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Home My WebLink AboutBuilding Permit #473-13 - 50 FARRWOOD AVENUE 12/18/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: 1 I r i I ---- I W IMPORTANT: Date Received must complete all items on this LOCATION -5-6- -�� / Lit,(c1r d` e1z, Ala��Z f;0 - Print PROPERTY OWNEF J# MAP NO: �6k P, IT Print 100 Year Old Structure yes EL;,—(�_ ZONING DISTRICT: Historic District yes Machine Shop Villaqe yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition 0 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 DESCRIPTION OF WORK TO BE PERFORMED: -5 I ri ,P °i' We- - Identification Please Type or Print Clearly) OWNER: Name: Address: CONTRACTOR Name:� Address:'K(o 6,/ (e f; 04 hone.g9f-37(,--76 e 79-67o--qW,7 Supervisor's Construction License: C� 1-5' '7gll7(o Exp. Date: &%3%/3 Home Improvement License: ARCH ITECT/ENGINEE Address: Date: l Phone: Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. -�osTotal Project Cost: $ 0,1;10 , 00 FEE: $ Check No.: b Receipt No.:�o NOTE: Persons contracting with unregistered contractors do not have accaranty fund Signature of Agent/Owner Signature of contractor= �? Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location-�►_j t1 baa No Date Check #�Y 26041 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $— Foundation Permit Fee Other Permit Fee �$ TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE.OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMk".ENTS DATE REJECTED 0 DATE APPROVED Reviewed on Siqnature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comme Conservation Decision: Comm Water & Sewer Connection/Signature Date Driveway Permit DPW Tower Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Maiq Street Fire Department signature/date COMMENTS Located 384 Osgood Street yes n0 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-$1000 fine NOTES and DATA — For department use ® Notified for pickup - Date E Doe.Building Permit Revised 2010 Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be stibm;tted with the building application Doc: Doc.Building permit Revised 2012 Massachusetts De,jS i-tment of Public SafetN %�$Oitrd (if Builtlin-$ ,ntlation` and Standards Construction Si3perv:sor Li; & $11} License: CS CS 79476 , {� 4 LAWRENCE E MORGAN JR 86 BILLERICA AVE UNIT 1 ' a N BILLERICA, MA 01862 Expiration: 6/3/2013 ('nnmiissi+rner Tr#: 16354 MOBILE EQUIPMENT___< OPERATOR CERTIFICATE THIS CERTIFICATE CONTIR,MS THAT i; It i :jv I; hos s;ec ,""Id lug aC lh t meed to 'cd =11 and emlwtion reGui;�; is Wait in;wl lotion ad'u hereby aWFq ized b o Ca 65e ype�sl d ecb k ai eq' pceV 6stad m the reerse. � I 1 fr u(ik ItJU a�-5 law8,1 �+ L, a I• OSHA 002329991 . I .1 U.S. Department of Labor Occupationar Safety and Health Administration LARRY MDR&AJ Y has successfully completed a 10 -hour Occupational Safety and Health sN Training Course in Construction Safety & Health LDut s RoNDE J 05AL (Trainer) ... ....... .......... ......._........ ._.... _......... ......... (Date) �VQ Y } Office!# o suerir m-Aras &ABtfsiness eguH:t1'0h ; HOME IMPROVEMENT CONTRACTOR i = t Registration: -- 137913 Type: Expiration: „1127/2013 Individual ENCE E MORGAN Jf2 ;;: LAWRENCE MORGAN JR 86 BILLERICA AVE UNIT'( .__ N.BILLERICA, MA 01862--Undersecretar} 11/27/2012 14:30 9786850521 AFFINITY REALTY Nov 271211;53a MORGAN CONSTRUCTION 9786706477 p.2 L.E. MORGAN CONSTRUCTION CO. PO. Box 75, 86 Billerica Avenue, Unit #1 N. Billerica, MA 01862 Office: 978-670-4747 - Fax; 978-670-6477 PROPOSAL Submitted To: Affinity Realty Management Address: 39 Rear Farrwood Rd., (Clubhouse) N. Andover, MA 01845 Date: November 25, 2052 Cell / Fax: 978-37"M / 978-685-0521 Job Site: Heritage Green Condominiums s0 -s2 Farrwood Rd., N. Andover, MA WE HEREBY submit our proposal for the following scope of work; Approx. 5,072 Square Feet 1. Remove the existing shingles down to the wood deck and dispose of off- site. 2. Install 6' of ice & water shield at the leading edges and 3' in the dormer valleys. 3. Install 15 lb. felt paper to the remainder of the wood deck. 4. Install r white aluminum drip edge to the entire perimeter & mechanically fasten. S. Install Certainteed Swlftstart shingles as a beginning course. 5. Install Certainteed landmark Silver Birch architectural shingles & hurricane nail. 7. Install 4 new pipe flanges, 2 slant back attic vents, new lead on the chimney. S. Install new ridge vent and matching cap shingles. 9. Remove the metal siding on dormers, & install 100% ice & water shield on the walls. 10. Install new white vinyl siding on all 3 dormers with white vinyl corners. 