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Home My WebLink AboutBuilding Permit # 10/16/2015 i %AORTy BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received � oR ED y � �.9 AERATED PPp �y Ss•�CHuse� Date Issued: RTANT: Applicant must complete all items on this page LOCATION �� Rrigt i PROPERTY OWNER In Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer; DESCRIPTION OF WORK TO BE PERFORMED: Id of ti ,P �s 'I'ypMrr'nMn. OWNER: Name: ® Phone: ® ®�p Address: b 1�► Contractor Name:L fflurqcm 0W. JV'Rhone: Email r , Address: Supervisor's Construction Licenser--Y-b / q�') Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER A . P. Phone: Address: Reg. No. I FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ A, Ud U _ FEE: � lCheck No.: Ll Receipt Np.;4—q -4— NOTE: Persons eontr ctingi with unregistered contractors do not have acce to tlae guaranty f nd Signature of Agent/Owner,4,� , / L14: Signature of contract ®RTS Andover fown of ® ti. 0 No. _. LAKE h ver, ass, coc"Ic"tWIC c A. S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .... .. ....- ® ..... .. ...................... Rough to be occupied as .............. 4� ...................................... ... Chimney provided that the person acce tin�this rmitshallin eve rY .res ect c�olmto 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C CTISTJ S Rough Service ................. . ... ..... .............................................. Final BUILDING INSPECTOR 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. t PROPOSAL L.E. Morgan Construction Company We Accept 86 Billerica Avenue,Unit#1 VISA N. Billerica,MA 01862 Office: (978) 670-4747/Fax: (97 8)670-6477 L r N- s L OAH ,f JOR r . S7 I Aril?1 ' 0( i� JOB tOGArtOrr In JT)HONE Strip down to-the wood deck, layers of shingles, dispose of debris to a icensed recycling facility: Install ice and water shield at the gutters feet of ice and water shield in valleys. Install 8" aluminum drip edge on all perimeters, color choices: White, ❑ Mill, ❑ Brown, ❑ Copper. Install asphalt saturated 15- lb. felt paper on the remainder of the wood decking. Install .50 year, w j�la DTVJL— architectural asphalt shingles, and hurricane nail. Install ridge vent manufactured by to all ridges and dormers. Install — new skylight flashing kits manufactured by Ad Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing on 106 d�� A#jJ riv A A chimneys and install new lead flashing. install matching cap shingles to all ridges, hips and dormers, WE PROPOSE hereby to furnish material and labor-complete in accordance with above specifications,for e sum of: ;g D_V�(2,ni �w� C Y1 t�C_ 1-_(_ _ ___ �.__—__. _._ ___ _. —do lays($ All material is guaranteed to be as specified.All work to be completed in aworkmanlike mariner according to standard practices.Any alteration or deviation from above Authorized Signature: specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.Our workers are fully covered Note:This proposal may be wit.lt 'ttwtt by Workmen's Compensation Insurance and Liability Insurance. by us if not accepted within ( days. Ll CE OF PROPOSAL—The above prices, Date of acceptance: and conditions are satisfactory and are Author zed s;snat�r'e: 7 I- ed.You are authorized to do the work as — ment will be made as outlined above. Additional Remarks: t ---- FT-; THANK YOU FOR CHOOSING L.E. MORGAN CONSTRUCTION The Commonwealth of Massachusetts Department oflndustrialAccidents d 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERIVIITTING AUTHORITY. Avplicant Information P14ase Print Legibly Name(Business/Organization/Individual) CA Address:bw (D 0V\x\JJ )' T 41 q -Vic)c City/State/Zip: P oU2a - Areyou mployer?Check appropriate box: Type of project(required): I. I am.a employer with employees(full and/or part-time).* 7. El New construction 2•❑I am a sole proprietor or partnership and have no employees working for me in 8. F1 Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself:[No workers'comp.insurance required.]i 9. F1 Demolition 4.❑I 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 I L Q 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. These sub-contractors have employees and have workers'comp.insurance.$ 13. ep ' s r 6.Q We are a corporation and its officers have exercised their right of'exemption per MGL c, 14. Other 1 oyees.[No workers'comp.insurance required.] 