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HomeMy WebLinkAboutBuilding Permit #341-2017 - 58 SETTLERS RIDGE ROAD 9/29/2016 BUILDING PERMIT of N°oT"qti TOWN OF NORTH ANDOVER o� h '`- ". 4° o APPLICATION FOR PLAN EXAMINATION 00 - 70 Permit No#: W t 7 Date Received ')01 C, 1e 7Rq°R�7eo�PP'y.(5 � Date Issued: -)-0 1 SSAC14 115�� IMPORTANT: Applicant must complete all items on this page LOCATION S QJ PROPERTY OWNER QL,,D— Print Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi 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 DE CRIPTION OF WORK TO BE PERFORMED: TD 4- C Ident' kation- Please Type or Print Clearly W �� OWNER: Name: ff Phone: Address: 44 9; pr. Contrafor Name: �. DI/f') Phone: -7 7 O'? Email: ' d Address: p f ; a.. Supervisor's Construction License:C5-x-161 U P Exp. Date:_[. Home Improvement License:1Exp. Date:_. ARCHITECT/ENGINEER A Phone: 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: $ 9�D FEE: $ ff;--76- Check No.: ���� Receipt No.: 3d�7� NOTE: Persons contractin ith nregistered contractors do not have accesyllo the guaranty fund 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. ❑ 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 HEALTH Reviewed on Signature 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: Located 384 Osgood Street FIRE DEPARTMENT - TempDumpster on site y_es nog Located�at 124iMain3treet 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) ❑ 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 01 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 durnpster 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 4, 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 Doc:Building Permit Revised 2014 Location <, r "7(_ 1)(• /,` No. 7 i Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $('13. 7t, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# S:I - r v`^building'Inspector TfIAORTH own o 0 Andover No. C' ver' Mass • �A CoCNICHIWICK y1' ' - O' R�rEo U BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT ........ .'�II�►.� BUILDING INSPECTOR has permission to erect .......................... buildings on ....3.. ........S..F5....ir al1c Foundation to be occupied as .............. Rough .. ....... .. .. . .. .... . .... . . ...... .. ........ provided that the person accepting. .this. .permit. . .shall. ..in. .every. .respect. conform to the terms of the application Chimney on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final 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 CONSTRUCAON ST Rough .... .... ....... ... .. Service ............. ................................. BUILDING INSPECTOR Final 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. -7- PROPOSAL -PROPOSAL, L.E. Morgan Construction Company We Accept: 86 Billerica Avenue,Unit#1 N.Billerica,MA 01862 _ Office:(978)670-4747/Fax:(978)670-6477 , OS aUBM1 ED'TO PHONE I OATE /• f JOS NAME T•STATE•A\/ND I�OO E A JOB LOCATION Y� AOT /LTi E/'"r( OTHER JOS PHONE in I Strip down to the wood deck, -L layers Of shingles, dispose of debris to a licensed recycling facility: Install (e ice and water shield at the gutters 3 feet of ice and water shield in valleys. Install synthetic underlayment on the remainder of the wood decking. Install 8" aluminum drip edge on'all perimeters, color choices: 0 White, lei Mill, 0 Brown, O Copper. InstallS"a year architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by +^cr(r•` to all ridges and dormers. 4 Install AIA new skylight flashing kits manufactured by /V/A Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing chimneys and install new lead flashing. Install matching cap shingles to all ridges, hips and dormers. WE PROPOSE hereby to fu nish material and labor-complete in accordance with above specifications,for the sum of �f2 ,�vou �ew� Nia+� h.sNrJi.c�Es��j7�y L dollars($ I I I Ali material is guaranteed to be as specified.All work to be completed in aworkmanlike manner according to standard practices.Any alteration or deviation from above Authorized$ignat 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 may be withdrawn I by Workmen's Compensation Insurance and 4ability Insurance. by its if not accepted within days. E A CONTRACT-The above prices, Date of acceptance: /nd conditions are satisfactory and are �f�,authorized Signature: .You are authorized to do the work as il`ent will be made as outlined above. Authorised Signature: Additional Remarks: S COL L, Q-1111111 111-14Z11 ) THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION T'he Commonwealth of Mc-rssachusetts N .Department of Indrrstrial.Accidents " _ =;�,A •s 1 Congress Street,Suite 100 d -- ' Boston,MI 02114-2017 :. yr www.mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ElE lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �y y� Please Print Leph Name(Business/Organization/Individual): 1M , Address: loo �Gl City/State/Zip: ! 1 r► to M ISImIne#: en Z_ 7 D Axe you an employer?CheckT ppiopriafe box: Type of project(required): 1. �Ia a employer with_. V employees(full and/or part-time)." 