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HomeMy WebLinkAboutBuilding Permit #849 - Exception 6/13/2011I. it 44 Permit NO: 6 Date Issued: & --f � - TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received AMPORTANT: Applicant must complete all items on this page if Print MAP NO: PARCEL: ZONING DISTRICT: TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Alteration Repair, replacement ❑ Demolition Li PROPOSED USE Residential ❑ One family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other M Historic District yes Machine Shop Village yes "i- 100 year-old structure yes 0 DESCRIP^ION OF WORK TO BE PERFORMED: Non- Residential ❑ Industrial ❑ Commercial ❑ Others: 0 (Identification Please Type or Print Clearly) OWNER: Name: Phone:`` ' Address: li�Tj.r,- 4. 1.0 A a n CONTRACTOR Name: L , �, s? r� ..•�' --�� -�✓ Phone: ��, • s _ � .� Address: Supervisor's Construction Licenser 7 c/'7 y (, Exp. Date: 61 3 / Home Improvement License:_. Exp. Date: ,W 7 3 ARCHITECT/ENGINEER Phone: Address: Reg. No, FEE SCHEDULE. BULDING PERMIT. $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $925.00 PER S.F. Total Project Cost: $ �5 `�(� 00 FEE: $ (p� Check No.:Zd3sl__�_ Receipt No.: NOTE: Perso s cont..actin - ' h regist red contractors ophave access to he u`Ira - �" ot,> �� .,+ � guaranty- n`C Location No. Date Check# 216i, Building Inspector TOWN OF NORTH ANDOVER Certificate of Occupancy $ S Building/Frame Permit Fee $ A 9 T Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 216i, Building Inspector 4. 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 Durnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT DATE APPROVED COMMENTS of �ti Y u ++ kx Y e J• t tl• m b m i 4 \.r U I lV IJ 1Y L.i �.f li Y 6 V I 1 Y GI I. �.Y I \+ COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Commen Com 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 Osgood 15,treet yes no 4 ' 'ruck COMMENTS n---� Dimension Number of Stories:_2 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 Doc:.Building Permit Revised 2011 June/mi P Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, lnterior Rehabilitation Permits ❑ Building Permit Application ® Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses a Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg PE: Addition or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses I iai i U' Y' k-i'C?P0SeCa VV01 K VVI'r V bpi 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 Perr 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) o Copy of Contract ❑ Mass check Energy Compliance Report . ❑ Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Perr 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 recordir must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi The Commonwealth of Massachusetts >I� Department oflndustrialAccidents (� "Cult. Office Investigationsof r,,.ig r ''' r _ 600 Washington Street Y i Itis Boston, MA 0.2111 _1: ;f `�`�5-" www rnassogov/dza Workers' Compensation Insurance Affidavit: Buiiders/Contractors/F fectricians/P%umbers .APPUcantInformation . Please PrMfLegibiy Name (Business/Organization/Individual): Address:S(„ City/State/Zip: Al, 6 i'l le j�ie,-A_,), -2 Phone #:—q %Y— 6127— �1 2� 2 Are you an employer? Check the appropriate box: L I�J I am a employer with ?; 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I ain 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.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ D6moliflon 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.0 Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ Other `R11yappucantthatchecks box #1 must also till out the section below showingtheir workers' compensation policy information. • t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 2Fdavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors acid their workers' comp. policy information. lam an employer that isproviding workers' compensation insurance for my employees Below is thepolicy andjob site information. - . 'A Insurance Company Name: C' U. Policy # or Self ins. Mc. #: C41 Expiration Date: Job Site Address: City/State/Zip:.,&.jf,�b�� 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 STOA WORK ORDER and a fine of up to $250.00A 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. o hereby cert under the pains and penalties ofpe►yury that the information provided above is t u and cor';rect.