152,§1(4),and we have no.empl *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. Iam an employer that ispro ' ing workers'compensation insurance or my employees.'Below is thepolicy andjob site information. Insurance Company Name; Policy#or Self-ins.Lie,#: � � Expiration Date: —/5 Job Site Address: W I-To A —City/State/Zip:–N. V4 Attach a copy of the workers'compensation policy declaration 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 the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage ver ation. Ido hereby c rtify under tlrepain ndpe Ities ofperjuiy fl t he information provide dgqa��bov is tru and correct. Sianatur Date: V Phone V V OVic al 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#: V CERTIFICATE OF LIABILITY INSURANCE DATE(M08/20LYYY) H1S,GERTIFICATE 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 endorsements), PRODUCER CONTACT NAME: BALDIAIM'AIELSH PARKER INS PHONE FAX 131 COOLIDGE ST.SUITE 4100 (A/C,No,Ext): (A/C,No)- E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE MAIC# INSURED f INSURER A: ANIERICAN ZURICH INSURANCE CONIPANY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: PO BOY 75 INSURER D: 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,TERMOR 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 HACH OCCURRENCE I$ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F7OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY Is GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE is POLICY 0 PROJECT[:]LOC PRODUCTS-COMP/OP AGG I$ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY I$ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY I$ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB 8 OCCUR EACH OCCURRENCE is EXCESS LIAB CLAIMS-MADE AGGREGATE Is DEDUCTIBLE Is RETENTION S Is A WORKER'S COMPENSATION AND XWC STATUTORY OTHER) EMPLOYER'S LIABILITY YIN UB-5B738312-14 12/14/2014 12/14/2015 LIMITS ANY PROPERITORIPARTNER/EXECUTIVE N/A E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE I S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/RESTRICTIONSISPECIAL 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 REPR TATVE NORTH ANDOVER,MA 01845 L l 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(MMIDD/YYYY) � 7/7/2Q15 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 OfficePHONE - FAX 562-7120 131 Coolidge Street,Suite 100 AIC No E#:(97g)5625652 Ne; 978) Hudson,MA 01749 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL# -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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MWDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 cLalrns MADE ®OCCUR NPP8237995 04/13/2015 04/13/2016 ED PREMISES Ea occurrence)AMAGE TO S 100,000 X Contractual Liabilit MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 2,000,000 POLICY❑JEF—]LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY EOMaBI EDSINGLE LIMIT S 1,000,000 BANY AUTO COM6230688 10/13/2014 10/13/2015 BODILY INJURY(Per person) 5 ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE S AUTOS Per accident 5 UMBRELLA UAB X OCCUR EACH OCCURRENCE S 5,000,000 C X EXCESS LIAB CLAIMS-MADE XLS0096729 04/13/2015 04113/2016 AGGREGATE S 5,000,000 DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY y/N STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A ',. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS belmv E.L DISEASE-POLICY LIMIT 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 - —_--- __ v^vara CI vt+"di�ng Reguiations and vr_andarvs v isurneJ _ Office o consumer �ft`acrs6c'�u�ine3s'"�eg�a ons -HOME IMPROVEMENTC License: GS-079476 t is = CONTRACTOR Registration: 137913 q� Type: �r E LAWRENCE E M . xpiration: ERG1/27/2017 Individual : 86 BILLMCA AVE L.. s LANCE E.MORGAN JR. N BILLFWCA NFA 0�86�a;_ a LAWRENCE MORGAN JR_ 86 BILLERICA AVE UNIT 1 Expiration N.BILLERICA,MA 01862 —'� Commissioner 06/03/2017 Undersecretary adn ttic�v,,, � 0 s,P This card acknowledges that the recipient has successfully completed a e.a trnerE of?Ctit 34-hour Ocbupational Safeb.1 and Health Training Course in O:ccrationatSafety and Health A t:rn r,rtatirn Construction Safety and Healtfi j �.A RRA 1°1OR&At-J Alr r �le has successfuiiy corm feted a!Glia P uOc upaiEon l Safetysnd Health • � Training Course in Construction Safet✓8 Health (Trafnername—print or type)'— (Course end date) S 1�GNI J 05A t&69 ROOF TOP RECYCLING STAN ANESTIS PRESIDENT&CEO 369 CODMAN HILL ROAD TEL: 978-263-1899 BOXBOROUGH,MA FAY- 978-263-1879 EMAIL:ROOFTOPI@VERIZON,NET CELL. 508-726-5341