HomeMy WebLinkAboutBuilding Permit # 10/16/2015 BUILDING PERMIT V%o oT H �� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#e Date ReceivedTED AC us Date Issued: I PORTANT: ADDlicant must complete all items on this page LOCATION - ®. 1 tvta PROPERTY OWNER qING Print O0 Year Structure yes no MAP PARCEL: DIST _CT: 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: ❑ Demolition ❑ Other El Septic ❑Well ❑Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO DE PERFORMED: j Idetifica n- 1 ase T e or]print Clearly OWNER: Name 1`TPhone:9-79` C) 6 1 107- Address3q 9rwo 0) I r -M Contrctor 6 Name: (VPhone: Y / Email: Lo Address: e �°t 1 Supervisor's Construction License: / Exp. Date: Home Improvement License: m Exp. Date: ARCHITECT/ENGINEER __ Phone: Address: Reg. No. III FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ _ FEE: $ A Check No.: ' Receipt No.: l? NOTBb Persons contractin%=Sjgnature tractors do not have accesst the guaranty fund Signature o A ent/Owne 'w g g _ r of contra N°RrH Town of ndover No. �AK� h ver, ass, /o /G COCNIC.t..'. 1' �i Aren ►QA°R . S t] BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT . .. ..... �� '� r-4, -�� �lii�iBUILDING INSPECTOR has permission to erect .......................... buildings on�. .. �°`^..!v.!:G .�tiG. .... Foundation Rough to be occupied as ..................... ...� oQ ..... ..... ... . ........................................................... Chimney provided that the person accepting this permit shall in every respect 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 PERMIT E IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service ...... Final BUIL ING INSPECTOR GASINSPECTOR Occupancy Permit Required t® 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. Oct 09 2015 02:54PM HP Fax page 1 L. E. MORGAN CONSTRUCTION I C. 86 BILLERICA AVE., N. BIILERiCA, M 01862 PH: 978-670-4747 / Fax: 978-6 -6477 PROPOSAL Submitted To: Affinity Realty Management Date: 6-15-15 Address: 39 Rear Farrwood Rd., (Clubhouse) N.Andover, MA 01845 Cell J Fax: 979-376-9687/978-685-0521 Job Site: Heritage Green Condominiums 1/3 Fernview Rd., N. Andover, MA,Approx.5,1 SQ FT WE HEREBY submit our proposal for the following scope of work; 1. Remove the existing shingles down to the wood deck and dispc se of off-site. 2. Install 6'of ice&water shield at the leading edges and 3'in all lalleys. 3. Install RHINO SHIELD synthetic underlayment to the remainder of the wood deck. 4. Install 8"white aluminum drip edge to the entire perimeter& i nechanically fasten. 5. Install Certainteed Swiftstart shingles as a beginning course. 6. Install Certainteed Landmark Silver Birch architectural shingles hurricane nail. 7. Install 4 new pipe flanges,2 slant back attic vents,new lead on the chimney. 8. Install new ridge vent and matching cap shingles. 9. Remove the metal siding on dormers, &install 100%ice&water shield on the walls. 10. Install new white vinyl siding on all 3 dormers with white vinyl corners. 11. Install white aluminum coil over all rake and fascia,and 100 ented vinyl on soffits. WE propose hereby to furnish materials&labor, complete in accorda ice with the above specifications,for the sum of; Eighteen Thousand Six Hundred Twent,Dollars: $18,620.00 AUTHORIZED SIGNATURE V�vow Le"T AM& Lawrence E. Mokan JV Presdent ACCEPTANCE of PROPOSAL:The above prices,specifications&condit ns are satisfactory and are hereby accepted.You are authorized to do the work as specie AUTHORIZED BUYER SIGNATU E �O T/ls THANK YOU FOR CHOOSING MOR Na)NSfRUCTION The Commonwealth of Massachusetts x Department oflndustrialAccidenfs I Congress Street, Suite 100 Boston,M4 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organization/Individual)�— rA Address: &,\�k 1 1 City/State/Zip . 1 ►\D I e#: /D t_1 -7 Are yon a ployer?Ch7�7 riate box: Type of project(required): 1. am a employer with loyees(full and/or part-time).* 7. [1 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition ❑4.F1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]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. f E ] - These sub-contractors have employees and have workers'comp.insurance.1 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL c. 14. Othe a 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit Us 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,'tliey must provide their workers'comp.policy number. Iam an employer that is pilo di g workers'compensation i urance for my employees.'Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.L'c.