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HomeMy WebLinkAboutBuilding Permit #848 - Exception 6/13/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit Flo: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION r7o—3r,../0o PROPERTY OWNER Print � MAP NO: PARCEL: Print ZONING DISTRICT: Historic District yes it Machine Shop Village yes 100 year-old structure yes QPTYPE OF IMPROVEMENT PROPOSED USE Residential El New Residential New Building ❑ One family ❑Addition ❑Two or more family y ❑ Industrial No. of units: ❑ Commercial X Repair, replacement ❑Assessory Bldg ❑ Demolition ❑ Others: ❑ Other L-J vV Gl Lia/✓1..Vv 4! DESCRIPTION OF WORK TO BE PERFORMED: . e Q (Identification Please Type or Print Clearly) OWNER: Name: -� Phone:.., �, Grp, � �j'a3ly Address: �� CONTRACTOR Name: L. E. 1LIQ I,,, .. I lwta Phone: `V— tr Address: � r ��E'�'' MA4 Supervisor's Construction License: �; `j `'� C/,7 q Exp. Date: 11-j Home Improvement License: 7 )3 Exp. Date: -11,717/13 ARCHITECT/ENGINEER Phone: Address: —. Reg. No. FEE SCHEDULE.BULDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. ` Total Project Cost: $ qL' !� FEE: Check No.: /„ Receipt No.: NOTE- Perso s cont actin 'h regist red contractors do not ave access to Ice uranty furz ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPE OF SEWERAGE DI Public Sewer DISPOSAL Tanning/Massage/Body Art ❑ —Swim irn,ng Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales El Private(septic tank,etc. ❑ Peunarient Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT El El COMMENTS COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision:— Comments Water & Sewer Connection/Signature & Date priytamw P-'—;" DPW Town Engineer: Signature: Located 384 Osd treet FIRE DEPARTMENT -Temp Dumpster on site yes-4-1V no -$z!L Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories:___ _ Total square feet of floor area, based on Ex erior dirnensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approvai of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No_ MGL Chapter 166 Section 21A—F and G min.$1o0-$1000 fine `�- NOTES and DATA—_(For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Bnterior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Pt- Addition or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan a Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses f G a�ItsCJY'/e.l v l;vtiill`YI�:ieVelLlui i i"iai &1; r'ropuseca 4/vorii VVI'111 i—la I m' o Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Pert. New Construction (Single and Two Family) a Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Peri' In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recordir. must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi 1'he Commonwealth ofMassachuseff .Department oflndustrial.Accidents Office of Investigations 600 Washington,Street Z Boston,Mit 02111 www.mass.gov/dict Workers, Compensation.111surrance Affidavit:Builiders/Contractors[Electriciaans/Plumbers Applicant Information Please Pr int'Legibiy Name(Business/Organization/Individual): " yj m�m — ---- Addl:ess: '(�, City/State/Zip: AZ 43i le 0 C)I&,;a Phone##: cf 7Y—6 20 Are you art employer?Check the appropriate box: Type of project(required): 1.� I am a employer with ^ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I atn a sole proprietor or partner- listed on the attached sheet. # 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. workers'comp,insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL . 11.0 Plumbing repairs or additions myself.[No workers'comp, c. 1,52,§1(4),and we have no 12.E]Roof repairs insurance required.]T employees.[No workers' 13.0 Other comp.insurance required.] *Any Applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. f lfomeowners who submit this affidavit indicating they ace 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 acid their workers'comp.policy information. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ Ce, Policy#or Self-ins.Lic.#: Ci`-/ (�_7i t S Expiration Date:__ .lob Site Address: City%State/Zip:1ft yt/,y t a:i _jU 14 Attach a copy of the workerscompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance'coverage verification. 1 do hereby certi under tlae pains and penalties of perjury tliat the inforination provided above is t cc and co��ect Si ature: w Date: I Phone#: 9`7 c EEOth only. Do not write in.this area,to be completed by city or town official orwn: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical{Inspector 5.PIumbing Inspector son: Phone#: DATE (MM/DDIYYYY) A� CERTIFICATE OF LIABILITY INSURANCE 06/10/2011 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). CONTACT PRODUCER NAME: _ NORTH ANDOVER INSURANCE AGENCY INC. ,N No , Eat)_ No):(978) 686-2266 1 FAX (978) 686-6410 (AIC, _LAIC.__.__ ..— _ _ ..1... __ -.- E-MAIL —_— M.J. FOSTER INSURANCE SERVICES ADDRESS: cfernandez@nafins_com PRODUCER an Construction 163 MAIN STREET CUSTOMER ID aMor 4 NORTH ANDOVER MA 01845-2508 _ _ INSURERS)AFFORDING COVERAGE NAIC# --- ---... ---- - I ._C# — INSURED INSURER A S.H. SMITH & COMPANY INC. Morgan Construction ----------- --- - ------__— __—r _. - g INSURER B RANOVE'R INSURANCE PO BOX 75S IN c ACE USA INSURER D :SCOTTSDALE INSURANCE_ 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. rA -- -- _----rPOLIbY EFF POLICY E%P�_--- - _ --LIMITS ------_- - - TYPE OF INSURANCE INSR VWD POLICY NUMBER (MMIDDIYYYY) ,(MMIDDIYYYY) GENERALLIABILITY i 04/13/2011 104/13/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED -- T - -- -- X COMMERCIAL GENERAL LIABILITY / / / / C PREMISES-(Ea ocurrence)- _,.