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HomeMy WebLinkAboutBuilding Permit #490-16 - 432 JOHNSON STREET 10/16/2015JICANNev /0/ Permit No#: * — Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I ` / ' RTANT: Anblicant must comblete all items on this baize I LOCATION o f.air, PROPERTY OWNER 1�" I Print MAPPARCEL: ZONING DISTRICT:® f+ne-L 100 Year Structure Historic District Machine Shop Villa yes no yes no ves no TYPE OF IMPROVEMENT PROPOSED USE Resid tial 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 ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer OWNER: Name: Address: Contract Email: 1, Address: DESCRIPTION OF WORK TO BE PERFORMED: Phone mom Supervisor's Construction License Yo `�� Exp. Date: (. �, �� Home Improvement License: Exp. Dater ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt 9ve NOTE: Persons cont" ctin with un�e iste>"ed contractors do not hacceo the uaran. nd g gg fY ,Signature of Agent/Owner- Signature of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiumning Pools ❑ 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 Siqnature COMMENTS HEALTH Reviewed on Siqnature 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: FIRE DEPARTMENT - Temp Dumpster onsite yes_ Located at 124�Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no. 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) ❑ 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 ❑ 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 a 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) ❑ 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 a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 2014 Location 22Tokf1 A .Sl No.44 '4�r Date 1% �o Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee 1�r Foundation Permit Fee $ Other Permit Fee TOTAL $ 93j�- Building Inspector `J jt9—*E: 41* r L = 0ZQ m C C u ++ 'O 0 O LL E v h0 cn u -z'C CL 41 (n 0 o N z > m C: } Z3 O LL t t O K A c E L U C LL O F N z > 0- s bD MO O C C LL 0 u z z u u W w t Op O d' • j v (n m C LL cc u z C7 Lto O Q' C LL W iy ai m O z N Y Ln O O v CL a) C� w c M u E a c E O ZM " Oi Q' F h `'' ANG O QCts d m a > r Cc G1 N CD O _ cp p O +r s s c c L Z tm - N O O d O a AQ�.y 3 a� Me-, 'S asp m m c O Ns O C� m N cn W C 'a +�'+ O O LL O ~' H N C O a .Q O V �• Z Lu Li d O-0 O Q NFE d>N J U) .a c c Z G CD Z Cl) w CL W C� G W a 0 W :a c7 J m Vn V 0 V J M v v O E � O O Z �(�1/)� Q Y/ • O �+ 0 0 CL s � Q O v_ J �CL0}; � Z O V N ca � CL PROPOSAL L.E. Morgan Construction Company 86 Billerica Avenue, Unit #1 N. Billerica, MA 01862 Office: (978) 670-4747 / Fax: (978) 670-6477 0 0 We Accept: V Strip down to. the wood deck, —,E layers of shingles, dispose of debris to a icensed recycling facility Install ice and water shield at the gutters 3 " feet of ice and water shield in valleys `r Install 8" aluminum drip edge on all perimeters, color choices: 0 White, ❑ Mill, ❑ Brown, ❑ Copper. Install asphalt saturated /5 lb. felt paper on the remainder of the wood decking. ("jaiy)t ,")2 architectural asphalt shingles, and hurricane nail. Install Jam© year g Install ridge vent manufactured by AAX to all ridges and dormers. Install new skylight flashing kits manufactured by '&Id Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing on 106104&0 rrh_ _ v 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 a sum of: do Lars ($,�, 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 l'/J become an extra charge over and above the estimate. Our workers are fully covered Note: This proposal may be with 'mwil by Workmen's Compensation Insurance and Liability Insurance. by us if not accepted within} days. ACCEPTANCE OF PROPOSAL -The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Additional Remarks: Date of acceptance: �i Authorized Signature: - b THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth of Massachusetts Department of IndustrialAccidents y d 1 Congress Street, Suite 100 t Boston, MA 02114-2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Name (Business/Organization/Individual) r YJ f V ' Address: & n iT hjo �-)v City/State/Zip: i P o �Da� qT Are you ploye r? Check t appropriate box: Type of project (required): :1. 1 am.a employer with employees (full and/or part-time).* 7. ❑ New construction 2. ❑ 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. El Demolition 3. F1I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ 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 ll.FJ Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5. ❑ I am a general contractor and 1 have hired the sub -contractors listed on the attached sheet. 13. rep ' s These sub -contractors have employees and have workers' comp. insurance.