11.1nstall white aluminum coil over all rake and fascia, and 100 % vented vinyl on soffits. WE propose hereby to furnish materials & labor, complete in accordance with the above specifications, for the sum of, Seventeen Thousand Four Hundred Twenty Dollars: $17,4x0.00 AUTHORIZED Lawrence E. MWW Jr. President ACCEPTANCE of PROPOSAL: The above prices, specifications & conditions are satisfactory and are hereby accepted. You are authorized to do the work as speed. AUTHORIZED BUYER SIGNATURE DATE �l rTHANK YOU FOR CHOOSING 0 GAN CONSTRUCTION PAGE 02/02 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 12/17/2012 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 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 - COT CT NAME: NORTH ANDOVER INSURANCE AGENCY INC. M. J.- FOSTER INSURANCE SERVICES 163 MAIN STREET PHONE (AIC, No, Ext): 978) 686-2266 (AIC, No): (978) 686-6410 E-MAIL - ADDRESS: crernandez@nafins.com PRODUCER tttt��r an Construction CUSTOMER ID 'gan ANDOVER MA 01845-2508 --- INSURER(S)AFFORDINGCOVERAGE C# - _ INSURER A :S. H. SMITH & COMPANY, INC. INSURED Morgan Construction PO BOX 75 INSURER B :SAFETY INSURANCE Y INSURER C :ZURICH INSURANCE CBC10000241200 INSURER D :SCOTTSDALE INSURANCE _ 4/13/2013 EACH OCCURRENCE $1,000,000 lNorth Billerica MA 01862— INSURER E INSURER F %1UVr.r%AUr0 CEKIIFICATE NUMBER- RFVICinkl MI IMGCD. 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 A INSR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP - -_ -- -- (MMIDDIYYYY) LIMITS A GENERAL LIABILITY Y CBC10000241200 4/13/2012 4/13/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY / / / / AMA E TO RPNTED PREMISES (Ea occurrences _ $ 100,000 CLAIMS OCCUR / / / / -MADE MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY_ $ 1,000,000 $ 2,000,000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: / / / / PRODUCTS- COMP/OP AGG $ 2,000,000 X POLICY PRO- JECT LOC / / / / _ - $ B AUTOMOBILE LIABILITY 6215111 0/13/2012 0/13/2013 COMBINED SINGLE LIMIT $ 1, 000, 000 (Ea accident) ANY AUTO — BODILY INJURY (Per person) $ ALL OWNED AUTOS -- — - ---- BODILY INJURY (Per accident) X $ SCHEDULED AUTOS -- $ X / / / / PROPERTY DAMAGE HIRED AUTOS (Per accident) X NON -OWNED AUTOS / / / / $ UMBRELLA LIAR OCCUR S0081465 4/13/2012 4/13/2013 EACH OCCURRENCE $ 5,000,000D EXCESS LIAB CLAIMS -MADE / / / / AGGREGATE $ 5, 000, 000 DEDUCTIBLE / / / is/ RETENTION $ / / / / $ `. WORKERS COMPENSATION TO BE DETERbCMED 2/14/2012 2/14/2013 1 WC STATU- OTH- t AND EMPLOYERS' LIABILITY Y / N -_ T RY LIMITS L. ER E.L. EACH ACCIDENT ANY PROPRIETORIPARTNERtEXECUTIVE $ 1, 000 000 , OFFICERIMEMBER EXCLUDED? ❑ N / A / / / / _-.__ _ (Mandatory in NH) E. L. DISEASE - EA EMPLOYE $ 1, 000,000 If yes, describe under / / / / -- - --- — DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required( CERTIFICATE HOLDER rAMf_FI I ATInM ^�� I ) (V'lass-ZUUV ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 120 MAIN STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845 - "_\j ^�� I ) (V'lass-ZUUV ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD J W S LL � a O m = v O LL v U a N z Z z Q 1 D m C O -0 � LL t tO :3 O d' C � L U f0 LL O U W Z Z m d L 7 O 4' C LL 0' W Z a U W W tU 7 O OC i> CJ N C LL O a Z y t 0 d' � LL �- Z CW W C W 25 LL N 3 m O 41 v a+ N cu Y O N n _ 2.5 t�. •Q. L A^ CL W �• CL — � o i- YL G Vr• y0i O E a� V = O 10 1 Q: •^I L V �• L rnQ�—�o o = = N N E c 0 C z �= o d. _N.= 7+.o 1 CJcc 0 .� c rn _ c cm o O N Q. V m LLJW = 'C +-+ O O LL '2 O N = N•7 yam-. :E.2 LW E v L y.0 > O y= c Hs . 0. o U �I. O w .ti Z2 AE W L Z CL 0 CM D � o .E M M O v D O O CL CL CL 's v J ca .CL 0; =Z0 CL� V N m r c 0 LLI U) to W W 19 W N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: s"6 Afb _ i City/State/Zip: ,& Q dob-? Phone#: 9'7,1'(p7 ��J Are you an employer? Check the appropriate box: 1 I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors Z. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. E] I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp, insurance required.) R, Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other kny applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :ontractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. tsurance Company Name: 2 U r t 64 Aicy # or Self -ins. Lie. #: j Expiration Date: / ►b Site Address:— "Jr� irGt,n ; 'J City/State/Zip: /r/, ,hoenm �-12V ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). iilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a -ie 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 up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage verification. to hereby certify der the pains and penalties ofperjury that the information provided above is trite and correct. Official use only. Do not write in this area, to be completer) by city or town official. City 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 #: 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 apartments 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 of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) 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/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) 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. A new 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-7274900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 evised 5-26-05 www.mass.anv/dia