electrical Inspector Yes
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc:.Building Permit Revised 2011 June/mi
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
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: Doc.Building Permit Revised 2008mi
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The Commonwealth of Massachusetts
Department oflndustrial.Accidents
Office oflnvestigations
600 Washington Street
Boston, MA 02111
S`
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/ContractorsfFIectricians/Plumbers
mlicant Information _ •_.
Name
Address:$� (l`l� tI.
City/State/Zip: Pho#:
� 1$C,�.-- ne
ArePOan employer? Check the appropriate box:
1 • L`7 I am a employer with 9
4. ❑ I am a general contractor and I
2. ❑employees (full and/orpart-tune).*
I am a sole proprietor or
have hired the sub -contractors
listed
partner-
ship and have no employees
on the attached sheet. t
These sub -contractors have
working for mein any capacity.
[No workers' comp. insurance
workers' comp, insurance.
5. ❑ We ale a corporation and its
;. ❑required.]
I am a homeowner doing all
.officers have exercised their
work
myself. [No workers' comp.
right of exemption per MGL
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp, insurance re fired
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demblition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roofrepairs
qu ]
JL
affidavit Homeowners who submit this
13.[:] Other I
*Any applicant that checks box a f cti
fidavit indicmust also fill out these below showing their workers' compensation policy information.
ating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information.
I am an employer that is providing workers' compensation insurance for my
information. employees th
Below is e policy and job site
Insurance Company Name: 5r r
Policy # or Self -ins. Lic. #: W C O',?o 4 24 7
Expiration Date: /2 �/�•/� t -z
Job Site Address:_ �Q- N a ,�i NQ ,
Oity/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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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
Of up to $250.00 a day against the violator. Be advised that a copy ofthis statement maybe forwarded to the Office of
Investigations of the DIA, for insurance coverage verification.
I do hereby certi under the pains andpena[ties ofperjury that file information provided above is true and correct:
Si nature: ••
"JJrclar use only. Do not write in this area, to be completed by city or town official.
City or Town:
Permit/LiePn.qP n
Issuing Authority (circle one):
I. 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 apartinents 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 ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have beenpresented to the contracting authority."
Applicants
PIease fill out the workers; compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), addresses) 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/licease applications in any given year, need only submit one affidavit indicating current
policy information (ifnecessary) 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. Anew 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 Commorcweattli off Massac'lalisetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston} MA, 42111,
Tel. # 617-727-4900 ext 4406 ox 1-877-1ASS,FE
Revised 5-26-05 Fax # 617,727-7749
Www.mass.gov/dia.
12.1.27,`2;-111 11:47 97BES50521 AF, INITY 'EALTY
lL..E. MORGAN CONSTRUCTION CO.
P.O. Sox 75, 86 Billerica Avenue, Unit #1
L4 i\!. Billerica, NIA 01862
Office: 978-670-4-747 - Fax: 9178-61-0-6477
PROPOSAL
submitted To: Aff rsity Realty Management
Address: a9 hear Farrwaod Rd.,
( Clubhouse )
N. Andover, MA 01845
Date; December 7, 2011
Cell / Fad.: 978-37&9687 /'978-685-0521
Job Site: Heritage Green Condominiums
33-48 Farrwood Rd., N. Andover, MA
WE HEREBY submit our proposal for the following scope of work;
Approx. 5,067 square Feet
1. Remove the existing shingles dawn to the wood deck and dispose of off- site.
1. IrEstali 6, of ice & water shield at the leading edges and 3' in the darner valleys.
3- Install 15 iia. felt paper to the remainder of the wood deck.
4.. install r white aluminum drip edge to the entire perimeter & mechanically fasters.
S. Install Certaiisteed Swiftstart shingles as beginning course.
6. Install Certainteed Landmark Silver 0imb architectural shingles & hurricane nail.
7. Install new pipe flanges & attic vents.
Ib. Install new !ead on the chimneys as needed.
9. In.wtall new ridge vent as needed.
10. install matching cap shingles. �
O
WE propose hereby to furnish materials & labor, complete inaccordance �idith the above
specifications, for the
sure of,• fifteen Thousand Six 1-lundred Twenty Dot, ars: � 15,620.00
AUTHORIZED SIGNATURE l,4`*�.��-� [l
Lawrence E.
ACCEPTANCE of PROPOSAL., The above prices, specifications +& conditions are satisfactory and
are hereby accepted- You are authorized to do the work as specified -
AUT DXrE_
Ai.l'; NJc3R1ZFla i.Sl1YE,17_�_-----------�._....—.______.
THANK YOU FOR CHOOSING MORGAN CONSTRUCTION
- �:J r
r�
Ths card ackr�ledges that the recgaent has suocesstuliy romrieted a
30 -hour Occupation' Safety and Healm Traimng Course in
Construction Safety and Health
/AAi
i Trainer name - pnrt or ty-,del (CO.— —d date)
f MOBILE EOUIPMEM
Q5''fl OPERATOR CEPTIFICATE
.V
LARRY !"10RGA�J Loki
...,�-
�RICt�4$-�TcS
LanS Roc-tDEAu F o5acxstA, Tka�UNj IN U2ei� �JHe
Office of n u=A fit & BJsint��itegulaf
HOME IMPROVEMENT CONTRACTOR
Registration: 137913 Type:
Expiration: 12712013 Individual
LAWRENCE E. MORGAN JR.
LAWRENCE MORGAN JR.
86 BILLERICA AVE UNIT 1
N.BILLERICA, MA 01862 Codersecretary
Massachusett. - Department of Public `afcth
Board of Buildin_ Reuulations and Standard.
