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HomeMy WebLinkAboutBuilding Permit #847-11 - 59 FARRWOOD AVENUE 6/13/2011TOWN OF FORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N®:_ —e_ -y� "(( Date Issued: 6— L2— IMPORTANT: Applicant must Print Date Received if Print MAP NO: PARCEL: ZONING DISTRICT: TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration Repair, replacement ❑ Demolition U YY cAL(Al 06.4Yl.L PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other r-- .-., t 7 all items on this Historic District yes Machine Shop Village yes 100 year-old structure yes n�o DESCRIPTION OF WORK TO BE PERFORMED: Non- Residential ❑ Industrial ❑ Commercial ❑ Others: f/gI (Identification Please Type or Print Clearly) OWNER: Name: 14P r I'r-fI _A _ �..�ee . , r__ Address: 13 CONTRACTOR Name: Phone: 41 Address: 8 t' B *I . Supervisor's Construction License: C �tl/ (o _Exp. Date: Home Improvement License: _ 13 7 `� 13 Exp. Date: 3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. • $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $_ FEE: $ k�; r— Check No.: CO S Receipt No.: aq0\1,Jr NOTE: FLvPersons cont actan ' h re gis red contractors do not have access to e guaranty fund Si nature of A ent/Owner - Signature of contractor I 'Y3,y Location hi 4-13,1 No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ f Building/Frame Permit Fee $ CHU Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# �7-3 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ It TYPE OF SEWERAGE DISPOSAL Public Sewer Art ❑ Wvjfmming Pools ElTanning/IVlassageBody , Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Peiananent Durnpster on Site ❑ Y THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS � ia4'iea als'ii i -.iia \GVI�.tV 1t x.1.5 Uil OiUila L61L. COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Commen Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood treet FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department; signature/date COMMENTS Dimension Number of Stories:_ 2, Total square feet of floor area, used 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.$10o-$1000 fine DocAuilding Permit Revised 2011 June/mi �� �r ri =i--' :.,-r:r_-.r• .....Ju at+w1/7 Yd/ 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 a Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Perr. Addition or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses U. co! -Dv 0-� Co„-tt.r'1: ct 'iGUI'/l,fv� ��!(i31`(/ IeVc(LiC3(i 'Plai Of i-'!'OPOSe0 VifC 1'K vt/an odpfi 1Kler i-- ian Alla 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) o 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) o Copy of Contract ❑ Mass check Energy Compliance Report a 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: Doe.Building Permit Revised 2008mi O z sj y _O Go cm y N1 m � � c N �p om CD :at.� o= a CL s w'0 o W = O a j.r m y._O C = m ism p O CL co W = r t •O N_ at O C LU �ECD'D v o C0 a CD as32 2 co') .. .� y 32 a$ m J CD w w P-4 A a 2 CD CD L Z CD CL O CO) � C CD CM COD -0 h m m CL CD CD cm CD i CL ecc o CL. 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O y � C CD cm �o CD g m m Li c CD �.- t CL ♦..� = CO � � � L cc o a E cm< c COCIO) 4- c V\Y J 'c 'FL O ; C CD CL C.3 CO) C �C C _c Q. 0 U) LU W 19 uiW N leiTlie Commonwealth of Massachusetts `a i SIS Department oflndustrial.Accidents Office of Investigations ' 600 YYaslaington Street Boston, MA 02111 www.mass gov/dia Mloekeas' Compensation Insurance Affidavit: )Builders/Contractors/Flectricia>ns/Plumbers Applicant Information . Please PrinfLeeibly Name (Basitiess/Organization/Individual): Address:_ 0/ 13 I IIPri—ce . U City/State/Zip: /' j3it Le i C ,QJ &, Phone #:--T 7,Y— 6 7 27 / Are you an employer? Check the appropriate box: Type of project (required): 1. 1;,:f I ama employer with _ 4. ❑ I am a general contractor and I 6. EJNew construction employees (full and/or part-time).* have hired the sub -contractors 2. ElI Tn a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. ❑ Demolition working forme in any capacity. [NO workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation and its g. Building addition required.] officers have exercised their I0.❑ EIectrical repairs or additions 3. ❑ I ain a homeowner doing all work right of exemption per MGL . 11.[[ Plumbing repairs or additions myself. [No workers' comp, c. 1,52, § 1(4), and we have no 12.[] Roof repairs " insurance requirecl.] i employees. [No workers' 13.0 Other comp. insurance required.] "nuy ¢ppiwanr mar cnecxs noxifi must also Lit out ttie section below showingtheir workers' compensation policy information. • f Homeowners who submit this affidavit indicating they aie doing all work and theft hire outside contractors must submit anew affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors acid their workers' comp. policy information. X am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: z Ce, 0 Policy # or Self -ins. Lic. #: C L/ Expiration Date: L2 b Y b Job Site Address: City/State/Zip- ' -4 ¢�/�y,� „moi Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. - 152 can lead 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 WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance'coverage verification. X do hereby cert under the pains and penalties ofpet, jury t/tat the infoimation provided above is t and ear eck =W SAMA� 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. PIumbing Inspector 6. Other Contact