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HomeMy WebLinkAboutBuilding Permit # 10/29/2015 i BUILDING PERMIT T%®D�6 gb TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received °9 RATED PP �� j �� I �SS�CHU`S Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 9 1 61 ve, , , t PROPERTY OWNERB I Print 100 Year,Structure yes--yes MAP PARCEL: I ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 4 TYPE OF IMPROVEMENT PROPOSED USE Reside 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 [I Wetlands I Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Pleas %,- e or Print Clearly OWNER: Name: (Al ...a�, I Phone: Address: ve to, (4y.14, Contractor Name: Phone: ' Email Address: Supervisor's Construction License: " Exp. Date: 1,2., Home Improvement License: " Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ L _FEE: $ Check No.: bo Receipt No.: V)qlcl DOTE: Persons contracting with unregistered contractors do not have acres o the guaranty fund Signature of Agent/Owner Signature of contract r "" Town of ._ � Andover ® : - :- 0% No. -t C, h ver, Mass, CITU r2 G l COC NIC Hl w�CK �1' AD RATED S V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ........D.!. �:�'...............d.z�.....!. ............................................................... B. � Foundation has permission to erect .......................... buildings on .. ..t.... .. .... ...!.�`!e!J. .................... Rough to be occupied as ............. .... 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 MONTHS PERMIT PIE I 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STA Rough Service ............................... ..... ..... ............................... Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough 'splay 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 Constructi®n Company We Accept: 86 Billerica Avenue,Unit#1 r VlSi4 "' N. Billerica,MA 01862 -- Office: (978)670-4747/Fax: (978)670-6477 R AIT D T tM �� PHONE DAT p' s 7 JOB NAMETT I IVB T ,- TE AND CODEJOB LOCATION C A T �Si<1ER JOB PHONE Strip down to the wood deck, J- layers of shingles dispose of debris to a licensed recycling facility: Install to ice and water shield at the gutters NIA 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: 21 White, ❑ Mill, ❑ Brown, ❑ Copper. InstallIsC year 3 66 rt hi eeti -al asphalt shingles, and hurricane nail. Install ridge vent manufactured by C-0 k N -t to all ridges and dormers. Install N� new skylight flashing kits manufactured by Flash all cheek walls, pipes, skylights, and penetrations to manufactures specifications. Remove existing lead flashing �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 the sum of: /� ) / r 8 0 —Y' j k-r ��1 v scow c� �cJ i K, �j c� ,J c+ cr-{arky foc5 dollars($�C/ O ). All material is guaranteed to be as specified.All work to be completed in a workmanlike Authorized Signatu e: manner according to standard practices.Any alteration or deviation from above 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 withdrawn by Workmen's Compensation Insurance and Liability Insurance, by us if not accepted within days. ACCEPTED AS A CONTRACT-The above prices, Date of acceptance: specifications and conditions are satisfactory and are Authorized Signature: hereby accepted.You are authorized to do the work as _ specified.Payment will be made as outlined above. Authorized signature: Additional Remarks: S E COLO e B O— nnTT A'kTT7' XTc%TT 'Vi-%1D rryLrnnQTXTlr T IM VP APO AXT V 1TATQ''TPTTVTTnTV The Commonwealth of Massachusetts Department of IndustrialAccidents rs d I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ElE lectricians/Plumbers. TO BE FILED WITH THE PERIVHTTING AUTHORITY. Applicant Information Please Print Legib Name(Business/Organizatiou/Individual): Address: i (a cw q - City/State/Zip: one#:—DR Are yon ployer?Check he appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 7. New construction 2.F1I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.F]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 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Ro f r airs These sub-contractors have employees and have workers'comp.insurance.* 6.Q We are a corporation and its officers have exercised their right of exemption per MGL a 14 Othe oyees.[Now comp.insurance required.] 152,§1(4),and we have no.empl *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit Ws affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors 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 ant an employer that is providing workers'compensation insurancefor my employees.'Below is the policy and job site information. Insurance Company Name: AAA 191C-121 I APolicy#or Self-ins.Lie.