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HomeMy WebLinkAboutBuilding Permit # 12/1/2015 t%ORTH BUILDING PERMIT ED TOWN OF NORTH ANDOVER 0� APPLICATION FOR PLAN EXAMINATION Date Received �RA�RaTo�Qa' Permit N® : 4_ Date Issued: la- , IMPORTANT: Applicant must complete all items on this page LOCATION L�Lt PROP, RTY O NERA�' MOA106(ef r 4 not p Print 1 Year Structure yes (no MAP {u PARCEL: ONING DI ICT: stork District yes Machine Shop Village yes 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 ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District D Water/Sewer DES RIPTION OF WORK TO DE PERFORMED: demi c ti Pie lie r' t OWNER: Name: 1 Pho Address. 39 61P, Contr ctor Name. Wofle: qqqq Email Address: ) SuConstruction p i ervsor's Supervisor's License. Exp. Date: � 171A Home Improvement Licenser Exp. Date: ) "T 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: $ µ - FEE: $ Check No.: Receipt No.:= y DOTE: Persons eontractiu tlz unregister conlraetors do not have recce o the guarano uezd Signature of Agent/Owner ture of contrac t%OR 'H town of Andover ® t.K. h ver, ass, coc Nlc"t WICK y�• gl.9s R�+r�o rPa��S U BOARD OF HEALTH M�_1T T L U E Food/Kitchen Septic System R THIS CERTIFIES THAT ......... .. ............. ...... ... ... . :.... ...... ......... . ...........�............................. THIS INSPECTOR � � W Foundation has permission to erect g.......................... buildin son ... . .. ..... ..... �: �� ..... .:........... _ 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough Service ................ .. .. .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinm Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspectedand rove y the Building Inspector. Burner Street No. Smoke Det. L. E. MORGAN CONSTRUCTION INC. 86 BILLERICA AVE., N. BILLERICA, MA 01862 PH: 978-670-4747 / Fax: 978-670-6477 PROPOSAL Submitted To: Affinity Realty Management Date: 11-3-15 Address: 39 Rear Farrwood Rd., ( Clubhouse N. Andover, MA 01845 Cell/Fax: 978-376-9687/978-685-0521 Job Site: Heritage Green Condominiums 40-42 Fernview Rd., N. Andover, MA,Approx. 5,179 SQ FT WE HEREBY submit our proposal for the following scope of work; 1. Remove the existing shingles down to the wood deck and dispose of off-site. 2. Install 6' of ice&water shield at the leading edges and 3' in all valleys. 3. Install RHINO SHIELD synthetic underlayment to the remainder of the wood deck. 4. Install 8"white aluminum drip edge to the entire perimeter& mechanically 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 1 dormers with white vinyl corners. 11. Install white aluminum coil over all rake and fascia, and 100%vented vinyl on soffits. WE propose hereby to furnish materials & labor, complete in accordance with the above specifications,for the sum of; Eighteen Thousand Six Hundred Twenty Dollars: $ 18,620.00 ' AUTHORtZ D SIGMA L ren& r P ACCEPTANCE of P OSAL:The above prices, specifica ns&co i ions are satisfactory and are hereby accept .You are authorized to do the work as specified. (,I> AUTHORIZED BUYER SIGNATURE DATE THANK YOU FOR CHOOSING MORGAN CONSTRUCTION The Commonwealth of Massachusetts l Department of.Xndustr"i:alAccidents w= 1 Congress Street, Suite 100 - ` Boston,MM 02114-2017 www rnass.gov/dia Workers'Compensation Insurance Affidavit:Builders/ContractorsfFIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information i A klease Print,Leizibly Naha (Business/Organization/Individual). Address: 6( q. 1 6 City/State/Zip4j �BNA ec� �,On fup &� 4- T) Y�V_ Are o eYt7ployer?Clrecl the appropriate box: Type of project(required): 1. m I am a employer with employees(full and/or part-time).* 7. Q New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Q Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10F]Building addition 4.Q 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.Q Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13, Roof r p ' These sub-contractors have employees and have workers'comp.insurance.t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Othe i d 6b 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 this 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. lam an employer that is pro 'ding worlkers'compensation insurance for nzy em I' es.' Below is the policy and job site information. Insurance Company Name: y q Policy#or Self-ins,Lic.