Construction Supervisor License
License: CS 79476
LAWRENCE E MORGAN JR i^
86 BILLERICA AVE UNIT 1
N BILLERICA, MA 01862
Expiration: 6132013
( .anmi��ioner Tr#: 16354
i4!'<'l 2 7'1 11:47 97SE85a521 AFFINITY REALTY P4iE N"!OS
S - _ L.E. MORGAIN CONSTRUCTION CO.
PO. Box 75. 86 Billerica Avenue, Unit #1
0-1 N. Billerica, NIA 01862
Office: 978-670-4747 Y Fax: 978-670-6477
PROPOSAL
Submitted To: ,%frinity Realty M311agemr nt
Address: 39 hear Fanwood Rd.,
( Clubhouse )
N. Andover, MA 61845
Date, December 7, 2611
Cell / Fax: 978-376.96871978-585-13521
Job Site: Heritage Green Condominiums
39-41 Farrwood Rd., N. Andover, MA
WE HEREBY submit our proposal for the following scope of worm.;
Approx. 5,067 Square Feet
1. Remove the existing shingles down to the wood deck and dispose of off- site.
2. install 8' of ice & water shield at the leading edges and 3' in the dormer Valleys.
3- Install 15 ib. felt paper to the remainder of the wood deck.
d. install r white aluminum drip edge to the entire perimeter & mechanically fasten.
S. In!, -tall Certainteed Swis'tstart shingles as beginning course.
5. Install Certainteed Landmark Silver Birch architectural shingles & hurricane nail.
7. Install new pipe flanges & attic Vrr_nts.
a. install new !ead on the chimneys as needed.
9- ln;tall new ridge Vent as needed.
10. Install matchir*g cap shingles.
WE propose hereby to furreislt materials & iabor, complete in accordance,kith the above
spe fications, for the sum Ot. Fifteen Thousand Six Hundred Twenty Doll` s: $15,626.3(3
Lavwrence E.
ACCEPTANCE of PROPOSAL., The above prices, specifications & conditions are =_atisfacto" and
are hereby accepted- You are authorized to do the work as specified.
AUTHORIZED SM SIGNATURE ----DATE-
THANK
------DATE„TH NK YOU FOR CHOOSING MORGAN CONSTRUCTION
1/9/2012 12:22 PM FROM: Foster TO: 1-978-670-6477 PAGE: 002 OF 002
ACORN CERTIFICATE OF LIABILITY INSURANCE
FOATE (1/09/2/201212
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CER71FICATE 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
CONTACT
NAME:
NORTH ANDOVER INSURANCE AGENCY, INC.
M. J. FOSTER INSURANCE SERVICES
163 MAIN STREET
PHONE
0. Est (978) 666-2266 " (978) 686-6910
(A2, No):
ADDRESS: cfernandez@nafins.com
PRODUCER ) 1org an Construction
CUSTOMER p
NORTH ANDOVER MA 01845-2508
INSURER(S) AFFORDING COVERAGE NAICi
INSURED
Morgan Construction
PO Box 75
INSURER A :S . H . SMITH 6 COMPANY, INC. .
INSURER a :SAFETY INSURANCE
INSURER c :STAR INSURANCE
INSURER D :SCOTTSDAIE INSURANCE
9/13/2011
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.
NSRTYPE
LTR
OF INSURANCE
OL
NSR
U
WVD
POLICY NUMBER
POLICY EFF
(WNDDIYYYY)
POLICY EXP
(M WDDNYYY)
LIMITS
A
GENERAL LIABILITY
Y
BC10000241200
9/13/2011
9/13/2012
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
/ /
/ /
PREMISES Ee oCCURence $ 100,000
CLAIMS�JIADE OCCUR
MED EXP (Any one person) $ 5,000
/ !
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
! /
/ !
}{ POLICY PRO VT FLOC
/ /
! !
B
AUTOM0131LE
LIABLITV
5215111
0/13/2011
0/13/2012
COMBINED SINGLE LIMIT$
1,000,000
ANY AUTO
/ /
/ /
(Ea aocidenl)
BODILY INJURY (Per person) $
ALL OWNED AUTOS
/ /
/ !
BODILY INJURY (Per socidert) $
xSCHEDUIEDAUTOS
/ 1
/ 1
PROPERTY DAMAGE
$
X
% !
HIREOAUTOS
/ !
(Per acddern )
X
NON-OVVNEDAUTOS
I 1
/ 1
$
$
D
X
UNBRELIA UAB
X
OCCUR
LS0071751
1/07/2011
4/13/2012
EACH OCCURRENCE $ 5,000,000
EXCESS LIAR
CLAIMS -MADE
/ /
/ /
AGGREGATE $
DEDUCTIBLE
$
/ /
/ /
RETENTION $
/ /
/ /
$
C
WORKERS COMPENSATION
C0709247
2/14/2011
2/19/2012
VVC STATU- OTH-
AND EMPLOYERS' LIABILITY
YIN
I TORY LIMITS I FP
EACH ACCIDENT E.L.OFFICEPAAEMSER
$ 1,000,000
ANY PROPRIETORtPARTNER/EXECURVE
EXCWOED7 El
NIA
(Mandatory in NH)
! /
/ /
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes. describe under
DESCRIPTION OF OPERATIONS below
/ /
E.L. DISEASE -POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS ! VEHICLES (Attxh ACORD 101, A"ti* MI RM"s SehNUle, It mots spaee is require!)
CERTIFICATE HOLDER rANCFI I ATInN
(978) 688-9545 (978) 688-9542
TOWN OF NORTH ANDOVER
1600 OSGOOD STREET
NORTH ANDOVER MA 01845 -
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
t ....... 1 v 1999-2009 ACORD CORPORATION. All rights reserved.
INS025 (200909) The ACORD name and logo are registered marks of ACORD