• v�Jr. Official use only. leo not write in. this area, to be completed by city or town official. City or Town: Permit/License # ,311 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 6. Other 11 Contact Person: Phone #: 1� i ��-� �® A'R CERTIFICATE OF LIABILITY INSURANCE DA TE (MMIODI YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 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. PHONE o eX1): (978)_ 686-2266 _ 1(A/c,_ Ne), (976) 686-6410 M.J. FOSTER INSURANCE SERVICES E-MAIL cfernandez@nafins.com ADDRESS: 163 MAIN STREET PRODUCER CUSTOMER ID #Morgan Construction NORTH ANDOVER MA 01845-2508 _ INSURER(S)_FFORDINGCOVERAGE NAIC# INSURER A :S . H . SMITH & COMPANY, INC. ------------ INSURED Morgan Construction INSURER B :HANOVER 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 r___——___._ _ A -LM POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER !(MMIDDIYYYY) '(MMIDDIYYYY) A GENERAL LIABILITY AUTHORIZED REPRESENTATIVE 120 MAIN STREET CBC10000241200 04/13/2011 104/13/2012 EACH OCCURRENCE $ 1,000,000 "�\ � Y` A, .,#a X COMMERCIAL GENERAL LIABILITY DAMAGETO - 100 000 PREMISES_( Ea_occurrenceL $..- ! _ CLAIMS -MADE LX OCCUR / / / / MEDEXP (Any one person) $ - 5 , 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $- 2, 000, 000 —$ / / / / I PRODUCTS-_ COMP/OP AGG I $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY 1—LOC B AUTOMOBILE LIABILITY 10/13/2010 0/13/2011 COMBINED SINGLE LIMIT is 1,000,000 �WN66529181 / / F(Ea accident) _ I ANY AUTO I i BODILY INJURY (Per person) $ I _._.-_.--_---- � ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS 1 PROPERTY DAMAGE HIRED AUTOS (Per accident) fI $ X$ NON -OWNED AUTOS -- -- - - --- i $ D X UMBRELLA LIAB X OCCUR bCLS0071751 01/07/2011 104/13/2012 �EACHOCCURRENCE $ 5,000,000 - _ j - EXCESS LIAB - CLAIMS -MADE J / / / I AGGREGATE DEDUCTIBLE $ - -- $ RETENTION $ C' WORKERS COMPENSATION C4 63 89 65 7' 2/14/2010 ;12/14/2011 WC STATU- 0TH -1 70RY�1MLT�!_ ER...' - AND EMPLOYERS' LIABILITY Y / N I I / / ! / / r- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000 000 � -- -- - - - _ - OFFICER/MEMBER EXCLUDED? ❑ I N / A (Mandatory in NH) / / / / ..._ I-- E.L. DISEASE - EA EMPLOYE $ 1 , 000,_000 If yes, describe under DESCRIPTION OF OPERATIONS below / / / / I E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 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- "�\ � Y` A, .,#a ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD f�q[.. .. j y.,,y\H Ll b«(efyrwWN SIM I .yr.r�- ..Y Thiscard acknowledges thtrt tili= rCelpietft.has8uccassftdly completed a I t-hour:OcEupatiogal $afetyand Health:Training Eovw,in Construction $afaty:and Health {!tamer=name —'print or type} (Courge end data)': OSHA 00232999.'x WCvpa Dnat Seiniy anG Health AC ustr-,:,Cis LARRY MDRGA6 J has Suci eSstwly ccnpieied a 2tt-, 111. " Icly dp<; ri:`aia: Tm,ning Co LOytS Ror-+DEAD OSAU&N (Trainer! ,r>aiul 4 llt i°ommr�x -lu :.rzc•rrysec•�t '__ Office of l�onsnmer A�>airs & Bdsiness I�egulatlon Ar q HOME IMPROVEMENT CONTRACTOR Registration: .137913 Type: Expiration: 1/27/2013 Individual LA NCE E. MORGAN JR, LAWRENCE MORGANJR. . 86 BILLERICA AVE UNIT 1 e N.BILLERICA, MA 01862 Undersecretary MOBILO- EOUIPME.NT { OPER.A.TOR CEPTIFICAfF T t s'IWA .d A h.f M uN he Axecrr+cd oar', a rl kNa� t 'TM_QLNQ C CAL IN QPLC r'-'- ala >achuuyt, DLp trtment of Ptiblit �sAvf.N 9 Board of Builds fj ,ulatinn, and �'tamlarth License: Z;S 79476 LAWRENCE E MORGAN JR t j 86 BILLERICA AVE UNIT 1 � N BILLERICA, MA 01862" `^ i -ra"T Expiration: 6/3/2013 (anmi..irnvv Tr=: 16354 L.E. MORGAN CONSTRUCTION CO. P.O. Box 75, 86 Billerica Avenue, Unit #1 N. Billerica, MA 01862 Office: 978-670-4747 - Fax: 978-670-6477 PROPOSAL Submitted To: Heritage Green Condominiums Address: 39 Farrwood Road N. Andover, MA Phone / Fax: 978-685-4434 / 978-685-0521 Date: October 29, 2010 Job Site: Building 67-69, 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 15 lb. asphalt saturated felt paper over the remaining wood deck. 5. Install " white alum u griggge to the entire perimeter & dormers.6. Install yr. GAF ring 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, $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. AUTHORIZED SIGNATURE: Lawrence E. Jr. ACCEPTANCE of PROPOSAL: The above prices, specifications and conditions are satisfactory And are hereby accepted. You are authorized to do the work as specified. Payment is due upon completion. Authorized Buyer&-, "Iel( Ei i ° Signature — i;p Date S THANK YOU FOR CHOOSING MORGAN CONSTRUCTION CA m X x CO) CA m C2 CO) 'v C � O Cos Cl) CD n Z y CD O 'v ar ? O O. a. y v CD CD O Q % d CD CDo CD O O CD CL v CO) • O CD C=D S7 C2 CO) O 1 Z CD .Ot O CD C CD A,, VJ n O cn m VJ 2 ON 4 O cn ,� o dr E w �O t H y CO. 'noCo mcia= m Ci m Gw VO pt O 9& =a 9 „ - o �i x t" H Fn CD o m of 0 ti � o Or o a a o '0 0 IN o ZS. O y, c2 C aco, ^� O m =rO- -..o0m o�OO TC=I) � no CK CA p d N + H O• d Q CL CO) '..F C t CID � co) y N O � m FF N .-� CD Cl ED a �, o CD gcD CD N o CD Cl N E CD -0 CL . nom: 0 0; :C 0 0 CO)0: o_. ,� o dr � w � w z oGa � w Ci ro n Gw VO pt O It n M.073 O o c o �i x t" H E 1 I y fl C