#: Expiration Dater Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiratidn 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 DIA for insurance coverage veri c tion. I do here t fy under the pains an ena t' s of perjury tliat the in r anon providf ed ab Frye is tr•u and correct. Si na e: Date: Pho e#: 1 kz fz ial 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#: y CERTIFICATE OF LIABILITY INSURANCE 07/08/27/08/2 IYYYY) 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(ies)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: BALDWINIWELSH PARKER INS PHONE FAX 131 COOLIDGE ST,SUITE 9100 (AIC,No,Ext): (A1C,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED 1 INSURER A: AMERICAN ZURICH INSURANCE COMPANlY L E MORGAN CONSTRUCTION INC INSURER B: INSURER C: INSURER D: PO BOX 75 INSURER E.- NORTH :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 is COMMERCIAL GENERAL LIABILITY CLAIMS MADE F7 OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) MED EXP(Any one person) 5 PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE Is POLICY E]PROJECT E:]LOC PRODUCTS-COMP/OP AGG I$ AUTOMOBILE LIABILITY COMBINED SINGLE 4$ ANY AUTO LIMIT(Ea accident) } ALL OWNED AUTOS BODILY INJURY 5 SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE S (Per accident) UMBRELLA LIAROCCUR EACH OCCURRENCE is EXCESS LIAB 8 CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S I$ A WORKER'S COMPENSATION AND X I WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-58738312-14 12/14/2014 12/14/2015 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 1600 OSGOOD ST,BLDG 20,STE 2035 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRTA VE Q NORTH ANDOVER,1 01845 7`` — f_ 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 DAT /YYYYj �✓ 717120 15 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 g78 562-5652 we Ne; 978 562-7120 131 Coolidge Street,Suite 100 Arc No Ext:( ) { ) Hudson,MA 01749 E-MAIL ADDRESS: INSURERS)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: 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 RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IINSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LIMITS INSD Vivo POLICY NUMBER MM/DD MMlDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE -1 OCCUR NPP8237995 0411312015 04/13/2016 PREMISES DAMAGE TO Roccurrence)NTEDES 100,000 Contractual Liabilit MED FRCP(Any one person) S 5,000 X PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY ] PRO- F—]JECT !OC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY Ea BINEDISINGLE LIMIT S 1,000,OOQ B ANY AUTO COM6230688 10/1312014 10/13/2015 BODILY INJURY(Perperson) S ALL OWNED X SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS X X NON-OWNED PROPERTY OPERTY8 AMAGE S HIRED AUTOS AUTOS 5 UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 C X EXCESS LIAB CLAIMS-MADE XLS0096729 04/13/2015 04/1312016 AGGREGATE S 5,000,000 DED I I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY y I N STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVEE.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S if yes,describe under '... DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 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. 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 - Bo and o f_0 uijidling g u at;o ns a)iu vLandar diJ Office o ODSllIp2r L)ECL�r� 6//-�- JAG `UJB�!;f xrr rrs&�uSines,Aegu ation z ..r4HOME IMPROVEMENT CONTRACTOR License: CS-079476 ;E Registration: 137913 Type: ypExpiration: 1/27/2017 Individual LAWRENCE E MftG 86 BILLERTCA AWELA1t�RENCE E.MORGAN JR. ' N BILLERICA MA 086 ` LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 JM X1 '1 141�� Expiration N.BILLERiCA,MA 01862 g�r Commissioner 06/0312017 Undersecretary SSP A5aretyangli�vtui - _ - aent,t�anson OS� ,C . This card acknowledges that the recipient has successfully completed a S-C 4y.a trnent of reit 30-hour Ocbupationai Safety and HealthTra ning Course in Occ_ra,ionat satery and Health Construction Safety and Health �ARRY MOR&A At _ r r _ w as successfully completed a?7-!:our oixupaEnonai Safety and Health Training Coume in Construction Safety&Health ~e- i r L6ui s I�oN 05At3Cs (Trainer name-print or type) 69 (course end date) — i (Trainer) (Date; ROOF AGR RECYCLING o . e SEAN ANESTIS PREs=wr&CEO 369 CODMAN HILL ROAD TEL: 978-263-1899 BO)MOROUGH,MA FAY- 978-263-1879 EMAIL:ROOFrOPI@VERIZON.NET CELL: 508-726-5341