#: Expiration Date: { I fob Site Address: t City/State/Zip: Attach a copy of the workers'compensation policy decl ration 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 WORD ORDER and a fine of up to$250.00 a day against tr4ion.. lator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance CON erage ver X do hereby •tify under the pains a pe ti ofpeijuz that the'afor ad provided above is true and correct. Sian ,Date: — ' Pho e#: ffzci Z 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.PIumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE °ATE(MMI°DIYYYY) f RTIFICATE 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: BALDWIMIYELSH PARKER INTS PHONE FAX 131 COOLIDGE ST.SUITE#100 (A/C,No,Ext): (AIC,No): E-MAIL HUDSON,MA 01749 ADDRESS: 27KLD INSURER(S)AFFORDING COVERAGE NAIC# INSURED I 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 I5 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 I POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MMIDMYYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE I5 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED I S CLAIMS MADE [7 OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) S PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY 0 PROJECT❑LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE IS ANY AUTO LIMIT(Ea accident) I` 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 LIAROCCUR EACH OCCURRENCE is EXCESS LIAR ®CLAIMS-MADE AGGREGATE $ S DEDUCTIBLE I RETENTION S IS A WORKER'S COMPENSATION ANDWC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-513738312-14 12/14/2014 12/14/2015 X I LIMITS ANY PROPERITORIPARTNER/EXECUTIVE FN7 N/A E.L.EACH ACCIDENT S 1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOWNT 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 REP R TA VE NORTHANDOVER;MA 01845 I;'I' �r-,-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 DATE(MM/DD/YYYQ 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 pol(cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subiect 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.1 Hudson Office PHONE 131 Coolidge Street,Suite 100 Ext:(878)562-5652 ac No):(978)562-7120 Hudson,MA 01749 E MAILADDRESS: 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 D1821 INSURERS: 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 CONTRACTOR 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. !LTR TYPE OF INSURANCE INSO PIVD POLICY NUMBER ADDLSUBR MM/ DDI OLICY EFF MNV DPOLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 I CLAIMS-MADE ®OCCUR NPP8237995 0411312015 04113/2016A R 100,000 PREMISES Ea occurrence S X Contractual Liabilit MED FRCP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY F—] PRO ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident s 1,000,OOQ B ANY AUTO COM6230688 10/13/2014 10/13/2015 BODILY INJURY(Perperson) 5 ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S NON-OWNED PROPERTY DAMAGE s X HIRED AUTOS X AUTOS Per accident/ 5 UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 C X EXCESS LIAB CLAIMS-MADE XLS0096729 04/13/2015 04/13/2016 AGGREGATE s 5,000,000 DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? F—] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS 1 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 d Massachusetts-Department of Public Safety " :ard.^.!Luliding Re9uiat ons and Standards , Office o/� a. ,f ;;c lcle7%1 —_ reonsumer }#'airs& r nessegu(ation _ ;.r'HOME IMPROVEMENT CONTRACTOR License: CS-079476 �-'•t Registration: 137913 Type: Expiration: 1/27/2017 individual LAWRENCE E MRG LA11VtENCE E.MORGAN JR. 86 BILLERICA ASE U W- 1 N BH LERICA NMA O g-JU' LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 Expiration N.BILLERICA,MA 01862 Commissioner 06/03/2017 Undersecretary .�S �5atntY�nGNeaRri - � _... LLJJ��LL ad tL[c�,Lien _ i ES' -t;,,+ = "46 r This card acknowledges that the recipient has successfully completed a - �,•�rtmant of:.ae;,t 30-hour Occupational Safebj and HealthYraining Course in i Oca:pationat Safety and i iealth s;ratice ! Construction Safety and fie-atth LARRY_ MO �A� _ 44' r "As successfully completed a!G-`:our Occupational Safety ani:Health { Training Course in i { _ + Construction Safe:4!u Health airL LDut S }�oN (Trainer name—print or type) Si 05A (Course end date) (ra,ner) - - - fDatel 1 ROOF TOP RECYCLING SEAN 1.11V L•.S 11.5 PRESIDENT&CEO 369 CODMAN HILL ROAD TEL: 978-263-1899 BOXBOROUGH,MA FAX. 978-263-1879 EMAIU ROOFTOP!@VERIZON.NET CELL.- 508-726-5341