Loading...
HomeMy WebLinkAboutBuilding Permit #846-11 - 53 FERNVIEW AVENUE 6/13/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: A46 // Date Received Date Issued: IMPORTANT: Applicant must com Tete all items on this age LOCATION �� _ S.� �2rrV Vi �+ PROPERTY OWNER lig; 'Tim l`�w Print MAP NO: PARCEL: TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration )4 Repair, replacement ❑ Demolition u v'W,�1lG1i:3wve. Print ZONING DISTRICT: PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other r; i DESCRIPTION OF WORK Historic District yes Machine Shop Village yes i 100 year-old structure yes no BE PERFORMED: Non- Residential ❑ Industrial ❑ Commercial ❑ Others: 0 (Identification Please Type or Print Clearly) OWNER: Name: 14-P e- "r I , o ^gym Address: 3el f CONTRACTOR Name:- -✓ Phone:', Address: e e 4ve �* I /IJ ,9 Supervisor's Construction License: cd'7 I Exp. Date Home Improvement License: _ ? )� Exp. Date: ARCH ITECT/ENGINEE Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT. • $72.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total •Project Cost: $ ��, ,�'�Q 00 FEE: $ Check No.: Receipt No.: NOTE: Perso�zs cont actin =i ' h �egist rets contractors d not have access to lae gn 'antyuned "7 ..... L i f G- At'""G rc f `J r " tt;, Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ... ................................ has permission to perform .... P —r ' .................... plumbing in the buildings of .... ....... I ............... at. . ... ..... , North Andover, Mass. Fee. ?�-o .... Lic. . .......... I . .... ..... PLUMBING INSPECTOR Check # 8 62- � Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Perrnanent Durnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT COMME DATE REJECTED 11 DATE APPROVED El COMMENTS HEALTH Reviewed on Signature I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comme Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date Located 384 Osc ood 19treet yes no �>< — COMMENTS U5 I/� i 0 � ~I '(jam 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No 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 o 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 PF Addition or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses G r'i lJi'/epi i C�LIi�JVF6/tel VelliUfl l' idizi U.1.,: i'iropt sea vvonr vvi'(V oprilIKi8;l' i�°Ilail 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 Peri New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 .Peri In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of AppealE that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recordin must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi TIze Commonwealth of Massachusetts I ,N, t I� Department of Indusit'ial Accidents , Office of Investigations U 600 WYashington Street a Boston, MA. 02.111 . www. masss gov/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/E iectricians/P lumberrg Applicant Information ]Please Prillt'Le�--ib Naive (Business/Organization/Individual): Address:v U City/State/Zip: 4/, 6 i t le fl��y%� f.LI � � Phone #:—q q 7X 6 7 6— '-12`/7 . Are you an employer? Check the appropriate box: 1. 1�f I am a employer with a, 4. ❑ I am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors 2. E,1 aim a sole proprietor or partner- listed on the attached sheet. # ship and have no employees These sub -contractors have working for mein any capacity, workers' comp, insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL - myself [No workers' comp, c. 152, § 1(4), and we have no insurance required.] f employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ EIectrical repairs or additions 11.0 Plumbing repairs or additions i 12.E] Roofreparrs " 13.