7. Q 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] 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.] 9. ❑Demolition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]Building addition ensure that all contractors either have workers'compensation insurance or are sole I L[]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. ❑ t 13.[f Roof rep ' s These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its of�cers have evercised their right of exemption per MGL c. 14. Other ` 152,§1(4),and we have nQ employees.fro workers'comp.insurance requived.] .Any applicant that checks liox41 must also fill out the section below showing their workers'compensation policy infoffiation. j1t Homeowners who submit ibis 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. ifthe-sub.c&firici&s have employees',' ey rimst provide their workers'comp.policy numbEr. •: ; I am an employer that is piovzd1hg workrs'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: 0MAA, r ' Policy#or Self-ins.Lic.#: Qj�,S$ g �q7� Expiration Date: LN Job Site Address: rs 16LA City/State/Zip: r m A- ol�ys Attach a copy of the workers'compensatlort policy d claration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e. 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 ofup 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 ve ' tion. I do hereby c r fy under the pains and penalties of per' ry that the information provided above is true and correct Si atur . Date: Phone : 7 0 -7 Offi __ . 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.Soar.of Health 2.BuildingDepartment 3.City/Town Clerk 4.Electrical Inspector S.Plumbing inspector b.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) TkIS.GEi2TIFICATE IS ISSUED AS A MATTER OF INFO191171gni r% RMATION 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 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 endorsements. PRODUCER CONTACT NAME: BALDWIMWELSH PARKER INS PHONE 131 COOLIDGE ST,SUITE#100 FAx (A1C,No,Ext): (AIC,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. LIMITS 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 EDOCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ JD POLICY [:]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 L_jCLAIMS-MADE AGGREGATE Is DEDUCTIBLE Is RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-5B738312-15 12/14/2015 12/14/2016 X LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE N N/A OFFICERIMEMBER EXCLUDED? E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 cribe under If yes,des DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/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 20,SUITE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER,MA 01845 AUTHORIZED REPR ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER ACCMEV DATE(MM/DDIYYYY) `„_ , CERTIFICATE OF LIABILITY INSURANCE 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. 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 g78 562-5652 FAX 978 562-7120 131 Coolidge Street,Suite 100 (A/C,No,Ext): ) tart.xo):( ) Hudson,MA 01749 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Insurance Company INSURED 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INS, WVD POLICY NUMBER MMIDDIYYYY MM/DDNYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMACLAIMS-MADE n REMISES(Ea occurrence) $ �OCCUR NPP8381520 04/13/2016 04/13/2017 PREMISES ETORENTED 100 000 P M ED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JEC7 n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO 6230688 10/13/2015 10/13/2016 BODILY INJURY(Per person) S ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE S X HIRED AUTOS X NON-OWNED AUTOS Per accident S UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAB CLAIMS-MADE XLS0099346 04/13/2016 04/13/2017 AGGREGATE S 5,000,000 DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEO S If yes,describe under E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/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 ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street,Bldg 20,Suite 2035 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 1 Board of Building Regulations and Standards Ulze Ccan�,zor.iaea�l/d�'C/ saclu�eli Office of Consumer Affairs&Business Regulation License: CS-0HOME IMPROVEMENT CONTRACTOR Construction Supervisor Registration:;;;137913 T ' Ype: LAWRENCE E MORGAN,JR '' Expiratiot #22fl17 Individual 100 IRON HORSE PARK NORTH BILLERICA MA 01862 LAWRENCE E. MORGAIS4�R LAWRENCE MORGAMW- t=. 100 IRON HORSE PARK-'—_ BILLERICA, MA 01862 Expiration: Undersecretary ' Commissioner 06/0312017 OSHArery.aiiil'ftaSiNi- 3dtaklSstr;Uou` '!meq S; A This card acknowledges tharjh,erebipieMI has;sucaessfult com IEte(a )' p 30-hour 06-bupational Saletyand Health Training Course in i Da : c;cnar sare:•�o 3 r id rieah�;r:::n;r�c aurin Coristruction Safety and Health 1 /e=.. has suCcessfull7 COrtpieted a an l Ic)•F �r Clr.=upa:i0fi315dfEiY H atr i h Trzieing Course n ' i < A. COnstruction Safely H2Wiil (Train ername—print orb1pej '— � ` Aja 5 RC't-JRF� � � (Course end date)