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HomeMy WebLinkAboutBuilding Permit #1274-2016 - 75 SETTLERS RIDGE ROAD 6/7/2016 ✓ o ptORTFt q V07AIly 4jde),'rb Lr BUILDING 16 BUILDING PERMIT � �? ,��::,,. , •�,.•6 °0 TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received__�� Date Issued: �9SSAC HUS��� © ®' !C� IMPORTANT: Applicant must complete all items on this page LOCATION 9 { AcheC. PROPERTY OWNER de. t Print MAP NO: PARCEL: ZO ING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi tial Non- Residential ❑ New Building T One family ❑ Addition 0 Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well 0 Floodplain ❑Wetlands 0 Watershed District 0 Water/Sewer r. ELI—' I O Identification Please Type or Print Clearly) OWNER: Name: d (, Phone-10e 6eq Address: 05 1 r S R i cl ' CONTRACTOR Name: j � F� E.1 n..1Phd14 Address: ` r, - I 01"77)_„7,)_ Supervisor's Construction License ,y Exp. Date: Home Improvement License: �• T—Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PER IT:$12A0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost9q�u FEE: $ CCheck No.: Receipt No.: 7 "4,6--7--- NOTE: Persons contracting with unregistered contractors do not have acces o the guaranty u d 5i nature of A ent/Owner _ c' _ g g _c _ _Signature of contrac 60 — �< OORTH BUILDING PERMIT ! O�StiEO ,6,1 ti0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION b � Permit No#: Date Received * 4 ��SSgCHus���5 Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: -El-Demolition- ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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 No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Aaer•., ; fer �Sianature of contractor_ ��� Plans Submitted^❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming 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 e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature i COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes a � Planning Board Decision: Comments Conservation Decision: Comments Walter& Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: -- FIREDEPAR�TiMENT steron site eyes oca e 384 Osgood Street Ternp�Dump - = t ;)oa Located,,at 1t2"4�,Main�St�eet _ um - ------ - Fi:re�Depat tment,,sibnature/tlate _ '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 I Time Contact Name Date - Doc.Building Permit 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 4, 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 dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4, 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 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 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 No. Date ,)102-7 • - TOWN OF NORTH ANDOVER y' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL $�_ Check# � G - • 46--- Building Inspector- j NORTH E � Town of �� _ L ndover No. 2bi T C,, h ver, Mass, COCHI x.95'tArED U BOARD OF HEALTH Food/Kitchen PERMIT D Septic System THIS CERTIFIES THAT A6:..A4W�. r 416... .... ..... .. ... BUILDING INSPECTOR Ar� .:� ... AP Foundation has permission to erect .............. ...... . buildings on .... ..... .. .f ��rr Rough to be occupied as .... . ............................ ................. ... Chimney provided that the person accepting thi per shall In every respect conform to the te applicatioFinal on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and 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 CONSTRjo ONS Rough Service .... .... ...... ....... ... ... .. ................. .... .. Final BUILDING I CT R GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. PROPOSAL . L.E. Morgan Construction Company WeAccept. 86 Billerica Avenue,Unit#1 m . N.Billerica,MA 01862 Office: (978)6704747/Fax: (978)670-6477 sT & T�t'•t �d.'�P��f l♦ t�€. �^ t�� �-.3 �0�13 f.>��jr� t��+ �'� D� 3 y 3 .-� � . - 7_1f r i da l � f.:r JOB NAME TY,-STAT AND 2I CODE _ //t C JOB LOCATION E F F f i! 1 / tt CONTACT - '� ij.pHONEil -, t 07 ER q III P104NE n Strip down to the wood deck, �- layers of shingles, dispose of debris to a licensed recycling facility: rl Install L. ice and water shield at the gutters J 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: 1! White, ❑ Mill, ❑ Brown, ❑ Copper. yeard= <Install Ct- �} architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by cz-— to all ridges and dormers. Install /LVA new skylight flashing kits manufactured by °°= Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing /3 /'J' `'•' chimneys and install new lead flashing. AInstall matching cap shingles to all ridges, hips and dormers. WE PROPOSE hereby tofurnish material and labor-complete in accordance with above specifications,for the sum of- dollars fdollars(s 1. - i All material is guaranteed to be as speeded.All work to be completed in a workmanlike Authorized Signature: manner according to standard practices.Any alteration or deviation.from above , . specifications involving extra costs will be executed only upon written orders,and will r become an extra charge over and above the estimate.Our workers are fully covered Note:This proposal maybe withdrawn by Workmen's Compensation Insurance and t.iability Insurance. by us if not accepted within f` days. ACCEPTED AS A CONTRACT-The above prices, Date of acceptance: .