❑ Other -Any Applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. • t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors fliat check this box must attached an additional sheet showing the name of thesub-contractors Md their workers' comp, policy information. lam an employer that is providing workeis' compensation insurance for my employees. Below is the policy and job site Information. „ Insurance Company Name: ece, fi Policy # or Self -ins. Lic. #: C°`-/ (� L (p_� Expiration Date:_ Job Site Address: City/State/Zip: ,& `.7 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Sedtion 25A of MGL c. 152 can Iead 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 fonn of a STOP WORD ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance*coverage verification. Ido hereby cert under the pains and penalties ofpeiyury that the information provided above is tt"' and coi',rect.' Official 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Q® A CERTIFICATE OF LIABILITY INSURANCE PATE (MM/DD/ I(��'(V/)^_ 06/10/201111 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 CONTACT NAME: NORTH ANDOVER INSURANCE AGENCY, INC.ar( CN No, Et)_ (978) 686-2266 tA,C,_N_o):(978) 686_6410 — -- M.J. FOSTER INSURANCE SERVICES EDDRE cfernandez@nafins.com ADDRESS: ., .--_----_-_------_--- ---- 163 MAIN STREET PRODUCER CUSTOMERID iY'g or an Construction DAMAGE TO RENTED 100 000 $ MA 01845-2508 _---_ _ _ _ __. INSURER(S) AFFORDING COVERAGE NAIC # INSURER A :S . H . SMITH & COMPANY,__ INC. _NORTH —ANDOVER_ --__ INSURED Morgan Construction INSURER B ;HANOVER INSURANCE PO Box 75 INSURER c ACE USA CLAIMS -MADE [I OCCUR INSURER D :SCOTTSDAI,E INSURANCE INSURER E p North Billerica MA 01062— JINSURER F rnvFaer_I:c CERTIFICATE NUMBER: REVISION NUMBER: vTHIS IS TOCERTIFYTHAT 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 ASUER , POLICY EFFT POLICY EXP LIMITS I LTR TYPE OF INSURANCE INSD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) A GENERAL LIABILITY AUTHORIZED REPRESENTATIVE 120 MAIN STREET BC10000241200 b4/13/2011 04/13/2012 EACH OCCURRENCE $ 1,000,000 / / / / DAMAGE TO RENTED 100 000 $ X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)—�. _ _! CLAIMS -MADE [I OCCUR / / / / MED EXP (Any one person) $ -- 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE 1 $ 2 ,-000,000 / / / / PRODUCTS - COMP/OP AGG L— 2, 000 , 000 ------I$ — GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PECO� LOC I / / / / B AUTOMOBILE LIABILITY NWN66529181 0/13/2010 0/13/2011 COMBINED SINGLE LIMIT $ 1,000,000 / (Ea accident) - --- -- — -- -- -- BODILY INJURY (Per person) ANY AUTO ALL OWNED AUTOS $ XBODILY SCHEDULED AUTOS / / / / INJURY (Per accident) PROPERTY DAMAGE $ I X HIRED AUTOS (Per accident) —---------------'--- $ `..---_---. - - ----- X NON -OWNED AUTOS I -- — — $ - -- - - — — i I D }{ UMBRELLA LIAR X OCCUR S0071751 1/07/2011 04/13/2012 EACH OCCURRENCE 9. 5 , 000,000 SS LIAB EXCESS —� CLAIMS -MADE : AGGREGATE $ I _ DEDUCTIBLE - is RETENTION $ C WORKERS COMPENSATION 4 63 89 65 7 2/14/2010 12/14/2011 WC STATU- OTH- I9J3Y� ITS — _FR. E.L. EACH ACCIDENT ) $ _ 1 OOH 000 AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PAR7NER/EXECUTIVE OF EXCLUDED? ❑ N / A / / / / I E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) mor=n ATF wni nFa CANCELLATION ACORD 25 (2009/09) © 1988-2009 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 AUTHORIZED REPRESENTATIVE 120 MAIN STREET NORTH ANDOVER MA 01845-I n �f I ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD card acknowledges that $n ieLaptaJathps successfully completed'a r u tloqaN�isl ninc )Codr'stfirt y� wry--.