Person: Phone #: Information. and Instruct' i®ns 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 ofthe 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 ofanother who employs persons to do maintenance, constructiqu or repair work on such dwelling house or -on the grounds or building appurtenant thereto shall not because of such employment be.deemed to bean 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 ofpublic 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•afffdavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) 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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. AIso 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 anyquestions 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 pennit/lieensenumber which. will be used as a reference number. in addition, an applicant that must submit muliiple�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 affidavitmust be f fled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business n 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 DePaTtmMt of Industrial Acoidents Office of Tnvestipti.ons 600 Washington Street - Boston, MA 02111 Tel. #- 617-727-4900 e&406 er 1-877 MASSAFE Revised 5-26-05 Fax # 617-727,7749 www.mass.gov/dia IQ ACORV CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) (`,� 06/10/2011 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. [A/C, No, EMI: -(978) 686-2266 JAA'C' Nu); (978) 686-6410 M.J. FOSTER INSURANCE SERVICES ADD"RIESS, cfernandez@nafins.com 163 MAIN STREET PRODUCER CUSTOMER ID XMOrgan Construction NORTH ANDOVER MA 01845-2508 INSURER(S) AFFORDING COVERAGE _NAIC # INSURER A :S. H. SMITH & COMPANY, INC.. _ INSURED Morgan Construction INSURER B :4MOOWR INSURANCE_ PO Box 75 INSURER C ACE_USA INSURER D :SCOTTSDALE INSURANCE INSURER E North Billerica MA 01862— 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 -DDS SU R POLICY EFF POLICY EXP LIMBS LTR INSR VUWVD POLICY NUMBER (MWDDIYYYY) (MM/DDNYYY) A GENERAL LIABILITY ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER CBC10000241200 4/13/2011 4/13/2012 EACH OCCURRENCE 1 , 000 , 000 / / / / 100,000 -----$ DAMAGE TO NTED X COMMERCIAL GENERAL LIABILITY PREMISES EaEoeczxence) $ _ — MED EXP (Any one person) $ 5,000 CLAIMS -MADE 1XI OCCUR / / / / _ _ $ 1,000,000 PERSONAL & ADV INJURY GENERAL AGGREGATE $ 2,000,000 / / / / $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG I — $ -- — X POLICY PRO- LOC / / / / B AUTOMOBILE LIABILITY kWN66529181 0/13/2010 0/13/2011 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) ANY AUTO $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS / / (Per (Pr aidt $ X NON -OWNED AUTOS / / / / $ D X UMBRELLA LIAB X OCCUR S0071751 1/07/2011 4/13/2012 EACH OCCURRENCE $ 5,000,000 $ EXCESS LIAB CLAIMS -MADE / / / / AGGREGATE DEDUCTIBLE $ RETENTION $ / / / / C' WORKERS COMPENSATION 4 63 89 65 7 2/14/2010 2/14/2011 WC STATU- OTH- yTORYLIMITS R N AND EMPLOYERS' LIABILITY YIN / / / / _—__ -_- ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH ACCIDENT $ 1 1[ 009 000 OFFICER/MEMBER EXCLUDED? ❑ N / A --- — ___... ..-- (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ _ 1_, 000, 000 If yes, describe under DESCRIPTION OF OPERATIONS beiow / / / / E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER 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- ACORD 25 (2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD 0SPA - This card acki okAedges that the recipient has successfully completed a 30 -hour Occupational Safety and Health Training Course in Construction Safety and Health ,-ArMy ucx.."li.a (Trainer name. — print or type) (Course end date) J' MOBILE EQUIPMENT OSS .A 7 OPERATOR CERTIFICATE LARRY MOR&At-J �Yn:ae ad o Meyadasd b gs�Iele Arakrd �•ot4 eyprer ia'm ro reaP. • �Rct�48-��5 il�--iD - ��� `3 J LOWS R4w4XN3p.M � - OSAU&OR TLLAl1 Nl1iJ 1�2Ci3 ��� 1 Office of coB�s�amer�Af�atrs B�si`ne�s� eigula6�oo a x HOME IMPROVEMENT CONTRACTOR ,` Registration: 137913 Type: Expiration: 1/27/2013 Individual 'LA CE E. MORGAN JR. LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 g_ N.BILLERICA, MA 01862 Undersecretary Massachusetts - Department or Public Safety Board of Building Rer ulations anti Standards Construction Supervisor License License: CS 79476 LAWRENCE E MORGAN JR 86 BILLERICA AVE UNIT 1 N BILLERICA, MA 01862 ( onmri..i.mer Expiration: 6!3/2013 Tr#: 16354 L.E. MORGAN CONSTRUCTION CO. P.O. Box 75, 86 Billerica Avenue, Unit #1 N. Billerica, MA 01862 Office: 978-670-4747 9 Fax: 978-670-6477 PROPOSAL Submitted To: Heritage Green Condominiums Address: 39 Farrwood Road N. Andover, MA Phone / Fax: 978-6854434 / 978-685-0521 Date: October 25, 2010 Job Site: Building 59-61, Farrwood 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 15 lb. asphalt saturated felt paper over the remaining wood deck. 5. Install W' whit&a at*.Wrip edge to the entire perimeter & dormers. 6. Install *-Yr. Silver Lining asphalt shingles, color to be as close as possible. 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, $15440.00 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. AUTHORIZED SIGNATURE: Lawrence E. Moigan Jr. ACCEPTANCE of PROPOSAL: The above prices, specifications and conditions are satisfactory And are hereby accepted. You are authorized to do the work^ specified. Payment is due upon completion. Authorized Buyer,(,�(�dcVi2c7Signat?MORGAIN C Date {�°fzi THANK OU FOR CHOOS G CONSTRUCTION