�. specifications and conditions are satisfactory and are Authorized Signature:„ O.L ;b2 L' n hereby accepted.You are authorized to do the work as ' specified.Payment will be made as outlined above. Authorized Signature: Additional Remarks:-SHINGLE COLOR= - I THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth of Massachusetts Department of IndustrialAccidents b I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ApOicant Information Please Print Legibly Name(Business/Organization/Individual): Address: � � � �'It ��� `•; tAe Lin 1.,.L City/State/Zip: /V�• ' i /e j 0 C 1 I I aw#: V 7 7 Are yo employer?Check propriate box: Type of project(required): 1. I 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. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10[]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole M❑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. 13• p trs 'i These sub-contractors have employees and have workers'comp.insurance.1 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 1 Othe 152,§1(4),and we have no employees.[No workers'comp.insurance required.] G�' *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. tContractors 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. i I am an employer that ispro t nig;ivoi-kersconipensationitisui-aticefornzyeniployees. Below is thepolicy and job site i information. r Insurance Company Name (a, AA ' Polis #or Self-ins.Lie.#: l J —6 )_ Y Expiration Date: Job Site Address: ! City/State/Zip �ay fn Attach a copy of the workers'compensation policy decl ration 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 th lator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ver' tc tion. I do hereby y ut//er tl a pan Is nd p t nities e ' y tl t the' rn:ation pro,, above tette and correct. Sin r 1 Date: P one#1 (13 n Iitycial use only. Do trot sprite in this area,to be completed by city or town official or Town: Permit/License# Issuing Authority(circle one): ; l..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 19/1 TML%r,ERTIFICATE 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 ITP AND THE CERTIFICATE HOLDER. PORTANT:If the certificate holder is an ADDITIONAL INSURED,the pol)cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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: BALDWIN\WELSH PARKER INS 131 COOLIDGE ST,SUITE#100 PHONE FAX (AIC,No,Ext): (AIC,No): HUDSON,MA 01749 E-MAIL 27KLD ADDRESS: 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 LTR ADD SUB POLICY EFF DATE POLICY EXP DATE TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE M OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ POLICY [:]PROJECT❑LOC ENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT(Ea accident) BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-15 12/14/2015 12/14/2016 X LIMITS ANY PROPERITORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? . NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000 000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/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 TA ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER .4��Ron CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C 4!14/2016 ERTfFICATE 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 Welsh&Parker Insurance Agency,Inc./Hudson Office NAME: Hu son,Coolid a Street,Suite 100 E-MAIL 8562-7120 PHONE /978 56 FAx 97 g (A1C,No,Ext):\ ) 2-5652 (A1C,No}:` HuMA 01749 ) ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Western World Insurance Company 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. /NSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE /NSD WYD POLICY NUMBER MMIDD/YE MOLICYVDDIXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE n OCCUR NPP8381520 04/13/2016 04/13/2017 PREM GES(Ea occurrence) $ 100,000 M ED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY Pn LOC PRO- ., PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B (Ea accident) S 1,000,000 ANY Aero 6230688 10/13/2015 10/13/2016 BODILY INJURY(Per person) S ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X HIREDAUTOS X NON-OWNED AUTOS PROPERTY DAMAGE S (Per accident) S UMBRELLA LIAR X OCCUR C X EXCESS LIAB CLAIMS-MADE XLS0099346 EACH OCCURRENCE $ 5,000,000 04/13/2016 04/13/2017 AGGREGATE S 00001000 DED RETENTION S WORKERS COMPENSATION S AND EMPLOYERS'LIABILITY PER OTH- YIN STATUTE ER ANY PROPRIETOR EXCLUDED? CUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS 1 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 1600 Osgood Street,Bldg 20,Suite 2035 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE 02FJe� a- ©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 - Ur/ Boar -u ding Pegu,- .i�i..n -, ✓ :004?L97 t i~n vi c+tiffu�,,y ,�,,,yuiauv„$ai„".a vianiaarva - ' Office O a� fir• d.... J9r lyU, y'{ f -- - - mac,. t onsumerT# irsu�iness�egu anon "'""` yHOME IMPROVEMENT CONTRACTOR NTRAGTOR License: CS-079476 Lam=�� ',-Registration: 1JI-S, _ r 137913 Type: Expiration_ 1/27/2017 Yp LAWRENCE E MOG. .