�,� .:�=- ��� , ir (daT o tor't a en itlate) 4 nn4 OSHA 002329-99'1 A! U.6. Ur^>arin Cpl of Lat,ui , Occupational Safei.yano Healft! AC:h.;T11SV.0cn LARRY Ho-g&A6 J has sucoesstuily m,,pleted a tiHt»r occup"."'ma Sy'(Gty ami ii -011 Tmnnq Clour.p. in LOU+S.Ron-it AU. OSAU&69 o. 6' �'aN Y" Offilce of Dnstimerl airs& s 1=,�' B si4ess I eg6latjon' HOME IMPROVEMENT CONTRACTOR Registration: 137913 Type: Expiration: 1127/2013 Individual µLAVO ENCE E. MORGANJR., LAWRENCE MORGAN:JR, I I 86 BILLERICA AVE UNIT 1 N.BILLERICA, MA 01867 Undersecretary .''S OPER -IF OPERATOR CEP7 ICIJE 6 t4wre- lot 4 -- L4!* ed H h� If- 0� �' W7 'TM-(' L k1j AI, I ri Q PC- i L) DvImi-1111cm 4 plibliv Sofel ' N Board ot'Buifdiwutfl -� Reation., and NlimdardN 7, 1 C., - c'erlse License: CS 79476 LAWRENCE E MORGAN JR 86 BILLERICA AVE UNIT 1 N BILLERICA, MA 01862 Expiration: 6/3/2013 ........ Tr--: 16354 L.E. MORGAN CONSTRUCTION CO. p.0. Box 75, 86 Billerica Avenue, Unit #1 N. Billerica, MA01862 Office: 978-670-4747 Fax: 978-670-6477 PROPOSAL Submitted Heritage Green To: Condominiums Address: 39 Fanwood Road N. Andover, MA Phone/ Fax: 978-685-4434/978-685-0521 Date: October 29,2010 Job Site: Building 53-55, Fernview Rd. WE HEREBY submit our proposal for the following scope of work; APPROX. 4,752 SQ FT 1. Remove all of the existing asphalt shingles on the various roof planes down to the wood deck. 2. Inspect the wood decking for any signs of damage or rotting and report results. 3. Install 6' of ice & water shield at the leading edges and 3' in the valleys. 4. Install 151b. asphalt saturated felt paper over the remaining wood deck. 5. Install ",whit��Sive!irp edge to the entire perimeter & dormers. 6. Install yr. Lining asphalt shingles, color to be as close as possible. b00A 7. Hurricane nail all shingles, a maximum of 6 nails per shingle, due to high wind area. 8. Install new pipe collars and new flashings on the dormers as needed. 9. Install GAF matching caps on top of the ridges and hurricane nail. 10. Disposal of all debris at a licensed recycling facility. 11. Morgan Construction will warranty all labor for a period of 10 -years. We Propose hereby to furnish materials and labor, complete in accordance with the above specifications, For the sum of; Fifteen Thousand Two Hundred Forty Dollars, $ 15,240.00 NOTE: The upper rear decks must be cleaned off to prevent damage while stripping the roof, as well as All Items on the ground in the rear grass area. AUTHORIZEDSIGNATURE: ACCEPTANCE of PROPOSAL: The above prices, specificatiGns and conditions are satisfactory And are hereby accepted. You are authorized to do the work as specified. Payment is due upon co�pletio , - upon_ co Authorized Buyer Q 61/W4jlt.) S i g n a t u .-:Date 61 THANK YOU FOR CHOOSING MORGAN CONSTRUCTION a W .z w v Cl) oo w � A w b w° x c U w o H w a x u. � a U a x co -cd w x p U. ` C7 x 00 C2 w z w w w w v ° z cn . Q v cn ;CL) o o tsi C y O G vO v C. G = o :oma C1: m •O+ C O O 1 = Is �0+ C. cm mi m c E m a O A : �' N y N CD G m 3 N �m o =c c ' N O O N E COD CD 0 C.c.s L m N m C C_ O Q �. wHo. o CD �. Go CL. c Q e " O G O = m :0S3 N CD $ y m$~ CD r W 0 � r 'O Z .f «. �. •N C.Z O C O oE CJ r o •N O V .m vmv� ~ ca E CO3 C. O = CD m Go CD C. *. m �lm z 0 W W CP O U C I am E L O � v Z co CL O y CO VI CD I O Aco m m CD cc H = CL f+ e_cv o a CL o�Q ca o -6-0� c Ccc Z CD v ca 'C c c y LU 0 Y/ 0 19 W W 19 W U) ..20-00 Location- '4�7epw 'v ele No. ;Ae Date TOWN OF NORTH ANDOVER 41 Certificate of Occupancy $ Awl S * 1.0 Building/Frame Permit Fee $ CHUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 6a!5:�- 4 u Building Inspector � � t MASSACHUSETTS UNIF ORMAPPLICATON FOR PER W TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date �. Building Locations _I.F-e7RAI V "y Permit L a Owner's Name �� ount $ e,.j v New ❑ Renovation ❑ Replacement Plans Submitted tYP or e Name_ t ' 1 tf 11� icy C Name of Licensed Plumber or Gas Fitter T n s , . it, -'i n: -e-.