$-. __ ._ 100,000 CLAIMS-MADE OCCUR / / / / M_ED EXP(Any one person) $ 5,000 PERSONAL&_ADV INJURY_ $ 1,000,000 r GENERAL AGGREGATE - $ __ _ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 JECT X POLICY PRO- LOC -I -- B AUTOMOBILE LIABILITY wN66529181 0/13/2010 0/13/2011 COMBINED SINGLE LIMIT is 1,00o,000 (Ea accident)ANY AUTO I BOD ILY INJURY(Per person) r$ ALL OWNED AUTOS X_ BODILY INJURY(Per accident), $ --_ -_ SCHEDULED AUTOS i � PROPERTY DAMAGE ; $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS / / / / _,. $ D X UMBRELLA LIAB X 1 �OCCUR 50071751 ;01/07/2011 p4/13/2012 1 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR __l_—J CLAIMS-MADE 1 1 / / I / / AGGREGATE $ -- DEDUCTIBLE - RETENTION $ / / / / I$ WORKERS COMPENSATION 4 63 89 65 7 2/14/2010 12/14/2011 WC STATU- ;OTH- C AND EMPLOYERS' __ LIABILITY - 1QBY�IMIISJ .--'_-ER.. ANY PROPRIETORIPARTNER/EXECUTIVE Y❑ / / I / / E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA - J - (Mandatory in NH) / / / / E.L.DISEASE-EA EMPLOYE q $ 1�000000 If yes,describe under / / / / 1 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 120 MAIN STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845- ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD This card ackdoW edges that the rempiept has svopessi(Iliy completed a 30 haul 00upaGoRa1$91ely and Health Tsaiping Course in Construction Safety and fiq$tti Ad (7falnenname print ortype) (Course entl'data)'. OSHA 002329994 02329994 � MOBILE_EOUIPMEN7' ' __ rIF4 y 6 ;r� OPERATOR CEPTIFICF�TE moi` arr:cnf=ccr.rr.,n;, t1.S%ky,arr i it pl!.at:.;r ft.. /)/1 Jnr Qxvpzt anal S`1 i�and Hraffh Pa:mxnsuatiai � a G )Vtn� LARRY oR&A� ��ti,t� 1" ablao rJ i,hr✓.r�a:.mtd b:he.t heyp;,d:rkeeq,�c,ksk : has s.l..cessfu'v•=crnpf:teda 10�-er,-:cupai,—Srcp•sn:t•:t�' iLsrt(2/`.�94-7�� �•1')(�. -�a )1�� r� T—Nnq Cou r Innv - �ows Ro►�DF_Au _ oSAtXsd9 (Tfainef7 (hale.) 'lot Z�,ommrq fetzl(..'c lA"ac!ixcpail; 11a�a tthu�ctl. t)Lp Lr!nt.ni of PuhhS �aFPt� Office o� oasumer Airs&Bds,n ess lYeg ula tion • HOME IMPROVEMENT CONTRACTOR Board of Buildm i2i2u1uliun,and t util;n'tls -i=;-.�� Registration: .137913 Type: >-' Expiration: 1/27/2013 Individual License: CS 79476 Lk CE E.MORGAN JR. � LAWRENCE E MORGAN JR r LAWRENCE MORGAN JR. 86 BILLERICA AVE UNIT 1 86 BILLERICA AVE UNIT 1 , N BILLERICA,MA 01862 N.BILLERICA,MA 01862 e- Undersccretary Expiration. 6/3/2013 --------- -- ..--- - —_. .__ —_ (�rinmi..i:m:•r T,z 163$4 1 L.E. MORGAN CONSTRUCTION CO. PO. Box 75, 86 Billerica Avenue, Unit#1 N. Billerica, MA 01862 Office: 978-670-4747- Fax: 978-670-6477 PROPOSAL Submitted Heritage Green To: Condominiums Address: 39 Farrwood Road N. Andover,MA Phone/Fax: 978-685-4434/978-685-052 Date: October 25,2010 Job Site: Building 70-72,Farrwood Rd. WE HEREBY submit our proposal for the following scope of work; APPROX. 4,752 SQ FT 1. Remove all of the existing asphalt shingles on the various roof planes down to the wood deck. 2. Inspect the wood decking for any signs of damage or rotting and report results. 3. Install 6' of ice & water shield at the leading edges and 3' in the valleys. 4. Install 15 lb. asphalt saturated felt paper over the remaining wood deck. 5. Install ' whit rip edge to the entire perimeter& dormers. 6. Install ST ver Lining asphalt shingles, color to be as close as possible. IfC 7. Hurricane nail all shingles, a maximum of 6 nails per shingle, due to high wind area. 8. Install new pipe collars and new flashings on the dormers as needed. 9. Install GAF matching caps on top of the ridges and hurricane nail. 10. Disposal of all debris at a licensed recycling facility. 11. Morgan Construction will warranty all labor for a period of 10-years. We Propose hereby to furnish materials and labor, complete in accordance with the above specifications, For the sum of; Fifteen Thousand Two Hundred Forty Dollars, $ 15,240.00 NOTE: The upper rear decks must be cleaned off to prevent damage while stripping the roof,as well as All Items on the ground in the ar grass area. AUTHORIZEDSIGNATURE: ;��'4a a,('Z 422 awrenceE. rications r. ACCEPTANCE of PROPOSAL: The above prices, specand conditions are satisfactory And are hereby accepted. You are authorized to do the work as specified. Payment is due upon completion. Authorized Buyer v v Signature 14)Date THANK YOU FOR CHOOSING MORGAN CONSTRUCTION NORTIy ® oAndover . No. - . LAKE o . dower, IVlass., i; -z2- 11 Co CNICNEWICK RATED PP 'C`� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......................... .. ................... Q ...'..................................... Foundation has permission to erect..................................... buildings on ...... Q- o ..... !1� ......, Rough to be occupied as.... Chimney provided that the person accepting this permit shall in everyrespect conform to the terms of the application on file in Final 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI ART Rough ...................... .................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIREDEPARTMENT. Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.