#: Expiration Date: Job Site Address: i r'e 111 v�ao City/State/Zip: W/1dw M p D INS -iS Attach a copy of the orkers' compensation policy declaration page(showing the policy number and expira ion 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 thAviolator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verlEpation. I dohere tify under the pains pe t' s ofperjury that th nformation provided ab a is r ue and correct. Si natu Date: 0 Phon #: qY 7 OfV 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.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE DATE(7/08/201 YYY) moirNJSX.ER TIFICATE 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: BALDWINIA'ELSH PARKER INS PHONE FAX 131 COOLIDGE ST.SUITE 4100 (A/C,No,Ext): (A1C,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED 1 INSURER A: AMERICAN ZURICH INSURANCE COMPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: INSURER D: PO BOX 75 INSURER E: NORTH BILLERICA-NIA 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 S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE �OCCUR. PREMISES(Ea occurrence) MED FRCP(Any one person) $ PERSONAL&ADV INJURY s GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE Is POLICY 0 PROJECT 0 LOC PRODUCTS-COMP/OP AGG I$ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY I5 SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY(Per accident) �$ NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR 8 OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S ($ A WORKER'S COMPENSATION ANDWC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-5B738312-14 12/14/2014 12/14/2015 X LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? r7N N/A E.L.EACH ACCIDENT Is 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE i S 1,000,000 If yes, Oe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 D DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONS/SPECIAL ITEMS 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. AUTHORIZED REPREffAT.VE / 0_NORTH ANDOVER,MA 01845 c`--_ ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. LEMORGA-01 BBOYER CERTIFICATE OF LIABILITY INSURANCE DATE 1 717/2 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.I Hudson Office PHONE g78 562-5652 Nc No: 978 562-7120 131 Coolidge Street,Suite 100 (AIC,No Ext A ) { ) Hudson,MA 01749 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western World Insurance Company INSURED INSURER B:Safety LE Morgan Construction Inc INSURER C.Scottsdale Insurance PO BOX 75 INSURER D: Billerica,MA 01821 INSURER E: INSURERF: 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 INSURANCEADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDD MMIOD A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ®OCCUR NPP8237995 04/1312015 04/13/2016Ar A E R NT 100,000 PREMISES Ea occurrence S X Contractual Liabilit MED EXP(Any one person) S 5,000 I PERSONAL BADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE Is 2,000,000 POLICY❑JECTPRO F—]LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1000000 Ea accident) > > BX ANY AUTO COM6230688 10113/2014 10/13/2015 BODILY INJURY(Perperson) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS PROPERTY DAMAGE S AUTOS ED Per accident HIRED AUTOS X NON-OWNED ''.. S UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 C X EXCESS LIAR CLAIMS-MADE XLS0096729 04/13/2015 04113/2016 AGGREGATE S 5,000,000 DED I I RETENTIONS S WORKERS COMPENSATION PER CRT TH- AND EMPLOYERS'LIABILITY y I N STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S If yes.describe under - DESCRIPTION OF OPERATIONS belmy E.L.DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I 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. 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 ©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 / vvaru vi DUif^eii�g Reguiaations and Standards ti', Officeotc i9wJ.'L37L' _ - — -- ion sumerA�lfairs Se'Bunessegufatton "="`= "' '�`=" HOME IMPROVEMENT CONTRACTOR -.. License: CS-079476 .,,1 Registration: 137913 r.t.s Expiration: 1/2712017 Type: Individual LAWRENCE E MOR" LR CE E.MORGAN JR. 86 BMLERICA AXE b r N BELLERICA AA 01$62:;Ta LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 141 Expiration N.BILLERICA,MA 01862 _4 Commissioner 06/03/2017 Undersecretary l0��jjrrTT� llFt- 5atatyanrtHoaRfi v+.;^E� - LLL...YYYAA asc�uen _ - t 0`�A " This card acknowledges that the recipient has successfully completed a w'S-D -a tr eaf ofCtit 30-hour Octupational Safety and Health Training Course in i D:a:pxionarsafety and :ealth;�.wr,t Construction Safety and Healthi A RY MO �A P J Y12 has successfully completed a -r Occupat:on?t safety and Hea)?h Training Course in _ r Construction Safety&Health OSAU&69 (Trainer name—print or type) (course end date) ; (i rainer) 'Date) ROOF TOP RECYCLING B + a 0 - SEAN ANESTIS PRESIDENTF&CEO 369 CODMAN HILL ROAD TEL: 978-263-1899 BOXBOROUGH,MA Five. 978-263-1879 EMAIL:ROOFTOP1@VERIZON.NHT CELL: 508-726-5341