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HomeMy WebLinkAboutBuilding Permit #005-2017 - 40 SETTLERS RIDGE ROAD 6/30/2016 414y � BUILDING PERMIToNORTN q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: ()wlDate Received ° L�v AreDDate Issued: CHU$ � I ORTANT: Applicant must complete all items on this page LOCATION W (S Rd, to.aMm r Print PROPERTY OWNER 1 f int 100 Year Structure yes Qno MAP \ PARCEL: ZONING STRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROP SED USE Re ' ential Non- Residential ❑ New Building NOnefamily ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: 0 Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: C 1 ! Intif{iou I Please Type or Print Clearly C, OWNER: Name: Phone: wy) Address: ( y �vQ F Contra for Name: 6- one: _ onvpW DU Email: Address:AWJ \ cin e r ,q MR, 51RU-J— Supervisor's Construction License�u1q q1 �p Exp. Date: 6i 3-, 'n Home Improvement License: Exp. Date: f . a - ARCHITECT/ENGINEER N Phone: i 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: $ d D FEE: $ 10 — Check No.: G) Receipt No.: "3a6-70 NOTE: Persons contracting with unregistered contractors do not have ace s o the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swumning 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 O HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ti Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE.DEPARINENT - Temp;Dumpster on,:s-ite yes 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 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) �1 ❑ Notified for pickup Call Email r-�Date Time Contact Name Doc.Building Permit 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) O 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 recording must be submitted with the building application O Doc:Building Permit Revised 2014 iu Location No. ��� � � yl� Date �Iilo r • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ y r. Foundation Permit Fee $ Other Permit Fee $ '^ TOTAL $ Check# Building Inspector r I + OORTH Town of � ndover O(JW5 �A 2611 oh , ver, Mass, J(Ar*JCSA1(* L K E .�. C OC HIC H(WICK 7 RgTEO ISP ��5 s U - BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • THIS CERTIFIES THAT ,,,, ,,,, ,,,,,, l,.. BUILDING INSPECTOR .............................. 9. .. ...... .............. has permission to erect ................... buildin s on ...... , ;,,, .,� .. .,. Foundation Rough to be occupied as ....... ` Y ...... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST 10 TS Rough Service .. .... ....... . ....... .... ............. .............. Final It UILDING I PECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. PROPOSAL L.E. Morgan Construction Company We Accept: 86 Billerica Avenue.Unit#1 rWS4 " N. Billerica,iVIA.01862 Office: 978 670-4747/Fax: 978 670-6477 ` ` ROP SAL S-BMITT f PHONE DAT JOB NAME ITY,�S7tT A�N'O I CODE } \ JOB LOCATION fit} 5 A4'T ELL PllO 'HER ()� C JOB PHONE N Strip down to the wood deck, _,:2� layers of shingles, dispose of debris to a licensed recycling facility: Install —&-� ice and water shield at the gutters A feet of ice and water shield in valleys. Install synthetic underlayment on the remainder of the wood decking. Install $" aluminum drip edge on'all perimeters, color choices: ❑ White,A Mill, U Brown, ❑ Copper. Install year cF �f�` ?;�1i`� architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by to all ridges and dormers. Install new skylight flashing kits manufactured by 41k-)1A Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashingchimneys and install new lead flashing. � Install matching cap shingles_to all ridges, hips and dormers. WE PROPOSE hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: J wt t u� K—A dc,--e-A 4.-t-,4t e A�"3 /C.j - dollars($ r All material is guaranteed to be as specified.All work to be completed in a workmanlike �. t " 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 maybe 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 acceptance: ` slaeci�zcations and conditions are satisfactory and are 6 ::.= uthorized Signature: hereby accepted.You are authorized to do the work as specified.Payment will be made as.outlin.ed above. Authorized signature: Additional Remarks: SMgGLE COLO THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION Ae Commonwealth ofMasst�,chcesetts z. Department oflndlustrialAceiclents — t 1 Congress Street,Suite 100 Mid Boston,NIA.02114-2017 www.massgovIdla Workers'Compensation Insurance Affidavit:Builders/Contractors/Elgetricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information 'n Please Print Le bl Name(Business/organizationadividual):�, f 1 Address: "+ P City/State/Zip:'V Aseyon employer?Chec pp`ropriate box: Type of project(required): t em to ees full and/orpart-time).* 1. I am a employer with p y ( 7. 0 New construction 2. 1 am a sole proprietor or partnership and have no employees Working for me in 8. Remod_elirig any capacity.[No workers'comp.insurance required] El 3_❑1 am a homeowner doing all work myself[No workers'comp..insurance required.]t 9. 