- 1 l eek one: Certificate Installing Company Corp. . ❑ Partner. gTi m/Co. INSURANCE COVERAGE I have a current liability Insurance policy or it's substantial equivalent. Check one: Yes If you have checked yes, please indicate the type coverage by checking the appropriate box. No❑ Liability insurance poli Y ❑ Other type of indemnity Bond ❑ Owner's Insurance Waiver: I am aware that the -licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Signature of Owner or Owner's Agent Check one: er Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate best of my knowledge and that all plumbing work and mi ons perfo ed under permit Is ed for is application will be in the compliance with all pertinent provisions of the ett�Ptate Gade�an�d Chi 14 f General Laws. Signature of: le Plumber y/TFn ❑ Gas Fitter. Master 'PROVED (*OFFICE USE ONLY) 0 Journeyman ged Plumber Or Gas Fitter p L icense Number x h w a w z z < a .G UB-BASEM ENT r. ASEM ENT + T. FLOOR [31R ND. FLOOR D. FLOOR 4TH. FLOOR STH. FLOOR 6TH. FLOOR 7TH. FLOOR FLOOR tYP or e Name_ t ' 1 tf 11� icy C Name of Licensed Plumber or Gas Fitter T n s , . it, -'i n: -e-.- 1 l eek one: Certificate Installing Company Corp. . ❑ Partner. gTi m/Co. INSURANCE COVERAGE I have a current liability Insurance policy or it's substantial equivalent. Check one: Yes If you have checked yes, please indicate the type coverage by checking the appropriate box. No❑ Liability insurance poli Y ❑ Other type of indemnity Bond ❑ Owner's Insurance Waiver: I am aware that the -licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement Signature of Owner or Owner's Agent Check one: er Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate best of my knowledge and that all plumbing work and mi ons perfo ed under permit Is ed for is application will be in the compliance with all pertinent provisions of the ett�Ptate Gade�an�d Chi 14 f General Laws. Signature of: le Plumber y/TFn ❑ Gas Fitter. Master 'PROVED (*OFFICE USE ONLY) 0 Journeyman ged Plumber Or Gas Fitter p L icense Number Date. . X. r-.11 � ........ TOWN OF NORTH ANDOVER,`�� PERMIT FOR GAS INSTAL�ZTIQN F7�' ( �' 11 / 0 This certifies that ........ .................................. has permission for,gas installation .... ................... in the buildings of "q F f ........................ at ... r -r ......... ........ North Andover, Mass. Fee. IR .... Lic. No.. ....... -YG�S INSPECTOR Check# /r, ) I -� 7260 f, Y 4 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or per) NORTH ANDOVER, MASSACHUSETTS Date Building Location 5737 — S�5' t %l /1%'� )` Permit Owner wr � � Amount New ❑ Renovation ❑ Replacement a' Plans Submitted' Yes ❑ No FiXTiTRFC (print llitype) Name .( �,Q %i D C'I Id Q Check one: Certificate Corp. Address C7 (-� Q t3 1:1 Partner. O �b Business Telepkwne ® 9.— 9 y x Fitm/Co. Name of Licensed Plumber. A Insurance Coverage: Indicate the type of msurance coverage by checking the appropriate boic Liability insurance pommy i❑� Other type of indemnity Bond ❑ Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Wature IOwner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in a ppcation are true and accurate to the best of my knowledge and that all plumbing work dins tions der P f this application will be in compliance with all pertinent provisions of the Mas ohus State P 1 of the General Laws. By- 01 Licensea Title Type offPlu�m .APPROVED (OFFICE USE ONLY _bing Li Cit cense um'—her es Mas (% '° "umeyman !_31 El