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HomeMy WebLinkAboutBuilding Permit # 7/8/2015 01 t%ORTH B "60"I,"I -UILDING PERMIT 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION OW Permit NO: Date Received AT- D ate Issued: Lr IMPORTANT: Applicant must complete all items on this page LCCATIC►NK ' U ............. --4 n "I"l- Y"', PROPERTY X 0"VVI", . MAP .........- ........... W rice / erS A AP NO _y, p ........ .. 011 9Machin° hip TYPE OF IMPROVEMENT PROPOSED USE Resiftntial * Non- Residential El New Building -0—one family [I Addition 11 Two or more family 11 Industrial 11 Alteration No. of units: 11 Commercial El Repair, replacement 11 Assessory Bldg 11 Others: [I Demolition 11 Other ldddpl6it, eilw hed�'Diitact 861?41i&,�/11 d'Well ;7 El, ........... . Identification Please Type or Print Clearly OWNER: Name: �k�t �Y,I 1'P one: Address: I ti ........... All I'll, 1 ?5 K 2M, 0 N"'Is,tkAotlt kRl' wl/ ,Ad .................... 10, H m e" y Date / 'F, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST B4SED ON$125.00 PER S.F. ---7qZl Total Project Cost: $ U FEE- $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have ac qe ;o the guaranty ,,,of Agent[ J I- Signature Owner: ignatu're,of:c .tract, tA®RT H own ot '. It T.", ndover 0 .� -.,•'� ase IST®. _ C% h Vel' Mass, r) O LAKE T COCHICHEWICK *1. 57 RAre® hf�`I- fi .(`3 U BOARD OF HEALTH PFMR� M� � IT T Food/Kitchen ® Septic System THIS CERTIFIES THATS .1. C. BUILDING INSPECTOR has permission to erect .......................... buildings on Foundation Rough to be occupied as ... .. .....Er..... ... .. .................................................... Chimney provided that the person acc ting this permit shall in every spect conform to the terms of the application Final 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 PERMITIft EXPIRES ELECTRICAL INSPECTOR ®liq LES Rough Service ........................................ Final BUILDING INSPECTOR GAS INSPECTOR ccupancy 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. 1. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY► TW&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(les)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 endorsement(s). PRODUCER CONTACT NAME: BALDWIMWELSH PARKER INS PHONE FAX 131 COOLIDGE ST,SUITE 4100 (A/C,No,Ext): (AIC,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C. INSURER D: PO BOX 75 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 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 DAMAGE TO RENTED $ CLAIMS MADE F_�OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY [—]PROJECT[:]LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB B CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-14 12/14/2014 12/14/2015 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE El 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 E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. JOB:ST.MICHAEL'S SCHOOL-80 MAPLE AVE.,NORTH ANDOVER,MA 01845 CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST,BLDG 20,STE 2035 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER,MA 01845 AUTHORIZED REPRFApVEN` ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER AcoR® CERTIFICATE OF LIABILITY INSURANCE DAT71712 D/YYYY) `--� 7/7/2015 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 FAX 131 Coolidge Street,Suite 100 A/C No Ell:(978)562-5652 A/c No):(978)562-7120 Hudson,MA 01749 AIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Insurance Company INSURED INSURER B: a ety LE Morgan Construction Inc INSURER C:Scottsdale Insurance PO BOX 75 INSURER D: Billerica,MA 01821 INSURERE: 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 ADD S B POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD/ A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR NPP8237995 04/13/2015 04/13/2016 DAMAGE RENTED 100,000 PREMISES Ea occurrence $ X Contractual Liabilit MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000 000 Ea accident , B ANY AUTO COM6230688 10/13/2014 10/13/2015 BODILY INJURY(Per person) $ ALL OWNEDX SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAB CLAIMS-MADE XLS0096729 04/13/2015 04/13/2016 AGGREGATE $ 5,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) '.. Proof of Workers Compensation coverage will be sent directly by the carrier. Job location: Saint Michael's School-80 Maple Ave.,North Andover,MA 01845 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 n. �,,,,�,�r� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety - - vodrd of Bul idi ncj leg u,i 14 io ns a ld 5tu^I d a fds e ifi nnsrrmor t�ffaiis i� 3ti4�inees Re" f HOME_IMPROVEMENT CONTRACTOR�uCatff n License: CS-079476 = Registraon:ti 137913 Type: -xpiraeion: 1 LAWRENCE F�% G � � /27/2017 Individiral 96 BILLERICA AVE LAWRENCE E. MOPGAN JR. N BMLERICA KA 0941-1,,' z I-AWRENCP MORGAN JR. s ti 86 C311_�F_RICA AVE UNIT I 1. � Expiration I I.3I!__[R(CA. ---_ — 7 _-- Commissioner (f/ff312Oi7 MA 01362 �Undcrsccretar•v a6�4,���i aoaii� ! This card acknowledges that the recipient has successfully completed'a 30-hour Octupationai Safety and Health Training Course in Construction Safety and Health C a 1t t e ---- Con t�cia�S�ti�R fiealti itU (TraineAi r name=print or type) (Course end data} L.6ttt 5 > �" At - -- I