# i 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 14. Other 1 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. lam an employer that ispro ' ing workers' compensation insurance for my employees. ' Below is thepolicy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: Vp City/State/Zip: At, 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 of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veration. Ido her y1C4,JtL4VW rtifyunder thepain ndp ties ofperjuty d t he information provided ga�bov is tru and correct. Sianatur (r /l�� �i Date: IV / ) 5 use only. Do not write in this area, to be completed by city or town official. or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: V CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 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. [4,46TnIFICATE 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(les) 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: PHONE FAX BALDWIMIA"ELSH PARKER INS 131 COOLIDGE ST. SUITE #100 (AIC, No, Ext): (AIC, Nog E-MAIL ADDRESS: HUDSON, MA 01749 27KLD INSURER(S) AFFORDING COVERAGE NAIC 1r INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: 1 INSURER C: PO BOX 75 NORTH BILLERICA, MA 01862 ( INSURER D: 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD L SUB R POLICY NUMBER POLICY EFF DATE (MMIDMYYYY) POLICY EXP DATE (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 1$ COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR. DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) S GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL & ADV INJURY IS GENERAL AGGREGATE S POLICY PROJECT ❑LOC PRODUCTS - COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS BODILY INJURY S SCHEDULE AUTOS (Per person) I BODILY INJURY I$ HIRED AUTOS NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB 8 OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE g DEDUCTIBLE S RETENTION S IS A WORKER'S COMPENSATION AND EMPLOYER'S LIABILITY YIN UB-513738312-14 12/14/2014 12/14/2015 X [WC STATUTORY LIMITS OTHERI ANY PROPECERIME BER EXCLUDED? OFFICERIMEMBER EXCLUDED? � NIA E. L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS belrnv E.L. DISEASE - EA EMPLOYEE IS 1,000,000 E.L. DISEASE- POLICY LIMIT IS 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOAST OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST, BLDG 20, STE 2035 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED REPR7�TA`�-_-- AL:UKU e5 (ZU1 U/Ub) 1 ne AGUKU name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER 14� R" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDtYYY1� 717/2Q15 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 1S 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 Welsh &Parker insurance Agency, Inc. / Hudson Office 131 Coolidge Street, Suite 100 Hudson, MA 01749 CONTACT NAME: PHONE FAX JV No Ext :(978) 562-5652 AIC No : {978) 562 7120 E-MAIL ADDRESS• INSURER(S) AFFORDING COVERAGE NAIC # X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Contractual Liabilit INSURER A: Western World Insurance Company INSURED INSURER B :Safety INSURER C:Scottsdale Insurance LE Morgan Construction Inc INSURER D: PO BOX 75 Billerica, MA 01821 INSURER E: INSURERF• L:UVtKAUtS CERTIFICATE NUMBER! RFVlclnu Idl IMRFR• 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_ INR LTR TYPE OF INSURANCEADDLSUSR INSD WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MWDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X Contractual Liabilit NPP8237995 04/1312015 04/13/2016 EACH OCCURRENCE S 1,000,000 PREMISES Ea o CUC soca 5 100,000 MED EXP (Any one person) 5 5,000 PERSONAL & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- JECT LOC GENERAL AGGREGATE 5 2,000,0100 PRODUCTS-COMP/OPAGG S 2,000,000 S OTHER: AUTOMOBILE LIABILITY ANY AUTO COM6230688 10113/2014 10/1312015 C,OMBBIINtlED SINGLE LIMIT S 1,000,000 (EaS BODILY INJURY (Per person) S ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY Per accident S ( ) X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE S Per accident 5 UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 C X EXCESS LIAB CLAIMS -MADE XLS0096729 04/13/2015 04113/2016 AGGREGATE S 5,000,000 DED I I RETENTIONS S WORKERS COMPENSATION AND EMPLOYERS LIABILITY y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A PER OTH- STATUTE ER E.L. EACH ACCIDENT S EL DISEASE - EA EMPLOYE S (Mandatory i e and If yes, dzscribe untler E.L DISEASE - POLICY LIMIT I S DESCRIPTION OF OPERATIONS beimv DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 7 more space is required) Proof of Workers Compensation coverage will be sent directly by the carrier. -.,,, ,. ." Town of North Andover 1600 Osgood Street, Bldg 20, Suite 2035 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 ©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 VVQrd n .. .. VO/vllj �• On ' �y .0 Vi ii U. 0-9 u; au Ons and VLal dards License: CS -079476 �t: rts LAWRENCE E M�RG.. - �! 86 BUIMCA AVE ; w N BEU;ERICA NFA 0186 e e a JY -6w— 141 Expiration Commissioner 06/03!2017 s` Sl 11 $�'�Ty f(� o-matresi 5ategandRwitfi namLL,Is�-.,9en This card acknowledges that the recipient has successfully completed a 30 -hour Octupational Safety and HealthTraining Course in Construction SafeV and Health i_'je! (Trainer name — print or type) (Course end date) Office �fllronsumerT a & ne J' �& ri egu ation ~, _ ,HOME IMPROVEMENT CONTRACTOR Registration: 137913 r'- Expiration: 1/2712017 IndividType: ual LAWRENCE E. MORGAN JR. LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 N.BILLERICA, MA 01862 Undersecretary 013�� GicccpavonatSafety and'realfh A.,:Ifi r:.,iratccn L' ARR`r MOR&AtQ p 1� 11,2<, successfully completed a ?i7 -`.our Gc;cupattonal Safety and -Health Training Course in Construction Safely 8 Health LOWS Ro JZ> OSAU6r6q �racner) 'Cate! - i me - L Recyclers of Asphalt Shingles SEAN ANEsTis PRBiDENTr & CEO 369 CODMAN HILI. ROAD TEL 978-263-1899 BOXBOROUGH, MA FAX: 978-263-1879 EMAIL: ROOFTOP1@VERIZON.NET CELL- 508-726-5341