4.F1I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.C1 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. 13. , Roof These sub-contractors bade employees and have workers'comp.insurance.! ttinq , 60d 6.Q We are a corporation and ifs officers have exercised their right of exemption perMGL c. 14. Other 152,§1(4),and wehave no employees.[No workers'comp,insurance required] a: '".Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information i Homeowners who subs if this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 tave employees,they must provide their workeis'comp.policy number: { lam­ an employer that is p/•ovzding worfcers'compensation insurancefor my employees.'Below is the policy and job site information. \ Insurance Company Name: M, I C kj Policy#or S elf-ins.Lic.#: VP),_ Expiration Date:- b6n 3 OA : o `1 Job Site Address: W � I J �,, t-10le City/StatelZip. t" -do dVM 9 D j M Attach a copy of the workers'compensation policy decl ration page(showing the policy number and expiration(late). 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 of up to$250.00 a day against the •olator.A,copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage ve ' c on. Ido hereby e fy under•the pains and alties erj/u tl at the or ation provided above is true and corp ect V_A Signature: V Date: L . Phone#/7 Oft f i use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 19/17/2015 fR L%LERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE PRODUCER AND 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 NAME: BALDWIMWELSH PARKER INS PHONE FAX 131 COOLIDGE ST,SUITE#100 (AIC,No,Ext): (A/C,No): HUDSON,MA 01749 E-MAIL ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: PO BOX 75 INSURER D: NORTH BILLERICA,MA 01862 INSURER E: INSURER F: COVERAGES 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. LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY 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 E]PROJECT❑LOC ENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE is EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND tWCSTATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-15 12/14/2015 12/14/2016 X LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE N/A OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT $ 1,000,000 (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/LOCATIONSIVEHICLES/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 Z0,SUITE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR TA NORTH ANDOVER,MA 01845 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. i LEMORGA-01 BBOYER A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/14/2016 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. i 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 NAME: Welsh&Parker Insurance Agency,Inc./Hudson Office PHONE 131 Coolidge Street,Suite 100 (AIC,No,Ext):(978)562-5652 (ma Hudson,MA 01749 E-MAIL c,No):(978)562-7120 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 INSURER D: Billerica,MA 01821 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF IN 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 MMIDD/YYYY MMIDDNYYY LIMBS A X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 1,000,000 CLAIMS-MADE n OCCUR NPPS381520 04/13/2016 04/13/2017 DAMAG TO RENTED PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JEn LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 6230686 (Ea accident) S 1,000,000 ALL OWNED X SCHEDULED 10/13/2015 10/13/2016 BODILY INJURY(Per person) S AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE AUTOS S Per accident S UMBRELLA LIAR X OCCUR C X EXCESS LIAB CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 EACH OCCURRENCE 5 5,000,000 AGGREGATE S 5,000,000 DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N I A E.L.EACH ACCIDENT $ (Mandatory in NH) if yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I 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 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards &XI, Ccow,"nor vealtl a194&4saCXrdett,� - � Office of Consumer Affairs&Business Regulation License: CS-079HOME IMPROVEMENT CONTRACTOR9 Construction Supervisor � p Re istration: 137913 LAWRENCE E MORGAN,JR Type: Ex iration---M M.17 Individual '- ��� 100 IRON HORSE PARK LAWRENCE E. R# MORCCVR y' NORTH BILLECA MA 01862 LAWRENCE MORG41iAk,>._- u 100 IRON HORSE PARK.-- ---- .�n C�j BILLERICA,MA 01862 Expiration: Undersecretary Commissioner 06/03/2017 Ct.�tt° SnfotyaaHiivailfi- . . _ E .... ._ .•..•...--.__ __ KA l-¢a �Pe y tt This rand acknowledges thatthe rebipiect has sucoessfufiy cawldtei a U.,.Ue,1artn.�:::aE 30-fiour 0*0ational Safety-and Health Tralriing :; y��!'_c Course in Dcarr•aticnar Sarer� r ��— 31C Heattr dUiT'1 1�l Ccsns#nlction Safety and Health j i LARRY O 1 :J has successfull•*Com feted 2.iC�•[ �r p t P O:upa[ro.r f Safety an4 Neat!h Trti:ting Course rn ' i ( Corisiruction safety$Pedal DTj 3g -- �€6 t I u0ser narne-.Print or bipej ` 1ms N .(course snd€tate) A fate) f